Perfil microbiológico, prevalencia de resistencia antibiótica y patrones de susceptibilidad en infección urinaria en una población pediátrica

Introducción: El incremento de la resistencia antibiótica se considera un problema de salud pública con consecuencias clínicas y económicas, por lo tanto se determinará la prevalencia de resistencia antibiótica en Infección del Tracto Urinario (ITU, el perfil microbiológico y los patrones de susceptibilidad en una población pediátrica atendida en la Fundación Cardioinfantil. Materiales y métodos: Estudio observacional de corte transversal, retrospectivo, entre 1 mes a 18 años de edad, con diagnóstico de ITU comunitaria atendidos entre Enero de 2011 y Diciembre de 2013. Se excluyeron pacientes con dispositivos en la vía urinaria, instrumentación quirúrgica previa, trayectos fistulosos entre la vía urinaria y sistema digestivo, ITU luego de 48 horas de hospitalización y recaída clínica en tratamiento. Se estableció la prevalencia de ITU resistente y se realizó un análisis descriptivo de la información. Resultados: Se evaluaron 385 registros clínicos, con una mediana de 1.08 años (RIQ 0.8 – 4.08), el 73.5% eran niñas. La fiebre predominó (76.5%), seguido de emesis (32.0%), disuria (23.7%) y dolor abdominal (23.1%). El uropatógeno más frecuente fue E.coli (75%), seguido de Proteus mirabilis (8.5%) y Klebsiella spp. (8.3%). La Ampicilina, el Trimetropim sulfametoxazol, la Ampicilina sulbactam y el ácido nalidixico tuvieron mayor tasa de resistencia. La prevalencia de BLEE fue 5.2% y AmpC 3.9%. La prevalencia de resistencia antimicrobiana fue de 11.9%. Conclusiones: La E.coli es el uropatogeno más frecuentemente aislado en ITU, con resistencia a la ampicilina en 60.2%, cefalosporinas de primera generación en 15.5%, trimetropin sulfametoxazol en 43.9%, cefepime 4.8%. La prevalencia de resistencia antimicrobiana fue de 11.9%.

Tipificación y perfiles de resistencia antibiótica en unidades neonatales de Bogotá durante los años 2008-2012

La sepsis neonatal ha sido un problema en las unidades de cuidado intensivo al rededor del mundo. Su incidencia aumenta diez veces cuando el recién nacido es de muy bajo peso. El aislamiento de gérmenes resistentes en los cultivos tomados a los recién nacidos ha permitido identificar el comportamiento de los antibióticos de uso común. El presente estudio analítico de corte transversal realizado durante los años 2008 al 2012 en diez unidades de cuidados intensivos neonatales de la ciudad de Bogotá analizó la base de datos de los laboratorios de microbiología, obteniendo un total de 22.153 muestras de las cuales 7.132 ( 32.9%) fueron elegibles. Utilizando el software Whonet 5.6 y tomando solo el primer aislamiento por año y por paciente se realizaron análisis descriptivos y de resistencia bacteriana. Los resultados obtenidos fueron similares a los reportados en la literatura donde los gérmenes gran positivos son los más comúnmente aislados con un 53.2%, seguidos en importancia por los gérmenes gran negativos. Klebsiella pneumoniae y Escherichia coli en conjunto aportan 27.22%, presentando un aumento en el porcentaje de BLEE (Betalactamasa de Espectro Extendido) y aparición de carbapenemasas durante los años de estudio. El Acinetobacter baumannii ha duplicado la resistencia a ampicilina sulbactam llegando al 66.7%. Las candidas fueron aisladas en un porcentaje muy bajo sin documentarse resistencias. El Estafilococo aureus no presenta resistencias que sugiera la aparición de nuevos clones.

Colloidal stable silica encapsulated nano-magnetic composite as a novel bio-catalyst carrier

A colloidal stable silica-encapsulated magnetic nano-composite of a controlled dimension is, for the first time, employed to carry beta-lactamase via chemical linkage on the silica overlayer: activity study reflects that this new type of immobilisation allows site (enzyme) isolation, accessibility as good as free enzyme and recovery & reusability upon application of magnetic separation.

