RESUMEN
OBJECTIVES: To describe clinical characteristics and outcome of Clostridium difficile infection (CDI) patients in Internal Medicine, to identify ribotypes (RTs); to evaluate the association between RT and patient clinical characteristics and report outcome. METHODS: One year prospective cohort study. Clinical data, Barthel Index (BI) and outcomes were collected for all inpatients suffering from CDI (nâ¯=â¯148) in hospital wards in Northern Italy. 84 fecal samples were analysed for molecular typing. RESULTS: 12 RTs were identified, predominantly RT018 (42.9%, nâ¯=â¯36/84) and RT356/607 (40.5%, nâ¯=â¯34/84). Patients with dementia were more frequent among those infected by RT018 [55.6% (nâ¯=â¯20/36) vs. 32.4% (nâ¯=â¯11/34), pâ¯=â¯0.05]. The median BI score of patients with RT018 was lower than BI score of patients with RT356/607 [10 (IQR 0-32) vs. 15 (IQR 5-50), pâ¯=â¯0.06]. RT018 infection was associated to higher levels of C-reactive protein [7.2â¯mg/dl (IQR 4.1-14.7) vs. 4.0â¯mg/dl (IQR 2.2-6.8), pâ¯=â¯0.01] and white blood cells ≥15,000/dl [33.3% (nâ¯=â¯12/36) vs. 14.7% (nâ¯=â¯5/34) of patients, pâ¯=â¯0.07]. Higher mortality was noted among RT018 infected patients. We found a continuous mortality increase according to the ATLAS score. CONCLUSIONS: Our results confirm that RT018 and RT356/607 are the two major RTs causing CDI in older patients with a high degree of disability in Northern Italy and RT018 is associated with more serious outcomes.
Asunto(s)
Clostridioides difficile/clasificación , Infecciones por Clostridium/mortalidad , Ribotipificación , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/uso terapéutico , Clostridioides difficile/aislamiento & purificación , Infecciones por Clostridium/tratamiento farmacológico , Infección Hospitalaria , Heces/microbiología , Femenino , Humanos , Italia , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Análisis Multivariante , Reacción en Cadena de la Polimerasa , Modelos de Riesgos Proporcionales , Estudios Prospectivos , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. METHODS: A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum ß-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. RESULTS: A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. CONCLUSIONS: MDRO colonization is common among residents in Italian LTCFs.
Asunto(s)
Farmacorresistencia Bacteriana Múltiple , Cuidados a Largo Plazo/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Infecciones Bacterianas/tratamiento farmacológico , Infecciones Bacterianas/epidemiología , Infecciones Bacterianas/etiología , Portador Sano/tratamiento farmacológico , Portador Sano/epidemiología , Portador Sano/microbiología , Farmacorresistencia Bacteriana Múltiple/genética , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Infecciones por Enterobacteriaceae/epidemiología , Femenino , Humanos , Italia/epidemiología , Tiempo de Internación/estadística & datos numéricos , Masculino , Staphylococcus aureus Resistente a Meticilina , Prevalencia , Factores de Riesgo , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Resistencia betalactámica/genéticaRESUMEN
This study compared a repetitive-element PCR (rep-PCR) method (DiversiLab system) to PCR ribotyping. The discriminatory power of rep-PCR was 0.997. Among the PCR ribotype 027 isolates tested, different rep types could be distinguished. rep-PCR showed a higher discriminatory power than PCR ribotyping. Nevertheless, this method requires technical skill, and visual interpretation of rep-PCR fingerprint patterns may be difficult.
Asunto(s)
Clostridioides difficile/clasificación , Tipificación Molecular/métodos , Reacción en Cadena de la Polimerasa/métodos , Adulto , Clostridioides difficile/genética , Humanos , Sensibilidad y EspecificidadRESUMEN
Thirty-two related and 68 unrelated isolates of Clostridium difficile, isolated in different Italian hospitals since 1987, were analysed by PFGE and PCR-ribotyping to investigate their genetic relatedness. The isolates were classified into 28 groups by PFGE and 20 ribotypes by PCR-ribotyping. A single clone of C. difficile was recognised as the cause of three geographically and chronologically distant outbreaks. The correlation between PFGE and PCR-ribotyping results was good, with agreement for 77 (84%) of the 92 isolates typed by both methods. However, among sporadic isolates the discriminatory power of PFGE was more evident. Eight isolates that were untypable by PFGE could be analysed by PCR-ribotyping. The dendrograms generated showed that the genetic relatedness of the C. difficile isolates obtained by both techniques was comparable. The majority of the isolates in recent years appeared to be genetically unrelated to isolates from past infections. However, two clonal groups identified in all time periods had a common origin and this seems to indicate that they share some advantageous biological characteristics. The constant monitoring of C. difficile epidemiology will allow acquisition of further important data on this nosocomial pathogen.
Asunto(s)
Clostridioides difficile/genética , ARN Ribosómico 16S/genética , ARN Ribosómico 23S/genética , Clostridioides difficile/clasificación , ADN Bacteriano/genética , Electroforesis en Gel de Campo Pulsado , Filogenia , Reacción en Cadena de la Polimerasa , Especificidad de la EspecieRESUMEN
The gene slpA, encoding the S-layer precursor protein in the virulent Clostridium difficile strains C253 and 79--685, was identified. The precursor protein carries a C-terminal highly conserved anchoring domain, similar to the one found in the Cwp66 adhesin (previously characterized in strain 79--685), an SLH domain, and a variable N-terminal domain mediating cell adherence. The genes encoding the S-layer precursor proteins and the Cwp66 adhesin are present in a genetic locus carrying 17 open reading frames, 11 of which encode a similar two-domain architecture, likely to include surface-anchored proteins.
