RESUMEN
This study aimed to evaluate the epidemiology and 30-day mortality of adult patients with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. We retrospectively reviewed the demographic and clinical data of adult patients with S. aureus bloodstream infections (BSI), admitted to a tertiary public teaching medical center in Porto Alegre, Southern Brazil, from January 2014 to December 2019. A total of 928 patients with S. aureus BSI were identified in the study period (68.5 per 100,000 patient-years), and the proportion of MRSA isolates was 22% (19-27%). Thus, 199 patients were included in the analyses. The median age was 62 (IQR: 51-74) years, Charlson Comorbidity Index (CCI) median was 5 (IQR: 3-6), the Pitt bacteremia score (PBS) median was 1 (IQR: 1-4), and the most common site of infection was skin and soft tissue (26%). Most infections were hospital-acquired (54%), empirical anti-MRSA treatment was initiated in 34% of the cases, and in 44% vancomycin minimum inhibitory concentration was 1.5mg/L or above. Sixty-two (31.2%) patients died up to 30 days after the bacteremia episode. Patients with more comorbid conditions (higher CCI; aOR 1.222, p = 0.006) and a more severe presentation (higher PBS; aOR 1.726, p<0.001) were independently associated with mortality. Empiric antimicrobial therapy with an anti-MRSA regimen was associated with reduced mortality (aOR 0.319, p = 0.016). Our study identified significant risk factors for 30-day mortality in patients with MRSA BSI in a population with a high incidence of S. aureus bacteremia. Empiric treatment with an anti-MRSA drug was a protective factor. No significant variation in the incidence of S. aureus BSI was recorded throughout the period.
Asunto(s)
Bacteriemia , Infección Hospitalaria , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas , Adulto , Humanos , Persona de Mediana Edad , Staphylococcus aureus , Estudios Retrospectivos , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiología , Infección Hospitalaria/epidemiología , Brasil/epidemiología , Bacteriemia/tratamiento farmacológico , Bacteriemia/epidemiología , Bacteriemia/etiología , Antibacterianos/uso terapéutico , Antibacterianos/farmacología , Factores de RiesgoRESUMEN
Hijacking the autophagic machinery is a key mechanism through which invasive pathogens such as Staphylococcus aureus replicate in their host cells. We have previously demonstrated that the bacteria replicate in phagosomes labeled with the autophagic protein LC3, before escaping to the cytoplasm. Here, we show that the Ca2+-dependent PKCα binds to S. aureus-containing phagosomes and that α-hemolysin, secreted by S. aureus, promotes this recruitment of PKCα to phagosomal membranes. Interestingly, the presence of PKCα prevents the association of the autophagic protein LC3. Live cell imaging experiments using the PKC activity reporter CKAR reveal that treatment of cells with S. aureus culture supernatants containing staphylococcal secreted factors transiently activates PKC. Functional studies reveal that overexpression of PKCα causes a marked inhibition of bacterial replication. Taken together, our data identify enhancing PKCα activity as a potential approach to inhibit S. aureus replication in mammalian cells.
Asunto(s)
Autofagia , Interacciones Huésped-Patógeno , Fagosomas/metabolismo , Proteína Quinasa C-alfa/metabolismo , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/metabolismo , Staphylococcus aureus/fisiología , Animales , Autofagia/inmunología , Células CHO , Línea Celular , Células Cultivadas , Cricetulus , Susceptibilidad a Enfermedades , Técnica del Anticuerpo Fluorescente , Genes Reporteros , Interacciones Huésped-Patógeno/inmunología , Modelos Biológicos , Fagosomas/inmunología , Proteína Quinasa C-alfa/genéticaRESUMEN
Bronchiectasis, which is an abnormal and irreversible dilation of one or several bronchial segments, causes significant morbidity and impaired quality of life to patients, mainly as the result of recurrent and chronic respiratory infections. Staphylococcus aureus is a microorganism known for its high infectious potential related to the production of molecules with great pathogenic power, such as enzymes, toxins, adhesins, and biofilm, which determine the degree of severity of systemic symptoms and can induce exacerbated immune response. This review highlighted the clinical significance of S. aureus colonization/infection in bronchiectasis patients, since little is known about it, despite its increasing frequency of isolation and potential serious morbidity.
Asunto(s)
Bronquiectasia/complicaciones , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/fisiología , Adhesinas de Escherichia coli/genética , Adhesinas de Escherichia coli/metabolismo , Toxinas Bacterianas/metabolismo , Biopelículas/crecimiento & desarrollo , Bronquiectasia/mortalidad , Exotoxinas/metabolismo , Humanos , Leucocidinas/metabolismo , Staphylococcus aureus Resistente a Meticilina/genética , Staphylococcus aureus Resistente a Meticilina/fisiología , Microbiota/fisiología , Pronóstico , Staphylococcus aureus/genética , Superantígenos/inmunologíaRESUMEN
The aims of the research reported here were to identify potential risk factors associated with the presence of Staphylococcus aureus intramammary infection (IMI) in pre partum dairy heifers on 17 dairy farms from three provinces of Argentina and to characterize, at molecular level, isolates from those heifers and lactating cows from two selected herds. A total of 1474 heifers and 4878 lactating cows were studied. The prevalence of Staphylococcus aureus IMI in the heifers, heifers at quarter level and lactating cow mammary quarters was 14.41, 4.82, and 14.65%, respectively. Univariate analysis showed the key variables associated with S. aureus IMI presence in the heifers were: S. aureus IMI prevalence in cows of the lactating herd, the time calves stayed with their dam after birth, the calf rearing system, the place of rearing (own farm or other dairy farm) and fly control on the farm. None of the variables included in the multivariable analysis was associated with the presence of S. aureus IMI in the pre partum heifers, probably due to low variability among management practices used by the farms for rearing the heifer calves. At the molecular level, S. aureus isolates were grouped into three main PFGE clusters and several genotypes within the clusters. Isolates from mammary secretion of pre partum heifers and milk of lactating cows comprised different PFGE clusters in both herds, although two exceptions occurred. The absence of gene fnbpB, which codifies for a virulence factor protein involved in cell invasion by S. aureus, was significantly more frequent in pre partum heifer secretion isolates than in isolates from lactating cow milk. These results suggest that, under these management conditions, isolates from mammary secretions of pre partum heifers do not originate from the milk of lactating cows, but rather other sources to which the heifer is exposed.