Silica-encapsulated nanomagnetic particle as a new recoverable biocatalyst carrier

Enzymes are versatile biocatalysts with major advantages of ultrahigh reaction selectivity and specificity under mild conditions, which currently find increasing applications. However, their applications are often hampered by difficulties in recovery and recycling. As a result, we carried out detailed investigations on the synthesis and characterization of silica-encapsulated iron oxide magnetic nanoparticles of controlled dimension as an enzyme carrier. It is shown that the relatively smaller sized silica-coated magnetic nanoparticle prepared by the microemlusion technique can a carry bulky enzyme, beta-lactamase, via chemical linkages on the silica overlayer without severely blocking the enzymatic active center ( which is commonly encountered in conventional solid supports). An activity study by Michalis-Menten kinetics reflects that this new type of immobilization allows enzyme isolation with accessibility as good as free enzyme. The recovery and reusability of the nanoparticle-supported enzyme upon application of magnetic separation are also demonstrated.

A novel system for large-scale gene expression analysis: bacterial colonies array

In the present work, we report the use of bacterial colonies to optimize macroarray technique. The devised system is significantly cheaper than other methods available to detect large-scale differential gene expression. Recombinant Escherichia coli clones containing plasmid-encoded copies of 4,608 individual expressed sequence tag (ESTs) were robotically spotted onto nylon membranes that were incubated for 6 and 12 h to allow the bacteria to grow and, consequently, amplify the cloned ESTs. The membranes were then hybridized with a beta-lactamase gene specific probe from the recombinant plasmid and, subsequently, phosphorimaged to quantify the microbial cells. Variance analysis demonstrated that the spot hybridization signal intensity was similar for 3,954 ESTs (85.8%) after 6 h of bacterial growth. Membranes spotted with bacteria colonies grown for 12 h had 4,017 ESTs (87.2%) with comparable signal intensity but the signal to noise ratio was fivefold higher. Taken together, the results of this study indicate that it is possible to investigate large-scale gene expression using macroarrays based on bacterial colonies grown for 6 h onto membranes.

Plasmid profile in oral Fusobacterium nucleatum from humans and Cebus apella monkeys

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

Evalution of methods for the detection of MRSA in patients of Botucatu Medical School Hospital, São Paulo, Brazil

Oxacillin is the main drug of choice for the treatment of S. aureus infections. However, S. aureus resistance to oxacillin has become a major problem in the recent decades. The study aimed assess the rates of oxacillin resistance in S. aureus samples obtained at the Botucatu Medical School Hospital, UNESP, and to compare phenotypic techniques for the detection of MRSA against the gold standard method (mecA gene detection) in these samples. A total of 102 samples, previously isolated between 2002 and 2006, and kept at the Culture Collection of the Department of Microbiology and Immunology, in the Botucatu Biosciences Institute, UNESP, were included. Oxacillin resistance was assessed by oxacillin and cefoxitin disk diffusion and agar dilution tests, screening tests using Mueller-Hinton agar with 6 mu g/mL of oxacillin and 4% NaCl, E-test, and mecA gene detection. of the samples analyzed, 46 (45.1%) were mecA-positive. Oxacillin disk sensitivity and specificity were 86.9% and 91.1%, respectively. Cefoxitin disk sensitivity and specificity were respectively 91.3% and 91.1%. The screening test with the cefoxitin disk showed almost the same level of sensitivity (91.3%) and specificity (91.1%). With E-test strips, sensitivity was higher (97.8%) and specificity was comparable to that found with the other methods (91.1%). Ninety-three percent of the samples produced beta-lactamase and five of them were mecA-negative. There was a gradual increase in the number of oxacillin-resistant S. aureus samples between 2002 and 2004. However, from 2004 to 2006, the number of resistant samples dropped from 55% of MRSA in 2004, to 45% in 2005 and 34.6% in 2006. The data obtained reveal that, among phenotypic methods, the E-test yielded the best results, with higher sensitivity levels when compared to the other methods. The decreased resistance rate observed over the most recent years may be explained by the rational use of antimicrobial agents associated with good practices in the control of hospital infection, or may be related to the diminished use of oxacillin as a treatment option.

Phenotype characterization of Staphylococcus species strains isolated from buffalo (Bubalus bubalis) milk

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

Kinetic studies on clavulanic acid degradation

Clavulanic acid (CA), a potent beta-lactamase inhibitor, is very sensitive to pH and temperature. It is produced by Streptomyces clavuligerus and to optimize both the fermentation step and the downstream process, the expression of the hydrolysis kinetics has to be determined. In the present work the CA degradation rate from various sources was investigated at temperatures of 10, 20, 25, 30 and 40degreesC and PH values of 6.2 and 7.0. The results showed that first-order kinetics explained very well the hydrolysis kinetics and the Arrhenius equation could be applied to establish a relationship between the degradation rate constant and temperature, at both pHs. It has been observed that CA from fermentation medium was much more unstable than that from standard solution and from a commercially available medicine. Also, it was observed that CA was more stable at PH 6.2 than at pH 7.0, irrespective of the CA source. (C) 2004 Elsevier B.V. All rights reserved.