Asunto(s)
Proteínas Bacterianas/genética , Clostridioides difficile/genética , Secuencia de Aminoácidos , Proteínas Bacterianas/química , Clostridioides difficile/química , Datos de Secuencia Molecular , Familia de Multigenes , Sistemas de Lectura Abierta , Homología de SecuenciaRESUMEN
During the clinical trial conducted in Italy to evaluate the efficacy of new acellular pertussis vaccines, the most favorable conditions for the recovery and characterization of Bordetella pertussis strains, isolated from children with cough, were adopted. The nasopharyngeal aspirates were collected and sent to the laboratory in refrigerated conditions within 24 hours. Charcoal agar selective and non selective plates were used, and most of the isolates were recovered after 3-4 days of incubation. Confirmation of all suspected colonies included the use of biochemical tests and specific agglutination reaction with B. pertussis antiserum. Serotyping of fimbriae, susceptibility to erythromycin and DNA fingerprinting by Pulsed Field Gel Electrophoresis (PFGE), were performed to characterize B. pertussis isolates and to determine relatedness among different strains. Serotype 1,3 was the most represented in the bacterial population examined. A predominant pulsetype (PTA) characterized most of the isolates accounting for 71.4% of the strains examined. Eight subclones (23.5%) and three unrelated pulsetypes were also found. No resistant strains to erythromycin were detected.
Asunto(s)
Bordetella pertussis/clasificación , Técnicas de Tipificación Bacteriana , Bordetella pertussis/aislamiento & purificación , Ensayos Clínicos como Asunto , Dermatoglifia del ADN , ADN Bacteriano/aislamiento & purificación , Electroforesis en Gel de Campo Pulsado , Fimbrias Bacterianas/inmunología , Humanos , Lactante , Italia/epidemiología , Pruebas de Sensibilidad Microbiana , Nasofaringe/microbiología , Serotipificación , Tos Ferina/epidemiologíaRESUMEN
Clostridium sordellii is an infrequent human pathogen. It has been demonstrated to be occasionally responsible for myonecrosis or gas gangrene. Interestingly, in the obstetric literature, some cases of postpartum maternal deaths have been associated with C sordellii infection causing a rapidly lethal toxin mediated syndrome. This is the first reported case of postpartum death in a 29 year old woman, in which a toxigenic C sordellii was isolated from the patient's blood antemortem during the fatal toxic shock, strongly indicating its role in this rare syndrome.
Asunto(s)
Cesárea , Infecciones por Clostridium/microbiología , Complicaciones Posoperatorias/microbiología , Choque Séptico/microbiología , Adulto , Animales , Toxinas Bacterianas/toxicidad , Clostridium/clasificación , Clostridium/aislamiento & purificación , Resultado Fatal , Femenino , Humanos , Ratones , Ratones Endogámicos BALB C , EmbarazoRESUMEN
The polymerase chain reaction (PCR) for the detection of Bordetella pertussis and Bordetella parapertussis DNA in clinical samples was well documented by recent studies. Different regions in Bordetella pertussis DNA have been successfully used as targets for this method by various authors. In this work we report the usefulness of the PCR assay also for speciating Bordetellae isolates in those cases where the biochemical and serological tests gave inconclusive results.
Asunto(s)
Infecciones por Bordetella/diagnóstico , Bordetella pertussis/aislamiento & purificación , Bordetella/aislamiento & purificación , Reacción en Cadena de la Polimerasa/métodos , Tos Ferina/diagnóstico , Aglutinación , Anticuerpos Antibacterianos/análisis , Bordetella/inmunología , Bordetella pertussis/inmunología , Cartilla de ADN , Electroforesis en Gel de Agar , Humanos , Sensibilidad y EspecificidadRESUMEN
Two oligonucleotide probes selected from the sequences of cepA and cfxA genes, respectively, were used to detect beta-lactamase production among strains of the Bacteroides fragilis group. By using these probes, colony hybridization was shown to be a specific and rapid method for identifying the more prevalent beta-lactamase, CepA, and the rarer CfxA enzyme among B. fragilis strains.
Asunto(s)
Bacteroides/genética , Cefalosporinasa/genética , Sondas de Oligonucleótidos , Secuencia de Bases , Cefalosporinasa/química , Datos de Secuencia MolecularRESUMEN
Strains of Bacteroides fragilis isolated from clinical specimens are known to be frequently resistant to penicillins or cephalosporins. The production of beta-lactamases is the major mechanism in this resistance. Up to now at least five types of beta-lactamase enzymes have been described in the Bacteroides fragilis group. The purpose of this study was to evaluate the susceptibility to different antibiotics and the prevalence of the beta-lactamase types among 100 Bacteroides fragilis strains isolated from clinical specimens in Italy. MICs of 11 antibiotics were determined by the reference agar dilution method and by the new E test (AB Biodisk, Sweden). Results showed an acceptable correlation between the MICs determined for most strains, although those obtained by the E test tended to be lower. In the beta-lactam resistant strains the enzyme activity and isoelectric points were determined on crude enzyme extract.