Asunto(s)
Mastitis Bovina/etiología , Infecciones Estafilocócicas/veterinaria , Animales , Argentina/epidemiología , Bovinos , Industria Lechera , Femenino , Mastitis Bovina/epidemiología , Mastitis Bovina/microbiología , Leche/microbiología , Prevalencia , Factores de Riesgo , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/genéticaRESUMEN
Intentar el tratamiento retentivo de material protésico ante heridas quirúrgicas infectadas por gérmenes resistentes es objeto de debate, especialmente cuando el agente causal es un Staphylococcus aureus resistente a meticilina (SARM). Una paciente diabética y con obesidad tipo I sufrió infección de la herida quirúrgica tras artroplastia de rodilla que no evolucionó bien con antibioterapia empírica y terapia hiperosmolar. Se planificó una reintervención que fue demorada por motivos extramédicos (falta de terapia de presión negativa para cubrir la herida postoperatoria, pues se preveía no poder realizar cierre primario). Mientras se conseguía este material, y tras obtener el consentimiento de la paciente, se iniciaron irrigaciones de la herida con sevoflurano tópico off-label, pues ese fármaco ha mostrado capacidad antimicrobiana. La evolución clínica fue excelente desde el inicio a pesar de que en el cultivo se aisló un SARM resistente a la antibioterapia empírica, por lo que se desestimó la reintervención y se continuó con sevoflurano tópico junto a la antibioterapia dirigida por antibiograma, lográndose la curación completa de la herida tras 6 semanas. Durante ese tiempo, la paciente no experimentó ningún efecto adverso atribuible al sevoflurano. El sevoflurano tópico aparece como una valiosa nueva opción terapéutica ante heridas postoperatorias infectadas, especialmente cuando los gérmenes causantes son resistentes a los antibióticos convencionales.
It is challenging to try a retentive treatment of prosthetic material superinfected by resistant microorganisms, especially when the causative agent is a methicillin-resistant Staphylococcus aureus (MRSA). A diabetic, obese female patient suffered from a postoperative wound infection after a knee arthroplasty. Initial treatment with antibiotics and hyperosmolar therapy failed and clinical evolution was no good. Surgery was scheduled, but it was delayed due to nonmedical reasons (lack of negative-pressure therapy to cover the wound since primary wound closure was anticipated to be very improbable to perform). While waiting for this therapy, off-label irrigations with topical sevoflurane were started after obtaining written consent, since this drug has exhibited antimicrobial properties. Clinical evolution turned out to be excellent since the very beginning, even though a MRSA resistant to the antibiotics empirically administered was isolated. Thus, surgery was discarded, and culture-guided antibiotic therapy was added to topical sevoflurane, which was followed by a complete healing of the wound after 6 weeks. Sevoflurane treatment was well tolerated as the patient reported no adverse effects. Therefore, treating postsurgical wounds with topical sevoflurane appears as a valuable new alternative, especially when infections are caused by microorganisms resistant to conventional antibiotics.
Asunto(s)
Humanos , Femenino , Anciano , Infecciones Estafilocócicas/tratamiento farmacológico , Infección de la Herida Quirúrgica/tratamiento farmacológico , Artroplastia de Reemplazo de Rodilla/efectos adversos , Sevoflurano/administración & dosificación , Infecciones Estafilocócicas/etiología , Infección de la Herida Quirúrgica/etiología , Administración Tópica , Staphylococcus aureus Resistente a Meticilina , AntibacterianosRESUMEN
BACKGROUND: Surgical site infection is an important complication in the postoperative period among liver transplant recipients. However, little is known about the risk factors in this patient group. Therefore, the objective of this study was to analyze the incidence and risk factors for surgical site infections among adult liver transplant recipients. METHODS: Medical records of adult liver transplant recipients from January 1, 2009, to December 31, 2015, were analyzed in this retrospective cohort study. RESULTS: We enrolled 156 recipients' medical records. Forty-two (26.9%) cases of surgical site infections were identified. The main isolated microorganisms were methicillin-resistant Staphylococcus species, extended spectrum ß-lactamase-producing Klebsiella species, carbapenem-resistant Pseudomonas aeruginosa, carbapenem-resistant Acinetobacter baumannii, and vancomycin-susceptible Enterococcus faecalis. We found that long operative times (≥487 minutes) and differences in body mass index between donor and recipient (≥1.3 kg/m2) increased the risk for surgical site infections by approximately 5 times (odds ratio [OR], 5.5; 95% confidence interval [CI], 2.5-11.8), and capillary glycemia ≥175 mg/dL in the first 96 postoperative hours increased the risk by approximately 3 times (OR, 2.97; 95% CI, 1.43-6.17). CONCLUSIONS: There was a high incidence of surgical site infections among the studied population and that some risk factors identified differ from those reported in the scientific literature.
