RESUMEN
hyplex®-MBL ID Multiplex PCR-ELISA, a novel method for identifying metallo-ß-lactamase genes directly in clinical specimens, was evaluated using a consecutive collection of 326 samples from three hospitals in Greece characterized by high prevalence of VIM producers. The method exhibited high sensitivity (98.0%) and specificity (98.6%) and was proven reliable in detecting bla(VIM) genes in blood, urine, pus, and sputum samples that, as confirmed by conventional methods, contained various VIM-producing species. Future multicenter studies should be considered for the thorough evaluation of this method and its potential diagnostic utility.
Asunto(s)
Proteínas Bacterianas/genética , Bacterias Gramnegativas/enzimología , Infecciones por Bacterias Gramnegativas/microbiología , Reacción en Cadena de la Polimerasa/métodos , beta-Lactamasas/genética , Proteínas Bacterianas/biosíntesis , Ensayo de Inmunoadsorción Enzimática/métodos , Bacterias Gramnegativas/genética , Bacterias Gramnegativas/aislamiento & purificación , Grecia , Humanos , Pruebas de Sensibilidad Microbiana/métodos , Sensibilidad y Especificidad , beta-Lactamasas/biosíntesisRESUMEN
A prospective study was conducted to determine the prevalence and the gene-cassette content of class 1 integrons in Escherichia coli of poultry and human origin. A total of 235 E. coli isolates were examined; 65 were derived from farm poultry, 80 from hospitalized, and 90 from nonhospitalized patients. Susceptibilities to a range of antimicrobial agents were determined by disk diffusion. Int1-specific polymerase chain reaction, conserved-segment polymerase chain reaction, and DNA sequencing were used to determine the presence, length, and content of integrons. The relatedness among the isolates was examined by pulsed-field gel electrophoresis of XbaI digests of genomic DNA. The integron carriage rate for poultry isolates was 49.2%, whereas the carriage rate for hospital isolates was 26.2% and for community 11.1%. Multidrug resistance (resistance to three or more classes of antibiotics) phenotypes were observed in 96.8% of the integron-positive isolates, whereas only 34.9% of nonintegron-carrying organisms were multidrug resistant (p < 0.001). Seven integron types ranging in size from 663 to 2674 bp were identified; six types were observed in poultry isolates, five in hospital, and three in community isolates. Each integron type carried a distinct gene-cassette combination. The most prevalent gene cassettes belonged to the aad and dfr families. Identical integrons were detected in E. coli of human and poultry origin. A large reservoir of integrons exists in E. coli of poultry origin. The horizontal transfer of class 1 integrons among bacteria of poultry and human origins may contribute in the dissemination of antimicrobial resistance.
Asunto(s)
Farmacorresistencia Microbiana/genética , Escherichia coli/genética , Integrones/genética , Aves de Corral/microbiología , Animales , Sangre/microbiología , ADN Bacteriano/química , Pruebas Antimicrobianas de Difusión por Disco , Farmacorresistencia Bacteriana Múltiple , Escherichia coli/clasificación , Escherichia coli/aislamiento & purificación , Enfermedades Transmitidas por los Alimentos/prevención & control , Tracto Gastrointestinal/microbiología , Grecia , Humanos , Pacientes Internos/estadística & datos numéricos , Pacientes Ambulatorios/estadística & datos numéricos , Fenotipo , Reacción en Cadena de la Polimerasa , Esputo/microbiología , Supuración/microbiología , Orina/microbiologíaRESUMEN
A prospective observational study was conducted to identify factors associated with bloodstream infections (BSIs) caused by integron-carrying Enterobacteriaceae and to evaluate the clinical significance of integron carriage. Consecutive patients with Enterobacteriaceae BSIs were identified and followed up until discharge or death. Identification of blood isolates and susceptibility testing were performed by the Wider I automated system. int-1-specific PCR, conserved-segment PCR, and DNA sequencing were used to determine the presence, length, and content of integrons. The relatedness among the isolates was examined by pulsed-field gel electrophoresis. Two hundred fifty episodes of Enterobacteriaceae BSI occurred in 233 patients; 109 (43.6%) were nosocomial, 82 (32.8%) were community acquired, and 59 (23.6%) were health care associated. Integrons were detected in 11 (13.4%) community-acquired, 24 (40.7%) health care-associated, and 46 (42.2%) nosocomial isolates. Integron-carrying organisms were more likely to exhibit resistance to three or more classes of antimicrobials (odds ratio [OR], 9.84; 95% confidence interval [95% CI], 5.31 to 18.23; P < 0.001) or to produce extended-spectrum beta-lactamases (OR, 5.75; 95% CI, 2.38 to 13.89; P < 0.001) or a VIM-type metallo-beta-lactamase (P, 0.003). Inter- or intraspecies integron transfer and cross-transmission of integron-carrying clones were observed. Use of cotrimoxazole (OR, 4.77; 95% CI, 1.81 to 12.54; P < 0.001) and a nosocomial or other health care setting (OR, 3.07; 95% CI, 1.30 to 7.22; P, 0.01) were independently associated with BSIs caused by integron-carrying Enterobacteriaceae. Patients with a nonurinary source of bacteremia (OR, 9.46; 95% CI, 2.77 to 32.32; P < 0.001) and a Pitt bacteremia score of > or =4 (OR, 23.36; 95% CI, 7.97 to 68.44; P < 0.001) had a significantly higher 14-day mortality rate, whereas integron carriage did not affect clinical outcomes. These findings may have implications affecting antibiotic policies and infection control measures.
