Estudo de resist��ncia da bact��ria Escherichia Coli a antibi��ticos em infec����es urin��rias na popula����o da Regi��o Aut��noma da Madeira

As infec����es do tracto urin��rio (ITU) s��o doen��as infecciosas comuns e distinguem-se em dois grandes grupos: o das infec����es do tracto urin��rio superior e o das infec����es do tracto urin��rio inferior. O principal agente etiol��gico envolvido nas ITU �� a bact��ria Escherichia coli (E. coli), representando 80-95% dos invasores do tracto urin��rio na popula����o em geral. �� mais comum entre os adultos do sexo feminino, principalmente com actividade sexual, embora as crian��as, mulheres gr��vidas e idosos tamb��m apresentam grande susceptibilidade. Paralelamente, a problem��tica da resist��ncia aos antimicrobianos �� um tema actual e muito debatido internacionalmente. Como tal, o presente estudo teve como principal objectivo contribuir para a identifica����o fi��vel da bact��ria E. coli em infec����es urin��rias bem como a determina����o do seu perfil de resist��ncia a antibi��ticos. Os dados apresentados referem-se a um estudo efectuado entre Outubro de 2008 e Junho de 2009 no Laborat��rio de An��lises Cl��nicas Castro Fernandes ��� MMC. Foram analisadas 6522 amostras de urina, das quais 390 corresponderam a uroculturas positivas. Verificou-se que o sexo feminino tem uma maior propens��o para infec����es urin��rias, havendo uma tend��ncia para o aumento das ITU com a idade. Na interpreta����o da cultura revelou-se importante a informa����o dada pelo exame cultural acerca do n��mero de leuc��citos. Concluiu-se que nas uroculturas cujo n��mero de col��nias foi superior a 105 com menos de tr��s esp��cies de col��nias diferentes na cultura, o n��mero de leuc��citos foi superior a 30 milhares de c��lulas por ��L, o que sugere a exist��ncia de infec����o urin��ria. No estudo do perfil de sensibilidade da bact��ria E. coli isolada, para a fam��lia dos betalact��micos (Ampicilina (AMP), Amoxicilina/��cido Clavul��nico (AMC), Piperacilina/Tazobactam (PIP/TZP)), fam��lia das cefalosporinas (Cefalotina (KF), Cefuroxima (CXM), Cefuroxima Acetil (CA), Cefotaxima (CTX), Ceftazidima (CAZ), Cefepima (FEP)), fam��lia dos aminoglicos��deos (Amicacina (AM), Gentamicina (GM), Tobramicina (TOB)) e para as nitrofuranto��nas (F), verificou-se uma grande sensibilidade e pouca resist��ncia em termos quantitativos, mas para a fam��lia das quinolonas (Ciprofloxacina (CIP), Levofloxacina (LEV), Norfloxacina (NOR)) e para os Trimetoprim/Sulfametoxazol (TMP/SMX) verificou-se resist��ncias quantitativamente superiores aos das fam��lias anteriormente referidas, sugerindo valores convergentes aos da tend��ncia europeia. Foram identificados fam��lias de fen��tipos tais como: os beta-lact��micos, os aminoglicos��deos, quinolonas, tetraciclinas, furanos e trimetoprim/sulfamidas.E. coli �� um microganismo cujo fen��tipo selvagem n��o tem resist��ncias intr��nsecas. Todas as resist��ncias s��o adquiridas. Actualmente, a realiza����o dos antibiogramas para E. coli tornou-se fundamental tendo em vista os factores ecol��gicos, gen��ticos, ambientais e pelo facto de que mais isolados s��o resistentes �� maioria dos antibi��ticos. Como conclus��o, este estudo permitir�� alertar para um problema s��rio que �� uma grande amea��a �� Sa��de P��blica.

Detec����o de Salmonella em tomates (Lycopersicon esculentum mill) pelos m��todos fda-bam e mini vidas-biomérieux.