Asunto(s)
Trasplante de Hígado , Infección de la Herida Quirúrgica/epidemiología , Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/etiología , Infecciones por Acinetobacter/microbiología , Infecciones por Acinetobacter/mortalidad , Acinetobacter baumannii/aislamiento & purificación , Brasil/epidemiología , Estudios de Cohortes , Femenino , Humanos , Incidencia , Masculino , Registros Médicos , Staphylococcus aureus Resistente a Meticilina/aislamiento & purificación , Persona de Mediana Edad , Estudios Retrospectivos , Factores de Riesgo , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/mortalidad , Infección de la Herida Quirúrgica/etiología , Infección de la Herida Quirúrgica/microbiología , Infección de la Herida Quirúrgica/mortalidadRESUMEN
CASE REPORT: A patient with a history of surgical resection of an acoustic neuroma presented with involvement of both the left facial nerve and the left trigeminal nerve. She initially consulted for exposure keratitis, but two weeks later presented with an infectious keratitis. After taking the corneal sample, she presented with persistent epithelial defect, which did not respond to medical management. Topical insulin was indicated, and a decrease in the area of the lesion was seen in the following 5 days. A therapeutic contact lens was also placed at that time and finally, two weeks after the initiation of insulin, the epithelial defect completely closed. DISCUSSION: This was a complex case due to the confluence of facial paralysis, neurotrophic keratitis, and infectious keratitis, which finally had a successful outcome. Topical insulin can be an effective adjuvant therapy in cases of neurotrophic ulcers that do not respond to standard therapy.
Asunto(s)
Traumatismos del Nervio Facial/complicaciones , Insulina/uso terapéutico , Queratitis/etiología , Neuroma Acústico/cirugía , Complicaciones Posoperatorias/etiología , Traumatismos del Nervio Trigémino/complicaciones , Administración Oftálmica , Antibacterianos/uso terapéutico , Terapia Combinada , Lentes de Contacto Hidrofílicos , Úlcera de la Córnea/tratamiento farmacológico , Úlcera de la Córnea/etiología , Úlcera de la Córnea/terapia , Parálisis Facial/etiología , Femenino , Humanos , Insulina/administración & dosificación , Queratitis/tratamiento farmacológico , Queratitis/microbiología , Queratitis/terapia , Persona de Mediana Edad , Moxifloxacino/uso terapéutico , Complicaciones Posoperatorias/tratamiento farmacológico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/etiología , Vancomicina/uso terapéuticoRESUMEN
The aims of this study were to determine the occurrence of subclinical mastitis in sheep of different breeds and the values for somatic cell count (SCC) in milk for the diagnosis of the disease at lactation and weaning, a fundamental prerequisite for identifying animals in need of control measures. Milk samples were obtained from 1,457 mammary halves of Santa Inês, Texel, Ile de France, and Dorper sheep at two different periods, during the second week of lactation and at weaning. After teats antisepsis, the samples were collected, and identification of the infectious etiology of mastitis and determination of SCC were performed. Microorganisms were identified in 117/762 (15.3%) mammary halves in the second week of lactation and in 86/694 (12.4%) at weaning. Coagulase-negative staphylococci (CoNS) were the etiological agents with the highest incidence alone and in association with other microorganisms, with percentages of 58.1% and 60.6%, respectively. The Santa Inês presented a higher incidence of subclinical mastitis when compared to the other breeds. The cut-off values of SCC for subclinical mastitis were determined at both sampling periods and varied according to stage of lactation, as well breed. These results illustrate the lack of a universal value that can be used for the diagnosis of mastitis and suggests the need for permanent follow-up in herds in order to control the disease.(AU)
Os objetivos do trabalho foram estabelecer a ocorrência da mastite subclínica em ovelhas de diferentes raças e os respectivos valores de triagem da contagem de células somáticas (CCS) no leite para o diagnóstico da doença durante a lactação e ao desmame, um pré-requisito fundamental para a identificação dos animais para o estabelecimento de medidas de controle. As amostras de leite foram obtidas de 1.457 metades mamárias de ovelhas das raças Santa Inês, Texel, Ile de France e Dorper, em dois diferentes períodos, durante a segunda semana de lactação e ao desmame. Após a antissepsia dos tetos, as amostras de leite foram colhidas para identificação da etiologia infecciosa dos casos de mastite e determinação da CCS. Dentre as metades mamárias investigadas, 117/763 (15,3%) apresentaram micro-organismos no leite na segunda semana de lactação e 86/694 (12,4%) apresentaram resultados microbiológicos positivos ao desmame. Estafilococos coagulase-negativos (ECN) foram os agentes etiológicos com maior ocorrência isoladamente e em associação com outros micro-organismos, 58,1% e 60,6%, respectivamente. A raça Santa Inês apresentou maior ocorrência de mastite subclínica, quando comparada às outras raças. Diferentes pontos de corte para CCS foram determinados em ambos os períodos. Os valores das contagens celulares para a triagem da mastite subclínica nas ovelhas variaram de acordo com a fase da lactação em que as amostras foram obtidas, assim como com as raças dos animais, o que denota não existir um valor universal que possa ser usado para o diagnóstico da mastite, sugerindo a necessidade de acompanhamento técnico permanente nos rebanhos para o controle da doença.(AU)
