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1.
Rev. esp. cir. ortop. traumatol. (Ed. impr.) ; 64(5): 318-325, sept.-oct. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-197610

RESUMO

INTRODUCCIÓN: Las infecciones osteoarticulares representan una complicación mayor en cirugía ortopédica. Se pretende identificar el porcentaje de cánulas de succión colonizadas y determinar la relación entre el tiempo de uso en cirugía y la colonización de estas. MATERIALES Y MÉTODOS: Estudio descriptivo y prospectivo que analiza 546 cánulas de succión utilizadas en cirugía ortopédica limpia en un centro de trauma, entre noviembre del 2017 a marzo del 2018. El extremo distal de la cánula fue cultivado para determinar la proporción de colonización. RESULTADOS: El 7,3% de las cánulas cultivadas tuvieron cultivos positivos para gérmenes patógenos, de los cuales el más frecuente fue Staphylococcus epidermidis con 27,5%. Además, se encontró asociación entre la colonización y el tiempo de uso de la cánula. La posibilidad de colonización de cánulas usadas entre 60 minutos o más, es mayor que en las que se usaron menos de 60 minutos; entre 60 y 90 minutos la posibilidad es dos veces mayor OR= 2,2 (IC:95% 1,1 - 4,1) y en las cánulas usadas por más de 90 minutos es 8 veces mayor OR= 8,49 (IC:95% 1,77 - 40,86). CONCLUSIONES: La proporción de colonización de las cánulas es menor a lo reportado en la literatura. El mayor tiempo de uso de la cánula en la cirugía aumenta el riesgo de la colonización de estas. Se considera realizar estudios de seguimiento para determinar si la colonización de las cánulas de succión se asocia a un incremento de infección postoperatoria


INTRODUCTION: Osteoarticular infections represent a major complication in orthopaedic surgery. The aim is to identify the percentage of suction cannulas colonised and to determine the relationship between the time they are used in surgery and the colonisation of these cannulas. MATERIALS AND METHODS: Descriptive and prospective study that analysed 546 suction cannulas used in clean orthopaedic surgery in a trauma centre, between November 2017 and March 2018. The distal end of the cannula was cultured to determine the colonisation rate. RESULTS: 7.3% of the cultured cannulas were positive for pathogens, the most frequent being Staphylococcus epidermidis at 27.5%. In addition, an association was found between colonisation and the length of time the cannula was used. The possibility of colonisation of cannulas used for between 60minutes or more, is greater than those used for less than 60 minutes; between 60 and 90 minutes the possibility is twice as high OR= 2.2 (CI:95% 1.1 - 4.1) and in cannulas used for more than 90 minutes it is 8 times higher OR= 8.49 (CI:95% 1.77 - 40.86). CONCLUSIONS: The colonisation rate of cannulas is lower than reported in the literature. The longer the cannula is used in surgery increases the risk of their colonisation. Follow-up studies are being considered to determine whether suction cannula colonisation is associated with increased postoperative infection


Assuntos
Humanos , Cânula/microbiologia , Sucção/instrumentação , Procedimentos Ortopédicos/estatística & dados numéricos , Doenças Ósseas Infecciosas/cirurgia , Contagem de Colônia Microbiana/métodos , Infecções Relacionadas a Cateter/microbiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/microbiologia
2.
PLoS One ; 15(9): e0239290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970712

RESUMO

BACKGROUND: The aim of this prospective study was to use direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) to rapidly diagnose periprosthetic joint infections (PJIs). METHOD: Synovial fluid was taken from 77 patients (80 joints, 41 hips and 39 knees) who met the International Consensus Meeting criteria for PJI, and inoculated into blood culture bottles (BCBs) and onto conventional swabs. Positive blood cultures were analyzed using either direct or routine MALDI-TOF MS. Pathogen identification and the time to identification was recorded. Differences between groups were analyzed using the Kruskal-Wallis test and Bonferroni's post-hoc test. RESULTS: Direct and routine MALDI-TOF MS both detected 64 positive results (80%), compared to 47 (59%) by conventional swabs (p = 0.002). Direct MALDI-TOF MS identified 85.3% of the gram-positive organisms and 92.3% of the gram-negative organisms. No fungi were identified by direct MALDI-TOF MS. In 17 BCBs that were flagged positive, identification by direct MALDI-TOF MS failed. Among the positive results in the direct MALDI-TOF MS group, Staphylococcus aureus accounted for 47%, followed by Staphylococcus epidermidis (17%), Escherichia coli (9%) and Klebsiella pneumoniae (9%). The median time to microorganism identification was significantly shorter with direct MALDI-TOF MS (12.7 h, IQR: 8.9-19.6 h) than with routine MALDI-TOF MS (39.5 h, IQR: 22.8-46.0 h) or swabs (44.4 h, IQR: 27.2-72.6 h) (p < 0.0001). In pairwise comparisons, there were significant differences in the time of microorganism identification between direct MALDI-TOF MS and routine MALDI-TOF MS (p < 0.0001) or swab culture (p < 0.0001). There was no significant difference between routine MALDI-TOF MS and swab culture (p = 0.0268). CONCLUSION: Compared with current laboratory practice, direct MALDI-TOF MS shortened the time to microorganism identification and had superior results compared to conventional swabs, except for fungi. Further studies should investigate whether the earlier administration of appropriate antimicrobial agents can improve the treatment outcomes of PJIs.