Resumo: Diversos surtos de Salmonella ocasionados pelo consumo de tomate contaminados com este micro-organismo t��m sido relatados ultimamente, o que torna primordial a investiga����o sobre a presen��a desse pat��geno nesse alimento. M��todos que permitam a avalia����o r��pida da presen��a de Salmonella em alimentos s��o de suma import��ncia. O objetivo desse estudo foi comparar o m��todo tradicional da Food and Drug Administration - Bacteriologycal Analytical Manual (FDA-BAM) com um m��todo r��pido da mini Vitek Immuno Diagnostic System Assay (Mini?Vidas-SLM)-bioMérieux, para detec����o de Salmonella Brazil inoculada artificialmente na superf��cie de tomates. Foram analisadas 215 amostras de tomates inoculadas artificialmente com Salmonella Brazil com n��veis de in��culos variando de 0,4 a 940 UFC/tomate. Os resultados obtidos mostraram que os m��todos estudados apresentaram uma ��tima concord��ncia entre si, para todas as faixas de in��culo analisadas.

Conflits de norms de justice distributive dans les fusions entre ��gaux Le cas de BioM.rieux-Pierre Fabre

Les strictes fusions entre ��gaux constituent un ph��nom��ne tr��s rare. Pourtant, de nombreux dirigeants communiquent sur l���aspect ��galitaire des fusions et acquisitions qu���ils con��oivent. Dans cet article, les auteurs expliquent pourquoi les dirigeants <<maquillent>> leurs F&A en <<fusions entre .gaux>> ; montrent en quoi le postulat ��galitaire initial accro��t la probabilit�� de conflits entre deux normes de justice distributive pourtant compl.mentaires : l�����galit�� et l�����quit�� ; et illustrent leurs propos avec un cas spectaculaire : la fusion ��galitaire, puis la separation des entreprises BioMérieux et Pierre Fabre. Paradoxalement, la simple formulation en termes ��galitaire des F&A favorise la diffusion de sentiments d���injustice distributive, qui nuit in fine �� la performance de l���op��ration.

A Recursive Perspective on Discursive Legitimation and Organizational Action in Mergers and Acquisitions

This paper challenges the predominant view that legitimation is merely a specific phase in merger or acquisition processes. We argue that a better understanding of postmerger organizational dynamics calls for conceptualization of discursive legitimation as an inherent part of unfolding merger processes. In particular, we focus on the recursive relationship between legitimation and organizational action. We have two objectives: to outline a theoretical model that helps one to understand the dynamics of discursive legitimation and organizational action in postmerger organizations, and to examine a revealing case to distinguish the inherent risks and problems in discursive legitimation. Our case analysis focuses on the merger between the French pharmaceutical companies BioMérieux and Pierre Fabre. We adopt a critical multimethod approach and distinguish specific discursive dynamics and pathological tendencies in this case. The analysis highlights the unintended consequences of discursive legitimation, the central role of sensegiving and sensehiding in discursive legitimation, the inherently political nature of legitimation and the risks associated with politicization, the special problems associated with fashionable discourses and the role of the media, the use of specific discursive strategies for legitimation and delegitimation, and the crucial role of actual integration results. This analysis adds to the existing research on mergers and acquisitions by treating discursive legitimation as part of the merger dynamics. In particular, our case analysis provides a new explanation for merger failure. We also believe that the recursive model connecting discursive legitimation and delegitimation strategies to concrete organizational action makes a more general contribution to our understanding of organizational legitimation.

A recursive perspective on discursive legitimation and organizational action in mergers and acquisitions

This paper challenges the predominant view that legitimation is merely a specific phase in merger or acquisition processes. We argue that a better understanding of postmerger organizational dynamics calls for conceptualization of discursive legitimation as an inherent part of unfolding merger processes. In particular, we focus on the recursive relationship between legitimation and organizational action. We have two objectives: to outline a theoretical model that helps one to understand the dynamics of discursive legitimation and organizational action in postmerger organizations, and to examine a revealing case to distinguish the inherent risks and problems in discursive legitimation. Our case analysis focuses on the merger between the French pharmaceutical companies BioMérieux and Pierre Fabre. We adopt a critical multimethod approach and distinguish specific discursive dynamics and pathological tendencies in this case. The analysis highlights the unintended consequences of discursive legitimation, the central role of sensegiving and sensehiding in discursive legitimation, the inherently political nature of legitimation and the risks associated with politicization, the special problems associated with fashionable discourses and the role of the media, the use of specific discursive strategies for legitimation and delegitimation, and the crucial role of actual integration results. This analysis adds to the existing research on mergers and acquisitions by treating discursive legitimation as part of the merger dynamics. In particular, our case analysis provides a new explanation for merger failure. We also believe that the recursive model connecting discursive legitimation and delegitimation strategies to concrete organizational action makes a more general contribution to our understanding of organizational legitimation.

