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Clinical and microbiological characterization of KPC-producing Klebsiella pneumoniae infections in Brazil
Beir?o, Elisa Maria;Furtado, Juvencio Jose Duailibe;Girardello, Raquel;Ferreira Filho, Heli;Gales, Ana Cristina;
Brazilian Journal of Infectious Diseases , 2011, DOI: 10.1590/S1413-86702011000100013
Abstract: in 2008 isolates of kpc-producing klebsiella pneumoniae (kpc-kpn) were detected for the first time at hospital heliópolis, s?o paulo, brazil. the aim of this study was to characterize the clinical and microbiological outcomes of infections caused by kpc-kpn. a historical cohort of patients from whom kpc-kpn strains were isolated was performed. isolates were identified as resistant to ertapenem by automated broth microdilution system and screened as carbapenemase producers by the modified hodge test. the beta-lactamase resistance gene blakpc was detected by pcr. the genetic relatedness of isolates was determined by pfge. the study provides early clinical experience in treating kpc-kpn infections in a brazilian tertiary center.
Nosocomial infections and microbiological agents in an intensive care unit
?osi? Gorana,?eki? Jelena,Raj?evi? Smiljana,Risti? M.
Archives of Biological Sciences , 2012, DOI: 10.2298/abs1204357c
Abstract: Hospital environments provide a special setting for the interaction of microbiological agents of infection and a host of patients and healthcare workers. Although the basic tenets about the spread of infections in hospital have not changed, new issues have emerged that make infection control more problematic. The aim of this paper was to provide the epidemiological characteristics of nosocomial infections and pathogens among patients in an intensive care unit (ICU), the department with the highest risk of the infections associated with medical devices and healthcare.
Evaluation of microbiological diagnostics in urogenital infections in postmenopausal women  [PDF]
Bla?enka Hunjak,,Zdenka Per?i?
Medicinski Glasnik , 2010,
Abstract: Objective To establish the percentage of infections in postmenopausal women with urinary symptoms which can be confirmed by microbiological analysis, the most common causative agents and whether the urethra and vagina in patients with cystitis are concurrently colonized by pathogenic microorganisms. Methods Laboratories of the Croatian National Institute of Public Health in Zagreb, in the period of two years, analyzed 245 samples taken from patients with urinary symptoms who had been postmenopausal at least for a year. Urine samples, as well as urethral and vaginal swabs were taken from each patient and tested for causative agents of urogenital infections, genital mycoplasma and Chlamydia trachomatis.Results Cystitis was confirmed by microbiological analysis in 31.4% women, urethritis in 24.8%, and vaginitis in 15.1%. The most common causative agent of urethritis was Ureaplasma urealyticum, while Gardnerella vaginalis was the most common in vaginal infections. E. coli was concurrently isolated in urine, urethral and vaginal samples in 65.1% of patients with E. coli cystitis, while Streptococcus agalactiae was isolated in urethral and vaginal samples in each patient with Streptococcus agalactiae cystitis.Conclusion Mucosal colonization of the urethra and vagina contributes to the incidence of cystitis in postmenopausal women. Microbiological diagnostics is necessary to distinguish between the symptoms of ageing of the urogenital system and infection, with a view to preventing unnecessary antibiotic therapy.
Surgical infections: a microbiological study
Saini, Santosh;Gupta, Naveen;Aparna,;Lokveer,;Griwan, M.S.;
Brazilian Journal of Infectious Diseases , 2004, DOI: 10.1590/S1413-86702004000200001
Abstract: surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. one hundred seventeen cases comprised of abscesses (n=51), secondary peritonitis (n=25), necrotizing fascitis (n=22) and wounds with devitalized tissues (n=19) were studied. the number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32). the aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. most secondary peritonitis (80%), necrotizing fascitis (75%) and wounds with devitalized tissues (66.7%) were polymicrobial. common microorganisms isolated in our study were e. coli, staphylococcus aureus, klebsiella spp., pseudomonas aeruginosa, bacteroides fragilis and peptostreptococcus spp. the most effective antibiotics for s. aureus were clindamycin (79.1%) and cefuroxime (70.8%). for gram-negatives (klebsiella spp., e. coli and proteus spp.), the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. pseudomonas aeruginosa was maximally sensitive to amikacin (35.2%) and ciprofloxacin (35.2%). the greatest degree of multidrug resistance to all the drugs was found in p. aeruginosa (52.9%), followed by klebsiella spp. (33.3%), proteus spp. (33.3%), e. coli (22.2%), and s. aureus (12.5%). all the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%). apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.