Assuntos
Infecções Bacterianas/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Espectrometria de Massas por Ionização e Dessorção a Laser Assistida por Matriz , Líquido Sinovial/metabolismo , Idoso , Artrite Infecciosa/diagnóstico , Artrite Infecciosa/genética , Artrite Infecciosa/microbiologia , Infecções Bacterianas/genética , Infecções Bacterianas/microbiologia , Escherichia coli/isolamento & purificação , Escherichia coli/patogenicidade , Feminino , Humanos , Klebsiella pneumoniae/isolamento & purificação , Klebsiella pneumoniae/patogenicidade , Masculino , Pessoa de Meia-Idade , Infecções Relacionadas à Prótese/genética , Infecções Relacionadas à Prótese/microbiologia , Manejo de Espécimes , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/patogenicidade , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/patogenicidade , Líquido Sinovial/microbiologia
3.
Plast Reconstr Surg ; 146(2): 301-308, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740580

RESUMO

BACKGROUND: Infections are challenging complications of implant-based breast reconstruction and augmentation. They pose a clinical challenge, with significant economic implications. One proposed solution is implant irrigation at the time of placement. There is no consensus on the optimal irrigant solution. METHODS: The authors tested the relative efficacy of 10% povidone-iodine, Clorpactin, Prontosan, triple-antibiotic solution, or normal saline (negative control) against two strains each of methicillin-resistant Staphylococcus aureus and Staphylococcus epidermidis. Sterile, smooth silicone implant disks were immersed in irrigant solution, then incubated in suspensions of methicillin-resistant S. aureus or S. epidermidis overnight. The disks were rinsed and sonicated to displace adherent bacteria from the implant surface, and the displaced bacteria were quantified. Normalized values were calculated to characterize the relative efficacy of each irrigant. RESULTS: Povidone-iodine resulted in reductions of the bacterial load by a factor of 10 to 10 for all strains. Prontosan-treated smooth breast implant disks had a 10-fold reduction in bacterial counts for all but one methicillin-resistant S. aureus strain. In comparison to Prontosan, triple-antibiotic solution demonstrated a trend of greater reduction in methicillin-resistant S. aureus bacterial load and weaker activity against S. epidermidis strains. Clorpactin reduced the recovered colony-forming units for only a single strain of S. epidermidis. Povidone-iodine demonstrated the greatest efficacy against all four strains. However, Clorpactin, triple-antibiotic solution, and Prontosan demonstrated similar efficacies. CONCLUSIONS: Povidone-iodine was the most efficacious of the irrigants at reducing methicillin-resistant S. aureus and S. epidermidis contamination. Given the recent lifting of the U.S. Food and Drug Administration moratorium, larger clinical studies of povidone-iodine as a breast implant irrigant solution are warranted. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, V.


Assuntos
Anti-Infecciosos Locais/administração & dosagem , Biofilmes/efeitos dos fármacos , Implante Mamário/efeitos adversos , Implantes de Mama/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Bacitracina/administração & dosagem , Benzenossulfonatos/administração & dosagem , Implante Mamário/instrumentação , Cefazolina/administração & dosagem , Combinação de Medicamentos , Gentamicinas/administração & dosagem , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Povidona-Iodo/administração & dosagem , Infecções Relacionadas à Prótese/microbiologia , Soluções , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/isolamento & purificação , Irrigação Terapêutica/métodos
4.
Am J Obstet Gynecol ; 223(5): 729.e1-729.e10, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32380174

RESUMO

BACKGROUND: Since the discovery of the bladder microbiome (urobiome), interest has grown in learning whether urobiome characteristics have a role in clinical phenotyping and provide opportunities for novel therapeutic approaches for women with common forms of urinary incontinence. OBJECTIVE: This study aimed to test the hypothesis that the bladder urobiome differs among women in the control cohort and women affected by urinary incontinence by assessing associations between urinary incontinence status and the cultured urobiome. STUDY DESIGN: With institutional review board oversight, urine specimens from 309 adult women were collected through transurethral catheterization. These women were categorized into 3 cohorts (continent control, stress urinary incontinence [SUI], and urgency urinary incontinence [UUI]) based on their responses to the validated Pelvic Floor Distress Inventory (PFDI) questionnaire. Among 309 women, 150 were in the continent control cohort, 50 were in the SUI cohort, and 109 were in the UUI cohort. Symptom severity was assessed by subscale scoring with the Urinary Distress Inventory (UDI), subscale of the Pelvic Floor Distress Inventory. Microbes were assessed by expanded quantitative urine culture protocol, which detects the most common bladder microbes (bacteria and yeast). Microbes were identified to the species level by matrix-assisted laser desorption and ionization time-of-flight mass spectrometry. Alpha diversity indices were calculated for culture-positive samples and compared across the 3 cohorts. The correlations of UDI scores, alpha diversity indices, and species abundance were estimated. RESULTS: Participants had a mean age of 53 years (range 22-90); most were whites (65%). Women with urinary incontinence were slightly older (control, 47; SUI, 54; UUI, 61). By design, UDI symptom scores differed (control, 8.43 [10.1]; SUI, 97.95 [55.36]; UUI, 93.71 [49.12]; P<.001). Among 309 participants, 216 (70%) had expanded quantitative urine culture-detected bacteria; furthermore, the urinary incontinence cohorts had a higher detection frequency than the control cohort (control, 57%; SUI, 86%; UUI, 81%; P<.001). In addition, the most frequently detected species among the cohorts were as follows: continent control, Lactobacillus iners (12.7%), Streptococcus anginosus (12.7%), L crispatus (10.7%), and L gasseri (10%); SUI, S anginosus (26%), L iners (18%), Staphylococcus epidermidis (18%), and L jensenii (16%); and UUI, S anginosus (30.3%), L gasseri (22%), Aerococcus urinae (18.3%), and Gardnerella vaginalis (17.4%). However, only Actinotignum schaalii (formerly Actinobaculum schaalii), A urinae, A sanguinicola, and Corynebacterium lipophile group were found at significantly higher mean abundances in 1 of the urinary incontinence cohorts when compared with the control cohort (Wilcoxon rank sum test; P<.02), and no individual genus differed significantly between the 2 urinary incontinence cohorts. Both urinary incontinence cohorts had increased alpha diversity similar to continent control cohort with indices of species richness, but not evenness, strongly associated with urinary incontinence. CONCLUSION: In adult women, the composition of the culturable bladder urobiome is associated with urinary incontinence, regardless of common incontinence subtype. Detection of more unique living microbes was associated with worsening incontinence symptom severity. Culturable species richness was significantly greater in the urinary incontinence cohorts than in the continent control cohort.