Asunto(s)
Animales , Femenino , Adulto , Ovinos/crecimiento & desarrollo , Mastitis/etiología , Mastitis/microbiología , Mastitis/veterinaria , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/veterinaria , Leche/microbiologíaRESUMEN
The aim of this study is to describe the presence of genes encoding for 4 virulence factors (pvl, eta, etb, and tsst), as well as the mecA gene conferring resistance to beta-lactam antibiotics, in patients with diabetes and a staphylococcal foot infection. We have also analyzed whether isolates of Staphylococcus aureus from bone infections have a different profile for these genes compared with those from exclusively soft tissue infections. In this cross-sectional study of a prospectively recruited series of patients admitted to the Diabetic Foot Unit, San Juan de Dios Hospital, San José, Costa Rica with a moderate or severe diabetic foot infection (DFI), we collected samples from infected soft tissue and from bone during debridement. During the study period (June 1, 2014 to May 31, 2016), we treated 379 patients for a DFI. S aureus was isolated from 101 wound samples, of which 43 were polymicrobial infections; we only included the 58 infections that were monomicrobial S aureus for this study. Infections were exclusively soft tissue in 17 patients (29.3%) while 41 (70.7%) had bone involvement (osteomyelitis). The mecA gene was detected in 35 cases (60.3%), pvl gene in 4 cases (6.9%), and tsst gene in 3 (5.2%). We did not detect etA and etB in any of the cases. There were no differences in the profile of S aureus genes encoding for virulence factors (pvl, etA, etB, and tsst) recovered from DFIs between those with just soft tissue compared to those with osteomyelitis. However, we found a significantly higher prevalence of pvl+ strains of S aureus associated with soft tissue compared with bone infections. Furthermore, we observed a significantly longer time to healing among patients infected with mecA+ (methicillin-resistant) S aureus (MRSA).
Asunto(s)
Pie Diabético/complicaciones , Osteomielitis/microbiología , Infecciones de los Tejidos Blandos/microbiología , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/patogenicidad , Estudios Transversales , ADN Bacteriano/análisis , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Osteomielitis/etiología , Reacción en Cadena de la Polimerasa , Estudios Prospectivos , Infecciones de los Tejidos Blandos/etiología , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/genética , Staphylococcus aureus/aislamiento & purificación , Factores de Virulencia/genéticaRESUMEN
BACKGROUND: Acute and acute hematogenous prosthetic joint infections (PJIs) are often treated with open debridement and polyethylene exchange (ODPE) in an effort to save the prosthesis, decrease morbidity, and reduce costs. However, failure of ODPE may compromise a subsequent 2-stage treatment. The purpose of this study is to identify patient factors that impact the success of ODPE for acute and acute hematogenous PJIs. METHODS: A retrospective review examined comorbidities, preoperative laboratory values, and patient history for patients with successful and failed ODPE treatment for acute perioperative or acute hematogenous periprosthetic hip or knee joint infections. Successful treatment was defined as retaining a well-fixed implant without the need for additional surgery for a minimum of 6-month follow-up with or without lifelong oral maintenance antibiotics. RESULTS: Fifty-three of 72 patients (73.6%) underwent successful ODPE. Of the 19 failures, 14 completed 2-stage revision with one subsequent known failure for recurrent infection. Patients with a Staphylococcus aureus infection were more likely to fail ODPE (48.3% vs 11.6%, P = .0012, odds ratio 7.1, 95% confidence interval 2.3-25.3). Patients with a preoperative hematocrit ≤32.1 were also more likely to fail ODPE (55% vs 16%, P = .0013, odds ratio 6.7, 95% confidence interval 2.2-22.4). When neither risk factor was present, 97.1% of PJIs were successfully treated with ODPE. CONCLUSION: S aureus infection and preoperative hematocrit ≤32.1 are independent risk factors for ODPE failure. ODPE is a safe alternative to 2-stage revision in patients without preoperative anemia and without S aureus infection. Two-thirds of patients with a failed ODPE were successfully treated with a 2-stage reimplantation.