Avalia����o, identifica����o e atividade enzim��tica de bact��rias psicotr��ficas presentes no leite cru refrigerado

Extended storage of refrigerated milk can lead to reduced quality of raw and processed milk, which is a consequence of the growth and metabolic activities of psychrotrophic bacteria, able to grow under 7oC or lower temperatures. Although most of these microorganisms are destroyed by heat treatment, some have the potential to produce termoresistant proteolytic and lipolytic enzymes that can survive even UHT processing and reduce the processed products quality. Recently, the IN 51 determineds that milk should be refrigerated and stored at the farm what increased the importance of this group of microorganisms. In this work, psychrotrophic bacteria were isolated from 20 communitarian bulk tanks and 23 individual bulk tanks from dairy farms located at Zona da Mata region of Minas Gerais State and from southeastern Rio de Janeiro. Selected milk dilutions were plated on standard agar and after incubation for 10 days at 7oC, five colonies were isolated, firstly using nutrient agar and after using McConkey agar for 24 hours at 21oC. The isolates were identified by morphology, Gram stain method, catalase production, fermentative/oxidative metabolism and by API 20E, API 20NE, API Staph, API Coryne or API 50 CH (BioMerieux). In order to ensure reproductibility, API was repeated for 50% of the isolates. Species identification was considered when APILAB indexes reached 75% or higher. 309 strains were isolated, 250 Gram negative and 59 Gram positive. 250 Gram negative isolates were identified as: Acinetobacter spp. (39), Aeromonas spp. (07), A. Hydrophila (16), A. sobria (1), A. caviae (1), Alcaligenes feacalis (1), Burkholderia cepacia (12), Chryseomonas luteola (3), Enterobacter sp. (1), Ewingella americana(6), Hafnia alvei (7), Klebsiella sp. (1), Klebsiella oxytoca (10), Yersinia spp. (2), Methylobacterium mesophilicum (1), Moraxella spp. (4), Pantoea spp. (16), Pasteurella sp. (1), Pseudomonas spp. (10), P. fluorescens (94), P. putida (3), Serratia spp. (3), Sphigomonas paucomobilis (1). Five isolates kept unidentified. Pseudomonas was the predominant bacteria found (43%) and P. fluorescens the predominant species (37.6%), in accordance with previous reports. Qualitative analysis of proteolytic and lipolytic activity was based on halo formation using caseinate agar and tributirina agar during 72 hours at 21oC and during 10 days at 4��C, 10oC and 7��C. Among 250 Gram negative bacteria found, 104 were identified as Pseudomonas spp. and 60,57% of this group showed proteolytic and lipolytic acitivities over all four studied temperatures. 20% of Acinetobacter, Aeromonas, Alcaligenes, Burkholderia, Chryseomonas, Methylobacterium, Moraxella presented only lipolytic activity. Some isolates presented enzymatic activity in one or more studied temperatures. Among Gram positive bacteria, 30.51% were proteolytic and lipolytic at 10oC, 8.47% were proteolytic at 7oC, 10oC, and 21oC, 8.47% were proteolytic at all studied temperatures (4oC, 7oC, 10oC and 21oC) and 3.38% were proteolytic only at 21oC. At 4oC, only one isolate showed proteolytic activity and six isolates were lipolytic. In relation to Gram negative microorganisms, 4% were proteolytic and lipolytic at 7oC, 10oC and 21oC, 10% were proteolytic at 10oC and 4.4% were lipolytic at 4oC, 7oC, 10oC and 21oC, while 6.4% of all isolates were proteolytic and lipolytic at 10oC and 21oC as well as lipolytic at 4oC and 7oC. These findings are in accordance with previous researches that pointed out Pseudomonas as the predominant psycrotrophic flora in stored refrigerated raw milk