Infections and cancer after ARV: a Portuguese cohort  [cached]
N Pereira,C Caldas,C Azevedo,P Andrade
Journal of the International AIDS Society , 2012, DOI: 10.7448/ias.15.6.18123
Abstract: Background and purpose of the study: The advent of antiretroviral therapy (ARV) resulted in a significant decrease in opportunistic infections; however these diseases still represent an important cause of morbidity and mortality. ARV also changed the spectrum of cancers presented by HIV patients as a result of immune recovery and increased life expectancy. We intend to describe the variety of infections and cancers, AIDS or non-AIDS related, identified in our patients in the new era of ARV and also identify possible risk factors related to this conditions. Methods: Assessment and registry of infectious and neoplastic conditions occurring after initiation of ARV in a cohort of HIV-infected patients who started ARV between January 2007 and December 2011. We included records of these conditions until March 2012. Epidemiological, clinical and laboratory data were analyzed and compared with a control group of HIV-infected patients that started ARV in the same period but did not experience those comorbidities. Patients lost to follow-up were excluded. Statistical significance of the differences encountered was evaluated with T-student test and chi-square; differences were considered statistically significant when p<0.05. Results: 497 patients were included (71.0% were men) with a mean age of 43.4±12.5 years and average follow-up of 30.9±16.8 months. In the analyzed period there were 112 events in 91 patients: 85 infections and 27 cancers. The most common infectious condition was tuberculosis (n=13) and the most common cancer was non-Hodgkin's lymphoma (n=8). The interval between the introduction of ARV and the onset of these conditions was 15.1 months (min: 0.03, max: 57.40). We identified 22 deaths: 11 were result of infection and 11 from cancer. Statistically significant differences between the groups compared were identified in the following variables: risk factor for HIV infection, co-infection with hepatitis B, clinical stage, viral load and CD4 T lymphocyte count before the beginning of ARV. Conclusions: We identified a substantial number of infections and cancers in our cohort, with tuberculosis and lymphomas continuing to be particularly noteworthy. Patients who had these conditions initiated ART with more severe immunosuppression and higher viral load which reinforces the importance to establish a prompt diagnosis which enables an efficient treatment and low morbidity associated with infections and cancers, particularly those related to AIDS.
Incidence and impact on clinical outcome of infections with piperacillin/tazobactam resistant Escherichia coli in ICU: A retrospective study
Agnès Meybeck, Jean-Damien Ricard, Guilène Barnaud, Mathieu Eveillard, Guillaume Chevrel, Roman Mounier, Didier Dreyfuss
BMC Infectious Diseases , 2008, DOI: 10.1186/1471-2334-8-67
Abstract: To assess incidence and impact on clinical outcome of infections with PIP-TAZ resistant E. coli in ICU patients, we conducted a retrospective cohort study with infections due to PIP-TAZ resistant (PIP-TAZ R) or to PIP-TAZ susceptible strains (PIP-TAZ S) between 1 January 2002 and 30 June 2004.Of 83 strains, 13 were PIP-TAZ R: 2 strains produced an extended-spectrum β-lactamase (2%), 11 produced a high level penicillinase (13%). Prior amoxicillin or amoxicillin/clavulanate prescription was reported in 7 cases (54%) of infections with PIP-TAZ R isolates and in 15 cases (21%) of infections with PIP-TAZ S isolates (p = 0.03). Time of onset of the infection from hospital admission was longer in case of infections with PIP-TAZ R than with PIP-TAZ S isolates (22 ± 32 vs 10 ± 21 days, p = 0.01). The overall ICU mortality rate was 38%. Mortality and length of stay in ICU were similar in case of infections with PIP-TAZ R isolates and with PIP-TAZ S isolates.Infections with PIP-TAZ R E. coli are frequent in ICU patients. No prognostic impact of this pattern of resistance was found. Prescription of PIP-TAZ for empirical treatment of E. coli infections in ICU however exposes to inappropriate therapy.The development of resistance to antimicrobial agents has been an ongoing and evolving process since antibiotics were introduced a half-century ago. Antimicrobial-resistant pathogens are becoming a prevalent cause of hospital-acquired infections, particularly in intensive care units (ICU) [1]. Members of the family Enterobacteriaceae are the most frequent organisms isolated in clinical microbiological laboratories. Escherichia coli is responsible of both community and nosocomial infection. It is frequently involved in sepsis in critically ill patients [2]. It is becoming increasingly resistant to commonly used antibiotics such as fluoroquinolones or amoxicillin-clavulanic acid [3]. The widespread presence of resistant bacteria in ICU has led to the common practice of using broad-spec
Clinical and microbiological characteristics of bloodstream infections in a tertiary hospital in Maceió, Alagoas, Brazil
Tenório, Maria Tereza Freitas;Porfírio, Zenaldo;Lopes, Antonio Carlos;Cendon, Sonia;
Brazilian Journal of Infectious Diseases , 2010, DOI: 10.1590/S1413-86702010000200011
Abstract: we observed the clinical and microbiological characteristics of several stages of bloodstream infections (bsi), as well as the mortality attributed to it in a tertiary hospital in the northeast of brazil (in the city of maceió, alagoas). a prospective cohort of 143 patients who had at least one positive blood culture was enrolled in the study. their clinical evolution was followed up for 30 days from october 2005 to december 2006. the relation among the qualitative variables was verified through chi-square test. the significance level was 5%. the statistical package adopted was spss 15.0 for windows. up to the thirtieth day, 30.1% of the patients presented bacteremia and 69.9% developed sepsis.among these, 20.3% developed severe sepsis and 10.5% septic shock. the mortality attributed to it was 37.8%. in bacteremia, sepsis, severe sepsis, and septic shock conditions, mortality rates were 9.3%, 50%, 65.5%, and 84.6%, respectively. respiratory (32.2%) and urinary (14%) sources and the ones related to central venous catheter (14%) were prevalent. in the wards 55.12% of the cases developed sepsis, whereas in the intensive care units, the rate was 87.69% (p < 0.05). chronic renal failure, diabetes melitus, and neuropathy were present in 21.7%, 26.6%, and 29.4% of the cases, respectively. coagulase-negative staphylococcus (25.9%), staphylococcus aureus (21%), and klebsiella pneumoniae (14%) were the most present microorganism in the sample. the high morbidity and mortality rates in this study are attributed to the lack of knowledge on bsi characteristics and on instituted protocols for detection and treatment in early stages.