Asunto(s)
Anemia/complicaciones , Artritis Infecciosa/cirugía , Prótesis de Cadera/efectos adversos , Prótesis de la Rodilla/efectos adversos , Infecciones Relacionadas con Prótesis/cirugía , Anciano , Antibacterianos/administración & dosificación , Artritis Infecciosa/complicaciones , Artritis Infecciosa/microbiología , Artroplastia de Reemplazo de Rodilla/efectos adversos , Transfusión Sanguínea , Desbridamiento , Femenino , Hematócrito , Humanos , Articulación de la Rodilla/cirugía , Masculino , Persona de Mediana Edad , Oportunidad Relativa , Polietileno , Infecciones Relacionadas con Prótesis/complicaciones , Infecciones Relacionadas con Prótesis/microbiología , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Infecciones Estafilocócicas/etiología , Staphylococcus aureus , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
BACKGROUND: Breast reconstruction with tissue expanders is the most common mode of reconstruction following mastectomy. Infection necessitating tissue expander removal is a significant complication leading to patient distress and increased health care costs. METHODS: Over 3 years, 127 breast reconstructions with tissue expanders were performed by a single surgeon. Fifty-nine of these reconstructions were performed using a standardized protocol in which patients washed with chlorhexidine several days before surgery and received intravenous antibiotics preoperatively. Intraoperatively, the submuscular pocket was irrigated with triple-antibiotic solution and the skin was prepared again with povidone-iodine before expander placement. This group was referred to as the preintervention group. Sixty-eight of the reconstructions were performed using the standardized protocol with the addition of biodegradable antibiotic beads (Stimulan with vancomycin and gentamicin) in the submuscular pocket. This group made up the postintervention group. The primary outcome was the rate of infection necessitating tissue expander removal. RESULTS: The rate of tissue expander loss caused by infection was 11.9 percent in the preintervention group and 1.5 percent in the postintervention group (p = 0.024). Higher body mass index was associated with a statistically significant increase in infections necessitating expander removal. CONCLUSION: The use of absorbable antibiotic beads in the submuscular pocket reduced the risk of periprosthetic implant infection necessitating implant removal by 8-fold. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
Asunto(s)
Antibacterianos/administración & dosificación , Profilaxis Antibiótica/métodos , Gentamicinas/administración & dosificación , Mamoplastia , Infección de la Herida Quirúrgica/prevención & control , Expansión de Tejido , Vancomicina/administración & dosificación , Adulto , Anciano , Antibacterianos/uso terapéutico , Sulfato de Calcio , Portadores de Fármacos , Quimioterapia Combinada , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/epidemiología , Infecciones por Escherichia coli/etiología , Infecciones por Escherichia coli/prevención & control , Femenino , Gentamicinas/uso terapéutico , Humanos , Mamoplastia/métodos , Mastectomía , Microesferas , Persona de Mediana Edad , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/epidemiología , Infecciones por Pseudomonas/etiología , Infecciones por Pseudomonas/prevención & control , Estudios Retrospectivos , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/prevención & control , Staphylococcus epidermidis/aislamiento & purificación , Infección de la Herida Quirúrgica/diagnóstico , Infección de la Herida Quirúrgica/epidemiología , Expansión de Tejido/instrumentación , Expansión de Tejido/métodos , Dispositivos de Expansión Tisular , Resultado del Tratamiento , Vancomicina/uso terapéuticoRESUMEN
The aims of this study were to determine the occurrence of subclinical mastitis in sheep of different breeds and the values for somatic cell count (SCC) in milk for the diagnosis of the disease at lactation and weaning, a fundamental prerequisite for identifying animals in need of control measures. Milk samples were obtained from 1,457 mammary halves of Santa Inês, Texel, Ile de France, and Dorper sheep at two different periods, during the second week of lactation and at weaning. After teats antisepsis, the samples were collected, and identification of the infectious etiology of mastitis and determination of SCC were performed. Microorganisms were identified in 117/762 (15.3%) mammary halves in the second week of lactation and in 86/694 (12.4%) at weaning. Coagulase-negative staphylococci (CoNS) were the etiological agents with the highest incidence alone and in association with other microorganisms, with percentages of 58.1% and 60.6%, respectively. The Santa Inês presented a higher incidence of subclinical mastitis when compared to the other breeds. The cut-off values of SCC for subclinical mastitis were determined at both sampling periods and varied according to stage of lactation, as well breed. These results illustrate the lack of a universal value that can be used for the diagnosis of mastitis and suggests the need for permanent follow-up in herds in order to control the disease.
Os objetivos do trabalho foram estabelecer a ocorrência da mastite subclínica em ovelhas de diferentes raças e os respectivos valores de triagem da contagem de células somáticas (CCS) no leite para o diagnóstico da doença durante a lactação e ao desmame, um pré-requisito fundamental para a identificação dos animais para o estabelecimento de medidas de controle. As amostras de leite foram obtidas de 1.457 metades mamárias de ovelhas das raças Santa Inês, Texel, Ile de France e Dorper, em dois diferentes períodos, durante a segunda semana de lactação e ao desmame. Após a antissepsia dos tetos, as amostras de leite foram colhidas para identificação da etiologia infecciosa dos casos de mastite e determinação da CCS. Dentre as metades mamárias investigadas, 117/763 (15,3%) apresentaram micro-organismos no leite na segunda semana de lactação e 86/694 (12,4%) apresentaram resultados microbiológicos positivos ao desmame. Estafilococos coagulase-negativos (ECN) foram os agentes etiológicos com maior ocorrência isoladamente e em associação com outros micro-organismos, 58,1% e 60,6%, respectivamente. A raça Santa Inês apresentou maior ocorrência de mastite subclínica, quando comparada às outras raças. Diferentes pontos de corte para CCS foram determinados em ambos os períodos. Os valores das contagens celulares para a triagem da mastite subclínica nas ovelhas variaram de acordo com a fase da lactação em que as amostras foram obtidas, assim como com as raças dos animais, o que denota não existir um valor universal que possa ser usado para o diagnóstico da mastite, sugerindo a necessidade de acompanhamento técnico permanente nos rebanhos para o controle da doença.