Comparison of methods for the identification of coagulase-negative staphylococci

Coagulase-negative staphylococci (CNS) species identification is still difficult for most clinical laboratories. The scheme proposed by Kloos and Schleifer and modified by Bannerman is the reference method used for the identification of staphylococcal species and subspecies; however, this method is relatively laborious for routine use since it requires the utilization of a large number of biochemical tests. The objective of the present study was to compare four methods, i.e., the reference method, the API Staph system (bioMérieux) and two methods modified from the reference method in our laboratory (simplified method and disk method), in the identification of 100 CNS strains. Compared to the reference method, the simplified method and disk method correctly identified 100 and 99% of the CNS species, respectively, while this rate was 84% for the API Staph system. Inaccurate identification by the API Staph method was observed for Staphylococcus epidermidis (2.2%), S. hominis (25%), S. haemolyticus (37.5%), and S. warneri (47.1%). The simplified method using the simple identification scheme proposed in the present study was found to be efficient for all strains tested, with 100% sensitivity and specificity and proved to be available alternative for the identification of staphylococci, offering, higher reliability and lower cost than the currently available commercial systems. This method would be very useful in clinical microbiology laboratory, especially in places with limited resources.

Infec����o do trato urin��rio em crian��as de um hospital p��blico do Par��-Brasil: perfil cl��nico-epidemiol��gico e genotipagem dos uropat��genos

A infec����o do trato urin��rio (ITU) �� uma das doen��as mais comuns na inf��ncia e em 80 a 90% dos casos �� causada por bact��rias da fam��lia Enterobacteriaceae, especialmente Escherichia coli e Klebsiella pneumoniae, as quais no mundo inteiro t��m emergido como produtoras de ESBL, um dos principais mecanismos de resist��ncia bacteriana a cefalosporinas de espectro-estendido e monobactans. A preval��ncia da ITU em crian��as, bem como as vari��veis, sexo, idade, febre, bact��ria mais frequente, presen��a de refluxo vesico-ureteral (RVU), presen��a de cicatrizes renais foram avaliadas no per��odo de janeiro de 2006 a mar��o de 2009, em hospital p��blico de bel��m, regi��o norte do Brasil e no per��odo de abril a agosto de 2009, isolados de cepas de E. coli e K. pneumoniae foram obtidos de urina de crian��as menores de 16 anos e avaliados fenotipicamente atrav��s do m��todo automatizado de caracteriza����o de ESBL, Vitek2, juntamente com a PCR para determinar se os genes^blaTEM, ^blaSHV e ^blaCTX-M1 estavam presentes em cada organismo. Foram confirmados 199 casos de ITU no per��odo estudado, 54,2% eram do sexo feminino, 46,2% eram menores de 02 anos de idade, febre ocorreu em 37,3% dos casos, RVU foi identificado em 38,6% das crian��as com ITU e cicatriz renal em 38%, a bact��ria mais frequente foi a E. coli (60%). Foram isoladas 43 amostras ( E. coli e K. pneumoniae, 74,4% e 25,6%, respectivamente), 95% foi resistente a ampicilina e sulfametoxazol-trimetroprim; 23,2% apresentaram fen��tipo ESBL. O gene^blaCTX-M1 foi o mais prevalente, encontrado em 19 cepas, seguido do gene ^blaTEM (18 cepas) e ^blaSHV (8 cepas). Esse estudo mostrou que bact��rias com perfil de resist��ncia ESBLcirculam no ambiente hospitalar em Bel��m e que os genes ^blaCTX-M1 e ^blaTEM e ^blaSHV est��o presentes em cepas de E. coli e K. pneumoniae causadoras de ITU em crian��as na regi��o norte do Brasil.