Assuntos
Biodiversidade , Microbiota , Bexiga Urinária/microbiologia , Incontinência Urinária por Estresse/microbiologia , Incontinência Urinária de Urgência/microbiologia , Actinomycetaceae/isolamento & purificação , Adulto , Aerococcus/isolamento & purificação , Idoso , Idoso de 80 Anos ou mais , Corynebacterium/isolamento & purificação , Estudos Transversais , Feminino , Gardnerella vaginalis/isolamento & purificação , Humanos , Lactobacillus/isolamento & purificação , Lactobacillus crispatus/isolamento & purificação , Lactobacillus gasseri/isolamento & purificação , Pessoa de Meia-Idade , Staphylococcus epidermidis/isolamento & purificação , Streptococcus anginosus/isolamento & purificação , Adulto Jovem
5.
Int J Oral Sci ; 12(1): 15, 2020 05 09.
Artigo em Inglês | MEDLINE | ID: mdl-32385260

RESUMO

The oral microbial community is widely regarded as a latent reservoir of antibiotic resistance genes. This study assessed the molecular epidemiology, susceptibility profile, and resistance mechanisms of 35 methicillin-resistant Staphylococcus epidermidis (MRSE) strains isolated from the dental plaque of a healthy human population. Broth microdilution minimum inhibitory concentrations (MICs) revealed that all the isolates were nonsusceptible to oxacillin and penicillin G. Most of them were also resistant to trimethoprim (65.7%) and erythromycin (54.3%). The resistance to multiple antibiotics was found to be largely due to the acquisition of plasmid-borne genes. The mecA and dfrA genes were found in all the isolates, mostly dfrG (80%), aacA-aphD (20%), aadD (28.6%), aphA3 (22.9%), msrA (5.7%), and the ermC gene (14.3%). Classical mutational mechanisms found in these isolates were mainly efflux pumps such as qacA (31.4%), qacC (25.7%), tetK (17.1%), and norA (8.6%). Multilocus sequence type analysis revealed that sequence type 59 (ST59) strains comprised 71.43% of the typed isolates, and the eBURST algorithm clustered STs into the clonal complex 2-II(CC2-II). The staphyloccoccal cassette chromosome mec (SCCmec) type results showed that 25 (71.43%) were assigned to type IV. Moreover, 88.66% of the isolates were found to harbor six or more biofilm-associated genes. The aap, atlE, embp, sdrF, and IS256 genes were detected in all 35 isolates. This research demonstrates that biofilm-positive multiple-antibiotic-resistant ST59-SCCmec IV S. epidermidis strains exist in the dental plaque of healthy people and may be a potential risk for the transmission of antibiotic resistance.


Assuntos
Placa Dentária/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Infecções Estafilocócicas/diagnóstico , Staphylococcus epidermidis/isolamento & purificação , Antibacterianos/uso terapêutico , Feminino , Humanos , Meticilina
6.
Balkan Med J ; 37(4): 215-221, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32270947

RESUMO

Background: Coagulase-negative staphylococci, which belong to the normal microbiota of the skin and mucous membranes, are opportunistic pathogens. sasX, a newly described protein, is thought to play an important role in nasal colonization and methicillin-resistant Staphylococcus aureus virulence, and it may be acquired from coagulase-negative staphylococci by horizontal gene transfer. It has been considered that understanding the function of sasX gene may help clarify the relevance of the different adhesion mechanisms in the pathogenesis of infections associated with biofilm. Aims: To investigate the sasX gene presence, staphylococcal cassette chromosome mec types, and antimicrobial resistance patterns of invasive and noninvasive coagulase-negative staphylococci isolates. Study Design: Cross-sectional study. Methods: The study included a total of 180 coagulase-negative staphylococci strains. Non-invasive isolates (n=91) were obtained from the hands of healthy volunteers who do not work at the hospital (n=30), the nasal vestibule of healthy volunteer hospital workers (n=26), and central venous catheter (n=35). Invasive isolates (n=89) were isolated from peripheral blood cultures of inpatients who do not have catheters. All isolates were identified by conventional microbiological methods, automated systems, and, if needed, with matrix-assisted laser desorption/ionization-time of flight. Staphylococcal cassette chromosome mec typing, sasX and mec gene detection, antibiotic susceptibility, and sasX gene sequence analysis were performed. Results: Peripheral blood, central venous catheter colonization, and nasal vestibule isolates were positive for the sasX gene, whereas hand isolates were negative. sasX gene was present in 17 isolates, and no statistical significance was found between invasive and noninvasive isolates (p=0.173). Sequence analysis of the sasX genes showed high homology to related proteins of Staphylococcus phage SPbeta-like and Staphylococcus epidermidis RP62A. staphylococcal cassette chromosome mec type V was the most prevalent regardless of species. staphylococcal cassette chromosome mec type II was more frequent in invasive isolates and found to be statistically important for invasive and noninvasive S. epidermidis isolates (p=0.029). Staphylococcus haemolyticus isolates had the overall highest resistance rates. Resistance to ciprofloxacin, trimethoprim-sulfamethoxazole, and erythromycin was found to be higher in isolates from catheter and blood culture. Staphylococcus hominis isolates had the highest rate for inducible clindamycin resistance. None of the isolates were resistant to vancomycin, teicoplanin, and linezolid. Conclusion: The sasX gene is detected in 9.44% of the isolates. There is no statistical difference between the sasX-positive and -negative isolates in terms of antibacterial resistance and the presence of sasX and SCCmec types. Further studies about the role of sasX at virulence in coagulase-negative staphylococci, especially from clinical samples such as tracheal aspirate and abscess isolates, and distribution of staphylococcal cassette chromosome mec types are needed.