Asunto(s)
Femenino , Animales , Adulto , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/microbiología , Infecciones Estafilocócicas/veterinaria , Leche/microbiología , Mastitis/etiología , Mastitis/microbiología , Mastitis/veterinaria , Ovinos/crecimiento & desarrolloRESUMEN
Spondylodiscitis consists of an inflammatory process of infectious origin that affects primarily the intervertebral disc and spreads to the adjacent vertebral bodies, often evolving into osteomyelitis, with consequent associated neurological damage. The diagnosis is often delayed, with an average of 2 to 6 months between the appearance of the first symptoms and the confirmation of the disease. Therefore, the laboratorial and imaging exams play an important role in the diagnosis of spondylodiscitis, as well as in the orientation for the treatment to be followed (conservative or surgical). We report a case of extensive involvement of the spine and discuss about the epidemiology of the disease, its diagnosis, and therapeutic principles.
Asunto(s)
Humanos , Masculino , Persona de Mediana Edad , Discitis/diagnóstico , Vértebras Cervicales , Infecciones Estafilocócicas/etiología , Discitis/cirugía , Discitis/complicacionesRESUMEN
Background and purpose - Treatment failure of osteomyelitis can result from genetic susceptibility, highlighting polymorphisms of the interleukin-1 (IL-1) family members, central mediators of innate immunity and inflammation. Polymorphisms are DNA sequence variations that are common in the population (1% or more) and represent multiple forms of a single gene. We investigated the association of IL1RNVNTR (rs2234663) and IL1B-511C > T (rs16944) polymorphisms with osteomyelitis development in patients operated on because of bone trauma. Patients and methods - 153 patients who fulfilled the inclusion criteria were enrolled from a referral public hospital for trauma. All the patients were followed up daily until hospital discharge and, after this, on an outpatient basis. Patients were treated with prophylactic antimicrobials and surgery according to traumatology service protocol. The IL1RNVNTR and the IL1B-511C > T polymorphisms were determined by PCR and PCR-RFLP, respectively. Results - The IL1RN*2/*2 genotype was associated (OR: 7; p < 0.001) with a higher risk of osteomyelitis and was also significantly associated with Staphylococcus aureus infection. The haplotypes (combination of different markers) *2-C and *2-T were also associated with osteomyelitis development. Interpretation - IL1B-511C > T and IL1RNVNTR polymorphisms were associated with osteomyelitis development, which may have implications for patients with bone traumas. These data may be relevant for new therapeutic strategies for this disease.
Asunto(s)
Proteína Antagonista del Receptor de Interleucina 1/genética , Interleucina-1beta/genética , Osteomielitis/genética , Polimorfismo de Nucleótido Simple/genética , Adolescente , Adulto , Anciano , Huesos/lesiones , Brasil , Niño , Preescolar , Femenino , Haplotipos/genética , Humanos , Lactante , Proteína Antagonista del Receptor de Interleucina 1/fisiología , Interleucina-1beta/fisiología , Masculino , Persona de Mediana Edad , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/genética , Adulto JovenRESUMEN
Patients with chronic kidney disease on peritoneal dialysis (PD) are susceptible to infections, with peritonitis being the primary cause of dropout. Peritoneal fluid culture is one of the essential elements for proper diagnosis and peritonitis treatment. The aim of this study was to compare the time required to obtain a positive culture using different laboratory methods. An in vitro cross-sectional study was conducted comparing different techniques for preparation and culture of bacteria in peritoneal fluid. The research was carried out with 21 sterile dialysis bags and 21 PD bags containing peritoneal fluid drained from patients without peritonitis. Fluids from the 42 PD bags were contaminated by injecting a coagulase-negative Staphylococcus suspension and then prepared for culture using 4 distinct techniques: A - direct culture; B - post-centrifugation culture; C - direct culture after 4 h sedimentation; and D - culture after 4 h sedimentation and centrifugation. This was followed by seeding. In the 21 contaminated sterile bags, mean times to obtain a positive culture with techniques D (19.6 h ± 2.6) and C (19.1 h ± 2.3) were longer than with technique A (15.8 h ± 3.0; p < 0.01), but not statistically different from group B (19.0 h ± 3.2). The same occurred in the 21 bags drained from patients, with mean times for techniques D (14.0 h ± 1.9) and C (14.5 h ± 1.7) being longer than technique A (12.22 h ± 1.94; p < 0.05) but not statistically different from technique B (13.2 h ± 1.3). The sedimentation and centrifugation steps seem to be unnecessary and may delay antibiotic sensitivity test results by approximately 8 hours.
Asunto(s)
Líquido Ascítico/microbiología , Contaminación de Equipos , Diálisis Peritoneal/efectos adversos , Peritonitis/etiología , Insuficiencia Renal Crónica/terapia , Infecciones Estafilocócicas/etiología , Staphylococcus/aislamiento & purificación , Estudios Transversales , Soluciones para Diálisis/química , Humanos , Diálisis Peritoneal/instrumentación , Peritoneo/microbiología , Peritonitis/microbiología , Infecciones Estafilocócicas/microbiologíaRESUMEN
The aim of the present study was to estimate the relative contribution of immunogenetic and microbiological factors in the development of recurrent tonsillitis in a Mexican population. Patients (n = 138) with recurrent tonsillitis and an indication of tonsillectomy (mean age: 6.05 years ± 3.00; median age: 5 years, female: 58; age range: 1-15 years) and 195 non-related controls older than 18 years and a medical history free of recurrent tonsillitis were included. To evaluate the microbial contribution, tonsil swab samples from both groups and extracted tonsil samples from cases were cultured. Biofilm production of isolated bacteria was measured. To assess the immunogenetic component, DNA from peripheral blood was genotyped for the TNFA-308G/A single-nucleotide polymorphism (SNP) and for the IL1B -31C/T SNP. Normal microbiota, but no pathogens or potential pathogens, were identified from all control sample cultures. The most frequent pathogenic species detected in tonsils from cases were Staphylococcus aureus (48.6%, 67/138) and Haemophilus influenzae (31.9%, 44/138), which were found more frequently in patient samples than in samples from healthy volunteers (P < 0.0001). Importantly, 41/54 (75.9%) S. aureus isolates were biofilm producers (18 weak and 23 strong), whereas 17/25 (68%) H. influenzae isolates were biofilm producers (10 weak, and 7 strong biofilm producers). Patients with at least one copy of the IL1B-31*C allele had a higher risk of recurrent tonsillitis (OR = 4.03; 95% CI = 1.27-14.27; P = 0.013). TNFA-308 G/A alleles were not preferentially distributed among the groups. When considering the presence of IL1B-31*C plus S. aureus, IL1B-31*C plus S. aureus biofilm producer, IL1B-31*C plus H. influenzae or IL1B-31*C plus H. influenzae biofilm producer, the OR tended to infinite. Thus, the presence of IL1B-31*C allele plus the presence of S. aureus and/or H. influenzae could be related to the development of tonsillitis in this particular Mexican population.