Estomatite prot��tica em pacientes com Diabetes mellitus: preval��ncia de Candida spp. e efici��ncia dos tratamentos com nistatina e desinfec����o de pr��teses por micro-ondas

Funda����o de Amparo �� Pesquisa do Estado de S��o Paulo (FAPESP)

Pesquisa de genes de resist��ncia do M. tuberculosis a isoniazida e rifampicina por sequenciamento e pela tecnologia de DNA-STRIP

Tuberculose (TB), causada por Mycobacterium tuberculosis, �� uma das doen��as infecciosas que mais causam mortes. Estima-se que mais de dois bilh��es de pessoas estejam infectadas no mundo. O tratamento da TB consite em associa����o de f��rmacos, isoniazida, rifampicina, pirazinamida e etambutol, nos primeiros 2 meses e 4 meses de isoniazida e de rifampicina. Internacionalmente, s��o consideradas cepas multi resistentes (MDR), as que apresentam resist��ncia simult��nea a isoniazida e a rifampicina. A r��pida detec����o de resist��ncia �� essencial para o controle e tratamento da TB, reduzindo, assim, o custo do tratamento e a transmiss��o da doen��a. Neste projeto, os isolados j�� identificados fenotipicamente como resistentes a isoniazida e/ou rifampicina, foram submetidos ao sequenciamento de Sanger para pesquisa de 3 genes relacionados a resist��ncia a isoniazida (katG, inhA e ahpC) e 1 gene de resist��ncia a rifampicina (rpoB). Foi realizada uma compara����o destes genes mutados para a resist��ncia utilizando o novo teste desenvolvido pela Biomérieux, denominado GenoType�� MTBDRplus, que se baseia na tecnologia DNA-STRIP. Atrav��s deste novo teste, foi observada muta����o em 22 isolados cl��nicos de M. tuberculosis para genes de resist��ncia a isoniazida e/ou rifampicina, sendo 4 provenientes do MS e 18 de SP. J�� pelo sequenciamento gen��tico foi observada muta����o em 24 isolados para genes de resist��ncia a isoniazida e/ou rifampicina, sendo 6 provenientes do MS e 18 de SP. Portanto, atrav��s do sequenciamento de Sanger, foi poss��vel detectar um n��mero maior de isolados mutados e mais muta����es quando comparado ao teste GenoType�� MTBDRplus. Isso acontece porque na t��cnica de sequenciamento, um fragmento do gene como um todo �� analisado e no caso do teste GenoType�� MTBDRplus, �� verificada apenas a aus��ncia ou presen��a das muta����es mais frequentes descritas na literatura, al��m de n��o ser analisado o gene ahpC. A grande ...

The modified Hodge test is a useful tool for ruling out klebsiella pneumoniae carbapenemase

OBJECTIVE: Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase. METHOD: From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk. RESULTS: Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively. CONCLUSION: Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase-2. The test may therefore be regarded as a good epidemiological tool.

The modified Hodge test is a useful tool for ruling out Klebsiella pneumoniae carbapenemase

OBJECTIVE: Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase. METHOD: From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk. RESULTS: Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively. CONCLUSION: Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase 2. The test may therefore be regarded as a good epidemiological tool.

Characterisation of probiotic strains for the control and prevention of enteropathogens in the food chain