Assuntos
Coagulase/análise , Staphylococcus/genética , Staphylococcus/metabolismo , Coagulase/sangue , Coagulase/metabolismo , Estudos Transversais , Humanos , Testes de Sensibilidade Microbiana/métodos , Staphylococcus/isolamento & purificação , Staphylococcus capitis/genética , Staphylococcus capitis/isolamento & purificação , Staphylococcus epidermidis/genética , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus haemolyticus/genética , Staphylococcus haemolyticus/isolamento & purificação , Staphylococcus hominis/genética , Staphylococcus hominis/isolamento & purificação , Staphylococcus lugdunensis/genética , Staphylococcus lugdunensis/isolamento & purificação , Staphylococcus saprophyticus/genética , Staphylococcus saprophyticus/isolamento & purificação
7.
Biofouling ; 36(3): 266-275, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32338055

RESUMO

In vitro activity against methicillin-resistant Staphylococcus aureus (MRSA) and Staphylococcus epidermidis biofilm producers from blood cultures of patients with prosthetic hip infections was evaluated. The Minimum Inhibitory Concentration (MIC) for AP7121 was determined and the bactericidal activity of AP7121 (MICx1, MICx4) against planktonic cells was studied at 4, 8 and 24 h. The biofilms formed were incubated with AP7121 (MICx1, MICx4) for 1 and 24 h. The anti-adhesion effect of an AP7121-treated inert surface over the highest MIC isolate was studied with scanning electron microscopy (SEM). The bactericidal activity of AP7121 against all the planktonic staphylococcal cells was observed at 4 h at both peptide concentrations. Dose-dependent anti-biofilm activity was detected. AP7121 (MICx4) showed bactericidal activity at 24 h in all isolates. SEM confirmed prevention of biofilm formation. This research showed the in vitro anti-biofilm activity of AP7121 against MRSA and S. epidermidis and the prevention of biofilm formation by them on an abiotic surface.


Assuntos
Antibacterianos/farmacologia , Biofilmes/efeitos dos fármacos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Staphylococcus epidermidis/efeitos dos fármacos , Aderência Bacteriana/efeitos dos fármacos , Biofilmes/crescimento & desenvolvimento , Prótese de Quadril/microbiologia , Humanos , Técnicas In Vitro , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Testes de Sensibilidade Microbiana , Microscopia Eletrônica de Varredura , Plâncton/efeitos dos fármacos , Plâncton/microbiologia , Infecções Estafilocócicas/prevenção & controle , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis/isolamento & purificação
8.
PLoS One ; 15(4): e0231389, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32267888

RESUMO

The diagnosis of implant-associated infections is hampered due to microbial adherence and biofilm formation on the implant surface. Sonication of explanted devices was shown to improve the microbiological diagnosis by physical removal of biofilms. Recently, chemical agents have been investigated for biofilm dislodgement such as the chelating agent ethylenediaminetetraacetic acid (EDTA) and the reducing agent dithiothreitol (DTT). We compared the activity of chemical methods for biofilm dislodgement to sonication in an established in vitro model of artificial biofilm. Biofilm-producing laboratory strains of Staphylococcus epidermidis (ATCC 35984), S. aureus (ATCC 43300), E. coli (ATCC 25922) and Pseudomonas aeruginosa (ATCC 53278) were used. After 3 days of biofilm formation, porous glass beads were exposed to control (0.9% NaCl), sonication or chemical agents. Quantitative and qualitative biofilm analyses were performed by colony counting, isothermal microcalorimetry and scanning electron microscopy. Recovered colony counts after treatment with EDTA and DTT were similar to those after exposure to 0.9% NaCl for biofilms of S. epidermidis (6.3 and 6.1 vs. 6.0 log10 CFU/mL, S. aureus (6.4 and 6.3 vs. 6.3 log10 CFU/mL), E. coli (5.2 and 5.1 vs. 5.1 log10 CFU/mL and P. aeruginosa (5.1 and 5.2 vs. 5.0 log10 CFU/mL, respectively). In contrast, with sonication higher CFU counts were detected with all tested microorganisms (7.5, 7.3, 6.2 and 6.5 log10 CFU/mL, respectively) (p <0.05). Concordant results were observed with isothermal microcalorimetry and scanning electron microscopy. In conclusion, sonication is superior to both tested chemical methods (EDTA and DTT) for dislodgement of S. epidermidis, S. aureus, E. coli and P. aeruginosa biofilms. Future studies may evaluate potential additive effect of chemical dislodgement to sonication.


