952 resultados para Multidrug-resistant gram-negative bacteria


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A revision was accomplished in the literature on the quinolones, antibacterial class that presents wide action spectrum, focusing, mainly, the sparfloxacin, third generation fluorquinolone which has potente activity against Gram positive organisms, including Streptococcus pneumoniae and methicillin-resistant Staphylococcus aureus (MRSA), Gram negative organisms, Legionelia spp, Mycoplasma spp, Chlamydia spp and Mycobacterium spp, including multidrug resistant organisms.

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Ninety eight strains of glucose-nonfermenting Gram-negative bacilli were analyzed and isolated from several clinical materials of 95 patients admitted at the Dr. Domingos Leonardo Cerávolo University Hospital and three from outpatients. All of them were assisted in the Laboratory of Clinical Analysis of Unoeste University, Presidente Prudente, SP, from the period of October of 1999 to April of 2001. In this work, the level of agreement between the semi-automated commercial system AutoScan-4 and the conventional system for the identification of those bacteria were studied comparatively. There was agreement in 81 (82.7%), showing that both methodologies are useful for identification; partial agreement in six strains (6.1%) and disagreement in 11 (11.2%). The comercial system did not identify nine (9.2%) of the strains and reported them as very rare biotypes.

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The presence of Staphylococcus aureus in the nasal cavities and pericatheter skin of peritoneal dialysis patients put them at high risk of developing peritonitis. However, it is not clear whether the presence of coagulase-negative staphylococci (CNS) in the nasal passages and skin of patients is related to subsequent occurrence of peritoneal infection. The aim of the present study was to verify the relationship between endogenous sources of S. aureus and CNS and occurrence of peritonitis in patients undergoing peritoneal dialysis. Thirty-two patients on peritoneal hemodialysis were observed for 18 months. Staphylococcus species present in their nasal passage, pericatheter skin and peritoneal effluent were identified and compared based on drug susceptibility tests and dendrograms, which were drawn to better visualize the similarity among strains from extraperitoneal sites as well as their involvement in the causes of infection. Out of 288 Staphylococcus strains isolated, 155 (53.8%) were detected in the nasal cavity, 122 (42.4%) on the skin, and 11 (3.8%) in the peritoneal effluent of patients who developed peritonitis during the study. The most frequent Staphylococcus species were CNS (78.1%), compared with S. aureus (21.9%). Among CNS, S. epidermidis was predominant (64.4%), followed by S. warneri (15.1%), S. haemolyticus (10.7%), and other species (9.8%). Seven (64%) out of 11 cases of peritonitis analyzed presented similar strains. The same strain was isolated from different sites in two (66%) out of three S. aureus infection cases. In the six cases of S. epidermidis peritonitis, the species that caused infection was also found in the normal flora. From these, two cases (33%) presented highly similar strains and in three cases (50%), it was difficult to group strains as to similarity. Patients colonized with multidrug-resistant S. epidermidis strains were more predisposed to infection. Results demonstrated that an endogenous source of S. epidermidis could cause peritonitis in peritoneal dialysis patients, similarly to what has been observed with S. aureus.

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Catheter-related bacteremia (CRB) is one of the various complications related to hemodialysis (HD). As a result of this high rate of infection, the antibiotic lock technique (ALT) has been recommended to prevent CRB. However, adverse effects of ALT such as increased emergence of strains resistant to antibiotics and increased mechanical dysfunction catheter were poorly evaluated. We prospectively evaluated the efficacy of catheter-restricted filling using an antibiotic lock solution in preventing CRB. A total of 233 HD patients requiring 325 new tunneled catheters while waiting for placement and maturation of an arteriovenous fistula or graft were enrolled in this study. Patients with a tunneled catheter were assigned to receive either an antibiotic-heparin lock solution (antibiotic group: cefazolin 10 mg/ml, gentamicin 5 mg/ml, heparin 1,000 U/ml) or a heparin lock solution (no-antibiotic group: heparin 1,000 U/ml) as a catheter lock solution during the interdialytic period. The present study aimed to assess the efficacy of ALT using cefazolin and gentamicin in reducing CRB in patients undergoing HD with tunneled central catheter and to identify its adverse effects. CRB developed in 32.4 % of patients in the no-antibiotic group and in 13.1 % of patients in the antibiotic group. CRB rates per 1,000 catheter-days were 0.57 in the antibiotic group versus 1.74 in the no-antibiotic group (p < 0.0001). Kaplan-Meier analysis also showed that mean CRB-free catheter survival was significantly higher in the antibiotic group than in the no-antibiotic group (log-rank statistic 17.62, p < 0.0001). There was statistically significant difference between the two groups in causative organisms of CRB, with predominance of negative culture in both groups, but this prevalence was higher in ALT group (57.9 vs 90.1 %, p < 0.0001), and the two groups also were different in prevalence of gram-positive bacteria as causing organisms (ALT group 21.05 vs = 0 % in control group, p < 0.0001). There was no statistically significant difference between the two groups in drug-resistant germs. There were statistically significant differences between the two groups in the catheter removal causes, with higher rate of infectious cause in control group (12.32 vs 2.22 %, p < 0.0001) and mechanical cause in ALT group (28.26 vs 37.78 %, p < 0.0001). The results suggest that ALT may be a beneficial means of reducing the CRB rate in HD patients with tunneled catheter, without association between ALT and emergence of strains resistant. However, mechanical complications were more prevalent in antibiotic group. Further studies are required to determine the optimal drug regimen, concentrations for ALT, and its adverse effects. © 2012 Springer Science+Business Media Dordrecht.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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Pseudomonas aeruginosa é um bacilo gram-negativo, importante patógeno para pacientes neutropênicos, queimados e em condições de ventilação artificial em Unidades de Tratamento Intensivo, onde causam infecção nosocomial. Nestas condições, a infecção pode ser séria e muitas vezes letal. Em pacientes com fibrose cística, o curso da patologia por P. aeruginosa evolui como uma infecção pulmonar crônica severa, pois a bactéria produz diversas toxinas e outros fatores de virulência responsáveis pelo estabelecimento da colonização persistente do trato respiratório destes pacientes. A apresentação característica da persistente infecção por P. aeruginosa é a produção de alginato mucóide e a formação de microcolônias, que é considerada a estratégia de sobrevivência da bactéria no meio ambiente, P. aeruginosa crescendo em biofilm é altamente resistente a antibióticos, estando usualmente associada com progressiva perda da função pulmonar. Esta pesquisa realizou uma avaliação epidemiológica e clínica de portadores de fibrose cística, colonizados por P. aeruginosa, atendidos no Hospital Universitário João de Barros Barreto, na cidade de Belém, Pará no ano de 2003. Foi feito coleta de escarro dos pacientes expectoradores e swab de orofaringe nos demais para estudo microbiológico realizado no laboratório microbiologia deste hospital. Foram avaliados 32 pacientes fibrocísticos, distribuídos em três grupos, conforme: ausência de infecção por P. aeruginosa (G1), infecção pela bactéria sem colonização (G2) e colonização crônica (G3). Pacientes pertencentes a G3 apresentaram complicações respiratórias mais frequëntes e mais graves que os demais. A ocorrência de cepas mucóidaes de P. aeruginosa foi significativamente mais prevalente neste grupo, onde a doença respiratória se apresentou de forma mais severa. Cepas não-mucóides foram identificadas de forma similar nos grupos G2 e G3. Os sintomas respiratórios foram os mais frequëntes ao diagnóstico. A idade média dos pacientes ao diagnóstico foi de 7 anos. Condições sócio-econômicas adversas, diagnóstico tardio, desnutrição e mutação genética parecem ter favorecido a colonização e contribuído para ocorrência de óbito no grupo G3.