60 strains (belonging to the genera Lactobacillus, Bifidobacterium, Leuconostoc and Enterococcus) were tested for their capacity to inhibit the growth of 3 strains of Campylobacter jejuni: Lactobacilli and bifidobacteria were left to grow in MRS or TPY broth at 37��C overnight in anaerobic conditions; Campylobacter jejuni was inoculated in blood agar plates at 37��C for 24-48 hours in microaerophilic conditions. The inhibition experiments were carried out in vitro using ���Spot agar test��� and ���Well diffusion assay��� techniques testing both cellular activity and that of the surnatant. 11 strains proved to inhibit the growth of Campylobacter jejuni. These strains were subsequently analised analised in order to evaluate the resistance to particular situations of stress which are found in the gastrointestinal tract and during the industrial transformation processes (Starvation stress, osmotic stress, heat stress, resistance to pH and to bile salts). Resistance to starvation stress: all strains seemed to resist the stress (except one strain). Resistance to osmotic stress: all strains were relatively resistant to the concentrations of 6% w/v of NaCl (except one strain). Resistance to heat stress: only one strain showed little resistance to the 55��C temperature. Resistance to pH: In the presence of a low pH (2.5), many strains rapidly lost their viability after approximately 1 hour. Resistance to bile salts: Except for one strain, all strains seemed to be relatively resistant to the 2% w/v concentration of bile salts. Afterward, strains were identified by using phenotipic and molecular techniques. Phenotipic identification was carried out by using API 50 CHL (bioMérieux) and API 20 STREP identification system (bioMérieux); molecular identification with species-specific PCR: the molecular techniques confirmed the results by phenotipic identification. For testing the antibiotic resistance profile, bacterial strains were subcultured in MRS or TPY broth and incubated for 18 h at 37��C under anaerobic conditions. Antibiotics tested (Tetracycline, Trimethoprim, Cefuroxime, Kanamycin, Chloramphenicol, Vancomycin, Ampycillin, Sterptomycin, Erythromycin) were diluted to the final concentrations of: 2,4,8,16,32,64,128,256 mg/ml. Then, 20 ��l fresh bacterial culture (final concentration in the plates approximately 106 cfu/ml) were added to 160 ��l MRS or TPY broth and 20 ��l antibiotic solution. As positive control the bacterial culture (20 ul) was added to broth (160 ul) and water (20 ul). Test was performed on plates P96, that after the inoculum were incubated for 24 h at 37oC, then the antibiotic resistance was determined by measuring the Optical Density (OD) at 620 nm with Multiscan EX. All strains showed a similar behaviour: resistance to all antibiotic tested. Further studies are needed.

In vitro activity of clinically implemented ��-lactams against Aerococcus urinae: presence of non-susceptible isolates in Switzerland.

We analyzed the in vitro susceptibility to several ?-lactams and vancomycin of 80 Aerococcus urinae isolates col- lected during 2011-2012 in Switzerland. MICs were determined by Etest (bioMérieux) on M��ller-Hinton agar with 5% sheep blood and interpreted according to the CLSI and EUCAST criteria set for viridans streptococci. MIC50/90 for penicillin, amoxicillin, ceftriaxone and vancomycin were 0.016/0.064 mg/l, 0.032/0.064 mg/l, 0.125/0.5 mg/l and 0.38/0.5 mg/l, respectively. Three (3.8%) isolates were resistant to ceftriaxone regardless of the criteria used (MICs ?2 mg/l); one of them was also non-susceptible to penicillin (MIC of 0.25 mg/l) according to CLSI. ?-lactam resis- tance in A. urinae is a concern and suggests that more studies are needed to determine the molecular mechanisms of such resistance.

Performance of HBsAg point-of-care tests for detection of diagnostic escape-variants in clinical samples

BACKGROUND Hepatitis B viruses (HBV) harboring mutations in the a-determinant of the Hepatitis B surface antigen (HBsAg) are associated with reduced reactivity of HBsAg assays. OBJECTIVES To evaluate the sensitivity and specificity of three HBsAg point-of-care tests for the detection of HBsAg of viruses harboring HBsAg mutations. STUDY DESIGN A selection of 50 clinical plasma samples containing HBV with HBsAg mutations was used to evaluate the performance of three HBsAg point-of-care tests (Vikia(��), bioMérieux, Marcy-L'��toile, France. Alere Determine HBsAg���, Iverness Biomedical Innovations, K��ln, Germany. Quick Profile���, LumiQuick Diagnostics, California, USA) and compared to the ARCHITECT HBsAg Qualitative(��) assay (Abbott Laboratories, Sligo, Ireland). RESULTS The sensitivity of the point-of-care tests ranged from 98% to 100%. The only false-negative result occurred using the Quick Profile��� assay with a virus harboring a D144A mutation. CONCLUSIONS The evaluated point-of-care tests revealed an excellent sensitivity in detecting HBV samples harboring HBsAg mutations.