Assuntos
Bactérias/isolamento & purificação , Biofilmes/efeitos dos fármacos , Quelantes/farmacologia , Infecções Relacionadas à Prótese/diagnóstico , Substâncias Redutoras/farmacologia , Sonicação , Bactérias/efeitos dos fármacos , Carga Bacteriana/métodos , Calorimetria , Ditiotreitol/farmacologia , Ácido Edético/farmacologia , Escherichia coli/isolamento & purificação , Escherichia coli/fisiologia , Humanos , Microscopia Eletrônica de Varredura , Infecções Relacionadas à Prótese/microbiologia , Pseudomonas aeruginosa/isolamento & purificação , Pseudomonas aeruginosa/fisiologia , Substâncias Redutoras/química , Cloreto de Sódio/farmacologia , Staphylococcus aureus/isolamento & purificação , Staphylococcus aureus/fisiologia , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/fisiologia
10.
Curr Pharm Biotechnol ; 21(11): 1052-1058, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32216735

RESUMO

BACKGROUND: Vancomycin is the first-line antibiotic used for the treatment of staphylococcal infections. Because of its narrow therapeutic window and the pharmacokinetics variability, vancomycin trough serum concentration should be monitored. However, due to the increased cases of staphylococcus' commensal species infections and the case of vancomycin resistance, the minimal inhibitory concentration should be considered on antimicrobial therapy. OBJECTIVE: This article aimed to show the importance of the minimal inhibitory concentration to infants on vancomycin therapy as regular criteria. MATERIALS AND METHODS: Three infants in the use of vancomycin, hospitalized in the same maternity hospital, and that had at least one blood culture performed during the intensive-care-unit hospitalization were included in the study. Vancomycin serum concentrations were determined by particleenhanced- turbidimetric inhibition-immunoassay. The vancomycin minimal inhibitory concentration data were interpreted by following the Clinical and Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST). The trough serum concentration range of 10 to 20 mg.L-1 was considered therapeutic. RESULTS: All three patients had at least one infection by S. epidermidis, being one patient exhibit vancomycin- resistant S. epidermidis infection. All patients had stoppages in the vancomycin treatment, and the minimal inhibitory concentration was performed for only one patient. CONCLUSION: The data obtained from these patients also showed the need to perform therapeutic monitoring by using minimal inhibitory concentration values, because, although the serum concentrations were within the reference range, they are insufficient to guarantee patient therapeutic success.


Assuntos
Antibacterianos/administração & dosagem , Cuidados Críticos/métodos , Monitoramento de Medicamentos/métodos , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus epidermidis/efeitos dos fármacos , Vancomicina/administração & dosagem , Antibacterianos/sangue , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana , Feminino , Humanos , Lactente , Recém-Nascido , Testes de Sensibilidade Microbiana , Infecções Estafilocócicas/sangue , Staphylococcus epidermidis/isolamento & purificação , Vancomicina/sangue , Vancomicina/uso terapêutico
11.
Infez Med ; 28(1): 55-63, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-32172261

RESUMO

The purpose of this prospective observational study was to evaluate the yield and clinical impact of blood cultures in a 78-bed Internal Medicine ward of a medium-sized Italian acute care hospital. During a two-month study period, 154 (mean age: 75.2 ++ 12.2 years; 94 males) out of 620 (24.8%) hospitalized patients underwent 174 blood cultures and were enrolled in the study. The rate of true-positive cultures was 11.5% (20/174) and the rate of false-positive (contaminants) was 5.7% (10/174). A total of 23 microorganisms (5 multidrug resistant strains), most frequently Escherichia coli (n = 10), Klebsiella pneumoniae (n = 3) and Staphylococcus aureus (n = 3), were isolated. The positivity rate was significantly higher in patients with urinary tract infection (31%) and abdomen infection (26.1%) than in patients with pneumonia (4.9%; p<0.01). Although the positivity rate in patients exposed to antibiotics was lower than in those not exposed, the difference was not statistically significant. Therapy changes due to blood culture positivity were observed in 7.1% of the patients overall. In-hospital death was observed in nine of the 136 patients with negative blood cultures (6.6%) and in none of the 18 patients with positive blood cultures. These results indicate that the yield and clinical impact of blood cultures is quite low in patients admitted to an Internal Medicine ward and suggest the need to improve the adequacy of the indications to perform the test.


Assuntos
Pacientes Internados , Medicina Interna , Pneumonia/sangue , Staphylococcus aureus , Infecções Urinárias/sangue , Abdome/microbiologia , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/uso terapêutico , Farmacorresistência Bacteriana Múltipla , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Reações Falso-Positivas , Feminino , Mortalidade Hospitalar , Humanos , Itália , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Masculino , Pessoa de Meia-Idade , Pneumonia/microbiologia , Estudos Prospectivos , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis/efeitos dos fármacos , Staphylococcus epidermidis/isolamento & purificação , Infecções Urinárias/microbiologia
13.
Cell ; 180(3): 454-470.e18, 2020 02 06.
Artigo em Inglês | MEDLINE | ID: mdl-32004459

RESUMO

Metagenomic inferences of bacterial strain diversity and infectious disease transmission studies largely assume a dominant, within-individual haplotype. We hypothesize that within-individual bacterial population diversity is critical for homeostasis of a healthy microbiome and infection risk. We characterized the evolutionary trajectory and functional distribution of Staphylococcus epidermidis-a keystone skin microbe and opportunistic pathogen. Analyzing 1,482 S. epidermidis genomes from 5 healthy individuals, we found that skin S. epidermidis isolates coalesce into multiple founder lineages rather than a single colonizer. Transmission events, natural selection, and pervasive horizontal gene transfer result in population admixture within skin sites and dissemination of antibiotic resistance genes within-individual. We provide experimental evidence for how admixture can modulate virulence and metabolism. Leveraging data on the contextual microbiome, we assess how interspecies interactions can shape genetic diversity and mobile gene elements. Our study provides insights into how within-individual evolution of human skin microbes shapes their functional diversification.