A putative twin-arginine translocation system in the phytopathogenic bacterium Xylella fastidiosa

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Infecções da corrente sanguínea por Klebsiella spp. produtora de Betalactamase de espectro expandido em unidades de terapia intensiva neonatal de hospital de ensino no estado do Pará: fatores de risco para letalidade

Klebsiella spp. produtora de beta-lactamases de espectro expandido (ESBL) tem emergido como um problema comum globalmente. Entretanto, dados relativos às características clínicoepidemiológicas e ao desfecho clínico em neonatos infectados por esta bactéria gram-negativa ESBL são ainda limitados. Estudo descritivo retrospectivo analítico avaliou os fatores de risco associados à letalidade e o perfil epidemiológico das Infecções de corrente sanguínea (ICS) por Klebsiella spp. ESBL em Unidade de Terapia Intensiva (UTI) neonatal de hospital de ensino no Estado do Pará, Brasil. Amostra composta por 27 neonatos, a maioria prematuros (77,8%), com a idade gestacional média de 34 semanas, variando de 27 a 41 semanas. Os episódios de ICS foram mais frequentes em recém-nascidos (RN) com peso ≤ 1500 g (40,7%), sendo que 14,8% abaixo dos de 1000g. O tempo médio de internação dos pacientes foi 40,51 dias variando de 5 a 101 dias (DP = ±29,61), com tempo médio de aparecimento da ICS de 12,2 dias após a admissão na UTI neonatal. A maioria das infecções foi provocada por bactérias da espécie Klebsiella pneumoniae (52%). A mortalidade geral encontrada foi 66,7%, com uma taxa de letalidade até o 14º dia da bacteremia de 51,8 %. O cateter vascular central (CVC) esteve presente em cerca de 60% dos RN e todos os pacientes apresentavam-se sob ventilação mecânica no momento do episódio da ICS. Quanto às variáveis associadas ao óbito até o 14° dia, apenas a inadequação da terapia antimicrobiana apresentou significância estatística (P<0,0017), já que todos os neonatos que receberam antibioticoterapia inapropriada evoluíram desfavoravelmente. As ICS causadas por Klebsiella ESBL têm se tornado um problema comum em RN prematuros com elevada mortalidade naqueles que recebem terapia inapropriada.

Detection of chromosomal bla(CTX-M-2) in diverse Escherichia coli isolates from healthy broiler chickens

The rise of extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in food-producing animals is a growing concern for public health. We investigated ESBL producers isolated from broiler chickens in Brazil and characterized 19 CTX-M-2-producing E.coli. The ISCR1 was detected upstream of the chromosome-located gene bla(CTX-M-2), associated with sul-1 type integron structure. CTX-M-2-producing E.coli exhibited different PFGE-types and phylogenetic groups, showing a non-clonal dissemination. The sequence types found (ST93, ST155 and ST2309) have been associated with humans and animals worldwide. Herein, we report the chromosomal location of bla(CTX-M-2) on E.coli, highlighting the risks of multidrug-resistant bacteria in food-producing animals.

IncIl/ST113 and IncIl/ST114 conjugative plasmids carrying bla(CTX-M-8) in Escherichia coli isolated from poultry in Brazil

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

Resistance to tetracycline and β-lactams and distribution of resistance markers in enteric microorganisms and pseudomonads isolated from the oral cavity

This study evaluated the occurrence of enteric bacteria and pseudomonads resistant to tetracycline and beta-lactams in the oral cavity of patients exhibiting gingivitis (n=89); periodontitis (n=79), periodontally healthy (n=50) and wearing complete dentures (n=41). Microbial identification and presence of resistance markers associated with the production of beta-lactamases and tetracycline resistance were performed by using biochemical tests and PCR. Susceptibility tests were carried out in 201 isolates of enteric cocci and rods. Resistance to ampicillin, amoxicillin/clavulanic acid, imipenem, meropenem and tetracycline was detected in 57.4%, 34.6%, 2.4%, 1.9% and 36.5% of the isolates, respectively. beta-lactamase production was observed in 41.2% of tested microorganisms, while the most commonly found beta-lactamase genetic determinant was gene bla(TEM). Tetracycline resistance was disseminated and a wide scope of tet genes were detected in all studied microbial genus.

Clonal relatedness and resistance patterns of Salmonella Corvallis from poultry carcasses in a Brazilian slaughterhouse

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)