Asunto(s)
Portador Sano/microbiología , Infecciones por Haemophilus/etiología , Interleucina-1beta/genética , Infecciones Estafilocócicas/etiología , Tonsilitis/etiología , Adolescente , Adulto , Anciano , Alelos , Biopelículas , Portador Sano/inmunología , Estudios de Casos y Controles , Niño , Preescolar , Femenino , Infecciones por Haemophilus/genética , Infecciones por Haemophilus/microbiología , Haemophilus influenzae/aislamiento & purificación , Humanos , Fenómenos Inmunogenéticos , Lactante , Masculino , México , Microbiota , Persona de Mediana Edad , Recurrencia , Factores de Riesgo , Infecciones Estafilocócicas/genética , Infecciones Estafilocócicas/microbiología , Staphylococcus aureus/aislamiento & purificación , Tonsilitis/genética , Tonsilitis/microbiología , Factor de Necrosis Tumoral alfa/genética , Adulto JovenRESUMEN
Se realizó una revisión retrospectiva durante 12 años de las infecciones por Staphylococcus aureus en pacientes adultos (PA) y pediátricos (PP) asistidos en el Hospital Interzonal General de Agudos Evita de Lanús, para conocer la incidencia, los focos y el origen de la infección, y analizar el perfil de resistencia antimicrobiana. Se documentaron 2125 casos de infección en PA y 361 en PP. La incidencia de casos en PA descendió significativamente en el último trienio (χ²; p < 0,05); en los PP aumentó significativamente durante los últimos 5 años (χ²; p < 0,0001). En ambas poblaciones se detectó un aumento significativo en las infecciones de piel y estructuras asociadas (PEA), de bacteriemias a punto de partida de un foco en PEA y de infecciones por S. aureus de inicio en el hospital (χ²; p < 0,005). La meticilino-resistencia (SAMR) aumentó del 28 al 78% en PP; en PA se mantuvo alrededor del 50%, con reducción significativa de la resistencia acompañante a antimicrobianos no betalactámicos en los SAMR de ambas poblaciones. En S. aureus documentados de infecciones de inicio en la comunidad (SAMR-CO) del último trienio, el porcentaje de meticilino-resistencia resultó del 57% en PP y 37% en PA; en infecciones con inicio en el hospital fue del 43 y el 63%, respectivamente. Si bien demostramos que S. aureus continúa siendo un patógeno asociado al ámbito nosocomial, hubo un aumento de infecciones por SAMR-CO, con compromiso en PEA en ambas poblaciones.
A twelve-year retrospective review of Staphylococcus aureus infections in adult and pediatric patients (AP and PP respectively) assisted in the Hospital Interzonal General de Agudos Evita in Lanús was performed to determine the incidence, foci of infection, the source of infection and to analyze the profile of antimicrobial resistance. An amount of 2125 cases of infection in AP and 361 in PP were documented. The incidence in AP decreased significantly in the last three years (χi²; p < 0.05); in PP it increased significantly during the last five years (χ²; p < 0.0001). In both populations was detected a notable increase in skin infections and associated structures (PEA) in bacteremia to the starting point of a focus on PEA, and in total S. aureus infections of hospital-onset (χ²; p < 0.005). Methicillin-resistance (MRSA) increased from 28 to 78% in PP; in AP it remained around 50%, with significant reduction in accompanying antimicrobial resistance to non-β-lactams in both groups of MRSA. In S. aureus documented from community onset infections (CO-MRSA) in the last three years, the percentage of methicillin-resistance was 57% in PP and 37% in AP; in hospital-onset infections it was 43% and 63% respectively. Although data showed that S. aureus remains a pathogen associated with the hospital-onset, there was an increase of CO-MRSA infections with predominance in PEA in both populations.