Assuntos
Evolução Molecular , Transferência Genética Horizontal , Interações entre Hospedeiro e Microrganismos/genética , Microbiota/genética , Polimorfismo de Nucleotídeo Único , Pele/microbiologia , Staphylococcus epidermidis/genética , Adulto , DNA Bacteriano/genética , Farmacorresistência Bacteriana/genética , Feminino , Voluntários Saudáveis , Humanos , Masculino , Pessoa de Meia-Idade , Filogenia , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/patogenicidade , Virulência/genética , Adulto Jovem
14.
PLoS One ; 15(2): e0227823, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32012172

RESUMO

Staphylococcus epidermidis has emerged as the leading agent causing neonatal late-onset sepsis in preterm neonates; although the severity of the episodes caused by this species is often underestimated, it might exert relevant short- and long-term detrimental effects on neonatal outcomes. In this context, the objective of this study was to characterize a collection of S. epidermidis strains obtained from meconium and feces of preterm infants, and to assess the potential role of the enteral feeding tubes as potential reservoirs for this microorganism. A total of 26 preterm infants were enrolled in the study. Meconium and fecal samples were collected weekly during their first month of life (n = 92). Feeding samples were collected after their pass through the enteral feeding tubes (n = 84). S. epidermidis was present in the fecal samples of all the infants in, at least, one sampling time at concentrations ranging from 6.5 to 7.8 log10 CFU/g. Initially, 344 isolates were obtained and pulsed-field gel electrophoresis (PFGE) profiling allowed the reduction of the collection to 101 strains. Among them, multilocus sequence typing (MLST) profiling showed the presence of 32 different sequence types (ST). Globally, most of the STs to hospital-adapted high-risk clones and belonged to clonal complexes (CC) associated to the hospital environment, such as CC2. The virulence gene most commonly detected among the strains was altE. High resistance rates to macrolides and aminoglycosides were detected and 64% of the strains harboured the mecA gene, which was codified in SCCmec types. Our results indicates the existence of a complex and genetically diverse S. epidermidis population in the NICU environment. A better knowledge of S. epidermidis strains may help to devise strategies to avoid their conversion from symbiont to pathobiont microorganisms in the NICUs.


Assuntos
Epidemiologia Molecular , Sepse Neonatal/genética , Infecções Estafilocócicas/genética , Staphylococcus epidermidis/genética , Antibacterianos/uso terapêutico , Eletroforese em Gel de Campo Pulsado , Nutrição Enteral/efeitos adversos , Fezes/microbiologia , Genótipo , Humanos , Lactente , Recém-Nascido , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Testes de Sensibilidade Microbiana , Sepse Neonatal/microbiologia , Sepse Neonatal/patologia , Sepse Neonatal/prevenção & controle , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/patogenicidade
15.
BMC Musculoskelet Disord ; 21(1): 38, 2020 Jan 18.
Artigo em Inglês | MEDLINE | ID: mdl-31954400

RESUMO

BACKGROUND: Septic arthritis of the elbow joint is a rare condition. Limited data is available on infections of the elbow joint following trauma or prior surgery on this joint. The aim of this study was to describe the etiology, comorbidities, bacterial spectrum and therapy of secondary purulent elbow infections. METHODS: Patients treated in our hospital were selected through retrospective chart review between 2006 and 2015. We included all patients with an empyema of the elbow after a trauma or surgical intervention on this joint. 30 patients between 26 and 82 years (mean: 52.47) were included. RESULTS: Seven patients (23.3%) were female, 23 (76.7%) male. 22 patients (73.3%) had a history of trauma, eight (26.7%) had prior elective surgeries on their elbow. Between one and 25 surgeries (mean: 5.77) were necessary for treatment. In nine patients, debridement and synovectomy were sufficient, eight patients (26.7%) received resection of the elbow joint. One patient was treated with a chronic fistula. In 18 patients (60%), cultures of aspiration/intraoperative swabs were positive for Staphylococcus aureus, four of these were methicillin-resistant. Four patients (13.3%) had positive cultures for Staphylococcus epidermidis, in five patients (16.7%) no bacteria could be cultured. CONCLUSIONS: Secondary infections of the elbow joint are a rare disease with potentially severe courses, requiring aggressive surgical treatment and possibly severely impacting elbow function. Staphylococcus aureus was the most common bacteria in secondary infections and should be addressed by empiric antibiotic treatment when no suspicion for other participating organisms is present.