Asunto(s)
Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Enterobacteriaceae/sangre , Infecciones por Enterobacteriaceae/transmisión , Integrones , Resultado del Tratamiento , Bacteriemia/epidemiología , Infecciones Comunitarias Adquiridas/sangre , Infecciones Comunitarias Adquiridas/microbiología , Infecciones Comunitarias Adquiridas/transmisión , Infección Hospitalaria/sangre , Infección Hospitalaria/microbiología , Infección Hospitalaria/transmisión , ADN Bacteriano/análisis , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Infecciones por Enterobacteriaceae/microbiología , Transferencia de Gen Horizontal , Humanos , Transmisión de Enfermedad Infecciosa de Profesional a Paciente , Pruebas de Sensibilidad Microbiana , Técnicas de Amplificación de Ácido Nucleico , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Factores de Riesgo , Análisis de Secuencia de ADNAsunto(s)
Infecciones por Klebsiella/tratamiento farmacológico , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/efectos de los fármacos , Adulto , Anciano , Bacteriemia/tratamiento farmacológico , Bacteriemia/microbiología , Estudios de Casos y Controles , Femenino , Humanos , Imipenem/farmacología , Imipenem/uso terapéutico , Infecciones por Klebsiella/mortalidad , Klebsiella pneumoniae/patogenicidad , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Análisis de Regresión , Estudios Retrospectivos , Tasa de Supervivencia , Resultado del Tratamiento , Resistencia betalactámica/genética , beta-Lactamasas/efectos de los fármacos , beta-Lactamasas/genéticaRESUMEN
We describe a fatal case of a 74-year old man with acute myeloid leukemia complicated by massive intravascular hemolysis due to Clostridium perfringens sepsis.
Asunto(s)
Infecciones por Clostridium/complicaciones , Clostridium perfringens/patogenicidad , Hemólisis , Sepsis/complicaciones , Anciano , Infecciones por Clostridium/sangre , Coagulación Intravascular Diseminada/etiología , Coagulación Intravascular Diseminada/microbiología , Resultado Fatal , Humanos , Masculino , Sepsis/sangre , Sepsis/microbiologíaRESUMEN
A fatal case is reported of Balantidium coli pneumonia in a 71-y-old woman suffering from anal cancer. The diagnosis was made by the discovery of motile trophozoites in a wet mount from bronchial secretions. The usual habitat of the parasite is the colon; lung balantidiasis is very rare.
Asunto(s)
Balantidiasis/diagnóstico , Balantidium/aislamiento & purificación , Huésped Inmunocomprometido , Enfermedades Pulmonares Parasitarias/diagnóstico , Infecciones Oportunistas/diagnóstico , Neoplasias del Recto/inmunología , Anciano , Animales , Resultado Fatal , Femenino , Humanos , Neumonía/diagnóstico , Neumonía/parasitología , Neoplasias del Recto/terapia , Medición de Riesgo , Índice de Severidad de la EnfermedadRESUMEN
A retrospective survey of the isolation rate of Enterococcus avium during the period March 1994-February 2000 conducted in Laikon General Hospital using the WHONET software, revealed a peak in the isolation rates of this species during March 1995-February 1996. The ten strains isolated during this time were studied further. No glycopeptide resistance was detected but resistance to ampicillin, ciprofloxacin, erythromycin, gentamicin (high-level) and streptomycin (high-level) was present in nine, ten, nine, three and seven of the isolates, respectively. The genes aac(6')-Ie+aph(2")-Ia and ant(6)-I, encoding for high-level gentamicin and streptomycin resistance, respectively, were detected only in the isolates with the corresponding phenotypes. Beta-lactamase production and haemolysis were not detected. There was evidence of ward-, floor- and building-specific distribution among the different aminoglycoside resistance phenotypes. DNA fingerprinting by PFGE grouped six of the ten isolates in a single cluster with 83% similarity, even though they expressed various resistance phenotypes. These results suggest dissemination of resistance genes among both genetically related and unrelated strains.