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Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

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The presence of yeasts and bacteria was studied in 26 patients with denture stomatites, and the results compared with the data of the normal mucosa foi edentoulous patients, who used or not upper dentures. The use of dentures caused an increase in the amount of yeasts, and there was a correlation with the severity of the stomatitis. Gram positives cocci and bacilus predominated in all studied groups, but in cases of stomatitis there was an increase in the amount of Gram negative cocci and filamentous. These results suggest that besides yeasts, modifications of the bacteria flora can be relevant for the development of denture stomatitis.

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

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Reports about acquired resistance to colistin in different bacteria species are increasing, including E. coli of animal origin, but reports of resistance in wild S. enterica of different serotypes from swine are not found in the literature. Results obtained with one hundred and twenty-six E. coli strains from diseased swine and one hundred and twenty-four S. enterica strains from diseased and carrier swine showed a frequency of 6.3% and 21% of colistin-resistant strains, respectively. When comparing the disk diffusion test with the agar dilution test to evaluate the strains, it was confirmed that the disk diffusion test is not recommended to evaluate colistin resistance as described previously. The colistin MIC 90 and MIC 50 values obtained to E. coli were 0.25 mu g/mL and 0.5 mu g/mL, the MIC 90 and MIC 50 to S. enterica were 1 mu g/mL and 8 mu g/mL. Considering the importance of colistin in control of nosocomial human infections with Gram-negative multiresistant bacteria, and the large use of this drug in animal production, the colistin resistance prevalence in enterobacteriaceae of animal origin must be monitored more closely.

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Abstract Background A typical purification system that provides purified water which meets ionic and organic chemical standards, must be protected from microbial proliferation to minimize cross-contamination for use in cleaning and preparations in pharmaceutical industries and in health environments. Methodology Samples of water were taken directly from the public distribution water tank at twelve different stages of a typical purification system were analyzed for the identification of isolated bacteria. Two miniature kits were used: (i) identification system (api 20 NE, Bio-Mérieux) for non-enteric and non-fermenting gram-negative rods; and (ii) identification system (BBL crystal, Becton and Dickson) for enteric and non-fermenting gram-negative rods. The efficiency of the chemical sanitizers used in the stages of the system, over the isolated and identified bacteria in the sampling water, was evaluated by the minimum inhibitory concentration (MIC) method. Results The 78 isolated colonies were identified as the following bacteria genera: Pseudomonas, Flavobacterium and Acinetobacter. According to the miniature kits used in the identification, there was a prevalence of isolation of P. aeruginosa 32.05%, P. picketti (Ralstonia picketti) 23.08%, P. vesiculares 12.82%,P. diminuta 11.54%, F. aureum 6.42%, P. fluorescens 5.13%, A. lwoffi 2.56%, P. putida 2.56%, P. alcaligenes 1.28%, P. paucimobilis 1.28%, and F. multivorum 1.28%. Conclusions We found that research was required for the identification of gram-negative non-fermenting bacteria, which were isolated from drinking water and water purification systems, since Pseudomonas genera represents opportunistic pathogens which disperse and adhere easily to surfaces, forming a biofilm which interferes with the cleaning and disinfection procedures in hospital and industrial environments.