Assuntos
Antibacterianos/uso terapêutico , Coinfecção/terapia , Desbridamento/métodos , Articulação do Cotovelo/microbiologia , Infecções Estafilocócicas/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Coinfecção/diagnóstico , Articulação do Cotovelo/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis/isolamento & purificação , Adulto Jovem
16.
Biosens Bioelectron ; 151: 111993, 2020 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31999592

RESUMO

Early stage detection of biofilm formation is an important aspect of microbial research because once formed, biofilms show serious tolerance to antibiotics in contrast to the free-floating bacteria, which significantly increases the difficulty for clinical treatment of bacterial infections. The early stage detection technology is desired to improve the efficiency of medical treatments. In this work, we present a biosensor consisting of a magnesium zinc oxide (MZO) dual gate thin-film transistor (DGTFT) as the actuator and an MZO nanostructure (MZOnano) array coated conducting pad as the extended sensing gate for the early stage detection of Staphylococcus epidermidis (S. epidermidis) biofilm formation. S. epidermidis bacteria were cultured in vitro on the nanostructure modified sensing pad. Charge transfer occurs between microbial cells and the MZOnano during the initial bacterial adhesion stage. Such electrical signals, which represent the onset of biofilm formation, were dynamically detected by the DGTFT where the top gate electrode was connected to the extended MZOnano sensing pad and the bottom gate was used for biasing the device into the optimum characteristic region for high sensitivity and stable operation. The testing results show that a current change of ~80% is achieved after ~200 min of bacterial culturing. A crystal violet staining-based assay shows that tiny bacterial microcolonies just start to form at 200 min, and that it would take approximately 24 h to form matured biofilms. This technology enables medical professionals to act promptly on bacterial infection before biofilms get fully established.


Assuntos
Biofilmes , Técnicas Biossensoriais , Nanoestruturas/química , Staphylococcus epidermidis/isolamento & purificação , Aderência Bacteriana/efeitos dos fármacos , Humanos , Staphylococcus epidermidis/genética , Óxido de Zinco/química
17.
Arch. Soc. Esp. Oftalmol ; 95(1): 45-47, ene. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-195318

RESUMO

Un varón de 55 años acudió a nuestro centro con una queratitis infecciosa en el ojo izquierdo afectando a una de las incisiones de una queratotomía radial que se había realizado 34 años antes. La colocación de dos puntos sueltos en dicha incisión fue clave para la resolución de la infección. Este paciente también fue diagnosticado de síndrome del párpado flácido. ¿Puede esto actuar como factor de riesgo para la queratitis infecciosa en pacientes que se han realizado una queratotomía radial? La asociación entre ambas entidades no ha sido descrita con anterioridad y además este caso representa el segundo en el que se describe el uso de puntos sueltos como tratamiento coadyuvante en este tipo de casuística


A 55-year-old male presented with an infectious keratitis in his left eye, affecting one of the incisions of the radial keratotomy he had undergone thirty-four years ago. Suturing the incision with two simple interrupted stitches was key to the resolution of the infection. Floppy eyelid syndrome was also found in this patient. Could this act as a risk factor for infectious keratitis in radial keratotomy? To our knowledge, this is the first reported case describing the association between both conditions, and the second reported case where sutures have been used as an adjuvant treatment in these types of cases


Assuntos
Humanos , Animais , Masculino , Pessoa de Meia-Idade , Blefaroptose/complicações , Ceratoconjuntivite Infecciosa/etiologia , Ceratotomia Radial/efeitos adversos , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Ceratoconjuntivite Infecciosa/cirurgia , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/cirurgia , Fatores de Tempo , Antibacterianos/uso terapêutico , Desbridamento , Quimioterapia Combinada , Ceratoconjuntivite Infecciosa/tratamento farmacológico , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/etiologia , Uveíte Anterior/cirurgia
18.
J Med Microbiol ; 69(1): 41-45, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31789588

RESUMO

Introduction. Vancomycin has become the first-line therapy for most infections caused by methicillin-resistant staphylococci.Aim. To evaluate the vancomycin MIC, staphylococcal cassette chromosome mec (SCCmec) types and clonality of coagulase-negative staphylococci (CoNS) isolates recovered from neonates with true primary bloodstream infections (BSI).Methodology. CoNS isolates were prospectively recovered from blood cultures of non-repetitive patients admitted to a neonatal intensive care unit (NICU) in a tertiary-care hospital during a 3-year period. BSI was defined based on established criteria. Micro-organisms were identified phenotypically and by PCR. MIC-values for vancomycin and oxacillin were determined by broth dilution method and E-test. The SCCmec type conferring methicillin resistance was determined by multiplex PCR. The heterogeneous vancomycin (hV) resistance phenotype was screened on brain heart infusion agar containing 4 µg ml-1 of vancomycin. The clonality was investigated by PFGE.Results. Seventy-four CoNS isolates were recovered from blood cultures of neonates during the study period but only 40 (54 %) were associated with true primary BSI. Nine (22.5%) babies died. Staphylococcus epidermidis was the most prevalent species (95 %; 38/40). All S. epidermidis isolates were methicillin-resistant (MR). SCCmec type IV was predominant (55.3 %; 21/38). Most (80.0 %; 32/38) isolates exhibited vancomycin MIC-values of 2-4 µg ml-1 not associated with the SCCmec type or clonality. Sixteen (42.1%) isolates displayed hV resistance. All babies who died were harbouring MR-S. epidermidis exhibiting vancomycin MICs of 2-4 µg ml-1.Conclusion. The findings of this study demonstrated that blood invasive MR-S. epidermidis isolates recovered at NICU tend to show decreased vancomycin susceptibility making therapy of those fragile patients difficult.