Asunto(s)
Humanos , Masculino , Femenino , Infecciones Estafilocócicas/etiología , Infecciones Estafilocócicas/epidemiología , Infección Hospitalaria/epidemiología , Staphylococcus aureus/efectos de los fármacos , Infección Hospitalaria/tratamiento farmacológico , Incidencia , Staphylococcus aureus Resistente a MeticilinaRESUMEN
BACKGROUND: The most common etiological agents in periprosthetic infections are Escherichia coli and Staphylococcus aureus. The frequency of these infections are found in knee replacement with 0.68 to 1.60% compared to the hip with 0.67 to 2.4%. OBJECTIVE: To identify what are the most common etiologic agents in periprosthetic infections in elderly patients with primary hip and knee surgery. MATERIAL AND METHODS: An observational study, transverse and retrospective case series was performed in a period from June 2011 to December 2014, patients over 60 years with a diagnosis of periprosthetic infection by two positive cultures with antibiograma. RESULTS: 62 patients were evaluated 59.7% were infections of knee and hip 40.3%, 59% were infections by Escherichia coli and Staphylococcus aureus 22%. The best sensitivity reported antibiotic trimethoprim-sulfamethoxazole was 40.3%. The largest penicillin G resistance 32.2%. CONCLUSION: The most common causative agents were Escherichia coli and Staphylococcus aureus.
Los agentes etiológicos más frecuentes en las infecciones periprotésicas son Escherichia coli y Staphylococcus aureus. La frecuencia de estas infecciones se presenta en el reemplazo articular de rodilla de 0.68 a 1.60% en comparación con el de cadera de 0.67 a 2.4%.
Asunto(s)
Artroplastia de Reemplazo de Cadera , Infecciones Relacionadas con Prótesis , Infecciones Estafilocócicas , Anciano , Antibacterianos , Artroplastia de Reemplazo de Cadera/efectos adversos , Artroplastia de Reemplazo de Rodilla , Humanos , Prótesis de la Rodilla , Persona de Mediana Edad , Infecciones Relacionadas con Prótesis/microbiología , Estudios Retrospectivos , Infecciones Estafilocócicas/etiología , Staphylococcus aureus/aislamiento & purificaciónRESUMEN
INTRODUCTION: Surgical site infection (ISO) is the most common nosocomial infection and is a process associated with multiple factors, which together generate a condition that directly affects the welfare of the patient. MATERIAL AND METHODS: Cross-sectional study, conducted over 1 year period, the sample size was established for all patients who met the inclusion criteria. An instrument takes the variables; double tabulation of patients is performed in Excel 2013 and data are analyzed in Stata version 11. RESULTS: The average age was 44.3 ± 18.8 years and the male: female ratio is 1.7:1. Clinical features, lower limbs are the most affected and 21.9 % of cases affect the femur. A prevalence of 6.6 % was found, being the most common deep infection classification. Staphylococcus aureus was cultured in 38.5% of which 40% were methicillin sensible. CONCLUSION: ISO prevalence in patients with closed fractures in HUS is 6.6% higher compared with literature data. The findings of this study it was established that hemoglobin below 10 g/dl, transfusion, reoperation and surgical risk ASA were associated statistically with ISO.
La infección de sitio operatorio (ISO) es la infección nosocomial más común y es un proceso asociado a múltiples factores, los cuales en conjunto generan una alteración que afecta directamente el bienestar del paciente.
Asunto(s)
Fracturas Cerradas , Infecciones Estafilocócicas , Infección de la Herida Quirúrgica , Adulto , Estudios Transversales , Femenino , Fracturas Cerradas/complicaciones , Fracturas Cerradas/microbiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Infecciones Estafilocócicas/epidemiología , Infecciones Estafilocócicas/etiologíaRESUMEN
Resumen: Antecedentes: Los agentes etiológicos más frecuentes en las infecciones periprotésicas son Escherichia coli y Staphylococcus aureus. La frecuencia de estas infecciones se presenta en el reemplazo articular de rodilla de 0.68 a 1.60% en comparación con el de cadera de 0.67 a 2.4%. Objetivo: identificar cuáles son los agentes etiológicos más frecuentes en infecciones periprotésicas en adultos mayores y en pacientes con cirugía primaria de cadera y rodilla. Material y métodos: Se realizó un estudio observacional, transversal y retrospectivo, tipo serie de casos en un período comprendido de Junio de 2011 a Diciembre de 2014, se incluyeron pacientes mayores de 60 años con diagnóstico de infección periprotésica mediante dos cultivos positivos con antibiograma. Resultados: Se evaluaron 62 pacientes, 59.7% presentaron infecciones de rodilla y 40.3% de cadera, 59% fueron infecciones por Escherichia coli y 22% por Staphylococcus aureus. El antibiótico que mejor sensibilidad reportó fue trimetoprim-sulfametoxazol (40.3% )y el de mayor resistencia fue penicilina G (32.2%). Conclusión: Los agentes etiológicos más frecuentes fueron Escherichia coli y Staphylococcus aureus.
Abstract: Background: The most common etiological agents in periprosthetic infections are Escherichia coli and Staphylococcus aureus. The frequency of these infections are found in knee replacement with 0.68 to 1.60% compared to the hip with 0.67 to 2.4%. Objective: To identify what are the most common etiologic agents in periprosthetic infections in elderly patients with primary hip and knee surgery. Material and methods: An observational study, transverse and retrospective case series was performed in a period from June 2011 to December 2014, patients over 60 years with a diagnosis of periprosthetic infection by two positive cultures with antibiograma. Results: 62 patients were evaluated 59.7% were infections of knee and hip 40.3%, 59% were infections by Escherichia coli and Staphylococcus aureus 22%. The best sensitivity reported antibiotic trimethoprim-sulfamethoxazole was 40.3%. The largest penicillin G resistance 32.2%. Conclusion: The most common causative agents were Escherichia coli and Staphylococcus aureus.