Clinical and Microbiological Characteristics of Perianal Infections in Adult Patients with Acute Leukemia  [PDF]
Chien-Yuan Chen, Aristine Cheng, Shang-Yi Huang, Wang-Huei Sheng, Jia-Hau Liu, Bo-Sheng Ko, Ming Yao, Wen-Chien Chou, Hui-Chi Lin, Yee-Chun Chen, Woei Tsay, Jih-Luh Tang, Shan-Chwen Chang, Hwei-Fang Tien
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0060624
Abstract: Background Perianal infection is a common problem for patients with acute leukemia. However, neutropenia and bleeding tendency are relatively contraindicated to surgical intervention. The epidemiology, microbiology, clinical manifestations and outcomes of perianal infection in leukemic patients are also rarely discussed. Method The medical records of 1102 adult patients with acute leukemia at a tertiary medical center in Taiwan between 2001 and 2010 were retrospectively reviewed and analyzed. Result The prevalence of perianal infection was 6.7% (74 of 1102) in adult patients with acute leukemia. Twenty-three (31%) of the 74 patients had recurrent episodes of perianal infections. Patients with acute myeloid leukemia had higher recurrent rates than acute lymphoblastic leukemia patients (p = 0.028). More than half (n = 61, 53%) of the perianal infections were caused by gram-negative bacilli, followed by gram-positive cocci (n = 36, 31%), anaerobes (n = 18, 15%) and Candida (n = 1, 1%) from pus culture. Eighteen patients experienced bacteremia (n = 24) or candidemia (n = 1). Overall 41 (68%) of 60 patients had polymicrobial infection. Escherichia coli (25%) was the most common micro-organism isolated, followed by Enterococcus species (22%), Klebsiella pneumoniae (13%), and Bacteroides species (11%). Twenty-five (34%) of 74 patients received surgical intervention. Acute leukemia patients with surgically managed anal fistulas tended to have fewer recurrences (p = 0.067). Four (5%) patients died within 30 days after diagnosis of perianal infection. Univariate analysis of 30-day survival revealed the elderly (≧ 65 years) (p = 0.015) and patients with shock (p<0.001) had worse outcome. Multivariate analysis showed septic shock to be the independent predictive factor of 30-day crude mortality of perianal infections (p = 0.016). Conclusion Perianal infections were common and had high recurrence rate in adult patients with acute leukemia. Empirical broad-spectrum antibiotics with anaerobic coverage should be considered. Shock independently predicted 30-day crude mortality. Surgical intervention for perianal infection remains challenging in patients with acute leukemia.
Microbiological characteristics of four ‘chorizo’ types commercialized in Hidalgo State, Mexico
Roberto Gonzalez-Tenorio,Irma,Sergio Soto-Simental,Blanca R. Rodriguez-Pastrana
Nacameh , 2012,
Abstract: Chorizo is a raw sausage commercialized in almost all Mexico, mainly in the central region. Chorizo is elaborated from small producers’ craftsman who sold their products in local markets, to big meat processors who distribute their products in supermarkets. These differences in elaboration affect chorizo quality. In this work commercial chorizo bought in four different points (local butchers, rural markets, supermarkets and supply centers). Mainly microbiological groups were determined. Techno-sanitary conditions regulation should be improved in order to establish quality criteria.
Common errors in diagnosis and management of urinary tract infections: Microbiological aspects  [PDF]
Boji?-Mili?evi? Gordana,Mikov Momir,Dautovi? Radomir
Medicinski Pregled , 2005, DOI: 10.2298/mpns0508380b
Abstract: Introduction Urinary tract infections (UTI) are among the most common infectious diseases affecting all age groups, from infants to the elderly. The majority of these infections occur in otherwise healthy individuals who present with symptoms of acute uncomplicated bacterial cystitis or pyelonephritis. Certain patient populations with complicated conditions are at increased risk for acquiring infection or failing therapy. Forty to 50% of adult women have a history of at least one urinary tract infection. Diagnosis and classification of UTI Although there are general guidelines concerning diagnosis and classification of urinary tract infections, there are wide variations in clinical practice. There are both errors which are frequently committed and mysteries that are still unsolved. Active management is important because under some circumstances urinary tract infections may cause permanent renal scarring. Imaging procedures are a cornerstone for critical evaluation of urinary tract infections, but avoidance of investigative routines will allow a marked saving in terms of costs and in terms of unnecessary radiation and psychological stress to the patient.
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