Assuntos
Resistência a Meticilina/genética , Meticilina/farmacologia , Staphylococcus epidermidis/efeitos dos fármacos , Antibacterianos/farmacologia , Bacteriemia/tratamento farmacológico , Suscetibilidade a Doenças , Farmacorresistência Bacteriana/genética , Humanos , Lactente , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Terapia Intensiva Neonatal , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Sepse/tratamento farmacológico , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus/efeitos dos fármacos , Staphylococcus/isolamento & purificação , Staphylococcus epidermidis/isolamento & purificação , Staphylococcus epidermidis/metabolismo , Vancomicina/farmacologia , Resistência a Vancomicina/genética
19.
Arch Soc Esp Oftalmol ; 95(1): 45-47, 2020 Jan.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-31780354

RESUMO

A 55-year-old male presented with an infectious keratitis in his left eye, affecting one of the incisions of the radial keratotomy he had undergone thirty-four years ago. Suturing the incision with two simple interrupted stitches was key to the resolution of the infection. Floppy eyelid syndrome was also found in this patient. Could this act as a risk factor for infectious keratitis in radial keratotomy? To our knowledge, this is the first reported case describing the association between both conditions, and the second reported case where sutures have been used as an adjuvant treatment in these types of cases.


Assuntos
Blefaroptose/complicações , Ceratoconjuntivite Infecciosa/etiologia , Ceratotomia Radial/efeitos adversos , Infecções Estafilocócicas/etiologia , Staphylococcus epidermidis/isolamento & purificação , Infecção da Ferida Cirúrgica/etiologia , Técnicas de Sutura , Animais , Antibacterianos/uso terapêutico , Desbridamento , Quimioterapia Combinada , Humanos , Ceratoconjuntivite Infecciosa/tratamento farmacológico , Ceratoconjuntivite Infecciosa/cirurgia , Masculino , Pessoa de Meia-Idade , Infecções Estafilocócicas/tratamento farmacológico , Infecções Estafilocócicas/cirurgia , Infecção da Ferida Cirúrgica/tratamento farmacológico , Infecção da Ferida Cirúrgica/cirurgia , Fatores de Tempo , Uveíte Anterior/tratamento farmacológico , Uveíte Anterior/etiologia , Uveíte Anterior/cirurgia
20.
Am J Ophthalmol ; 212: 34-42, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31770517

RESUMO

PURPOSE: Rapid identification of virulent pathogens is essential to strengthen the therapeutic strategy of acute endophthalmitis. OBJECTIVES: This study sought to compare the contribution of a combination of polymerase chain reaction (PCR)-based tests to culture methods, in patients with postoperative endophthalmitis. DESIGN: Prospective multicenter study diagnostic evaluation. METHODS: Setting: university referral centers. PARTICIPANTS: 153 consecutive patients presenting with acute or delayed-onset postoperative endophthalmitis, between 2008 and 2015. There were a total of 284 aqueous humor (AH) and/or vitreous fluid (VF) samples. Outcomes and measurements: microbiological tests of intraocular samples included bacterial culturing of pediatric blood culture bottles; 16SrDNA amplification and sequencing (panbacterial PCR) for detection and identification of all bacterial species; real-time PCR (qPCR) assays targeting the femA or lytA gene for detection of Staphylococcus aureus (S. aureus) or Streptococcus pneumoniae (S. pneumoniae), respectively; and a qPCR assay targeting the tuf gene for detection and quantification of Staphylococcus epidermidis (S. epidermidis). RESULTS: At the time of admission, the rate of detection of microorganisms by PCR-based tests was not significantly different than that by culturing (38% versus 30% in AH samples [n = 69]; 66% versus 63% in VF samples [n = 82], respectively). In contrast, after 1 intravitreal injection (IVI) of antibiotics, the identification rate by PCR-based tests was higher than that in VF by culturing (62% vs 48%, respectively; n = 94; P = 0.05). Bacteria were identified in 70% of patients, with a predominance of Gram-positive bacteria (93%). Specific qPCR tests targeting S. aureus and S. pneumoniae did not provide additional diagnoses but provided earlier results. The S. epidermidis load in vitreous at the time of patients' admission was higher in cases of final visual acuity (VA) of <20/40 (127,118 ± 125,848 DNA copies/mL) in patients with a VA of ≥20/40 (40350,000 ± 46,912 DNA copies/mL; P = 0.09). No significant changes in S. epidermidis load was found after one IVI. CONCLUSIONS: Patients with acute or delayed-onset endophthalmitis should benefit from microbiological identification in vitreous samples by combined analysis using bacterial cultures in pediatric blood culture bottles and panbacterial PCR. The last test was more effective than cultures in vitreous samples collected after an IVI of antibiotics. The qPCR tests targeting S. aureus and S. pneumoniae gave earlier results than culture and panbacterial PCR but did not provide additional diagnoses. As for S. epidermidis infections, determination of bacterial load using the qPCR test targeting the tuf gene could help evaluation of the visual prognosis of patients. Its role in the follow-up of patients after antibiotic treatment needs further investigation.


Assuntos
Endoftalmite/diagnóstico , Infecções Oculares Bacterianas/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Infecções Estafilocócicas/diagnóstico , Doença Aguda , Idoso , Antibacterianos/uso terapêutico , Humor Aquoso/microbiologia , Técnicas Bacteriológicas/métodos , Extração de Catarata/efeitos adversos , DNA Bacteriano , DNA Ribossômico , Endoftalmite/tratamento farmacológico , Feminino , Humanos , Masculino , Técnicas de Amplificação de Ácido Nucleico/normas , Reação em Cadeia da Polimerase/normas , Estudos Prospectivos , Reação em Cadeia da Polimerase em Tempo Real/normas , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/isolamento & purificação , Staphylococcus epidermidis/isolamento & purificação , Streptococcus pneumoniae/isolamento & purificação , Trabeculectomia/efeitos adversos , Acuidade Visual/fisiologia , Vitrectomia/efeitos adversos , Corpo Vítreo/microbiologia
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