RESUMEN

This study focuses on the genomic characterization of a multidrug-resistant Escherichia coli strain responsible for a severe gastrointestinal infection in a 33-year-old male. The patient initially received sulfamethoxazole/trimethoprim treatment, which proved ineffective. Fecal culture confirmed the presence of E. coli displaying a MDR profile to ampicillin, nalidixic acid, ciprofloxacin, sulfamethoxazole, trimethoprim, and tetracycline. Serotyping identified the strain as ONT:H19. Virulence analysis indicated a highly virulent profile with numerous virulence markers. Plasmid analysis uncovered various plasmids carrying both antimicrobial resistance and virulence genes. MLST assigned the strain to ST10955. Phylogenomic analysis revealed similarity to an older Brazilian isolate, suggesting the persistence of a common lineage with evolving antimicrobial resistance. This report highlights the first identification of a multidrug-resistant ST10955 E. coli strain with a wide resistome and virulence potential, emphasizing the importance of ongoing surveillance of E. coli strains due to their potential for severe infections, resistance development, and virulence.

Asunto(s)

Farmacorresistencia Bacteriana Múltiple , Infecciones por Escherichia coli , Escherichia coli , Genoma Bacteriano , Filogenia , Humanos , Escherichia coli/genética , Escherichia coli/efectos de los fármacos , Escherichia coli/aislamiento & purificación , Escherichia coli/patogenicidad , Escherichia coli/clasificación , Infecciones por Escherichia coli/microbiología , Infecciones por Escherichia coli/diagnóstico , Adulto , Masculino , Farmacorresistencia Bacteriana Múltiple/genética , Genoma Bacteriano/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Heces/microbiología , Plásmidos/genética , Tipificación de Secuencias Multilocus , Factores de Virulencia/genética , Enfermedades Gastrointestinales/microbiología , Enfermedades Gastrointestinales/diagnóstico , Virulencia/genética , Serotipificación , Brasil

Asunto(s)

Infecciones por Escherichia coli , Síndrome Hemolítico-Urémico , Escherichia coli Shiga-Toxigénica , Humanos , Síndrome Hemolítico-Urémico/diagnóstico , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Diarrea/etiología

RESUMEN

BACKGROUND: Urinary tract infection (UTI) recurrence is important in immunocompromised patients. There is a trend to study genotypically and phenotypically the role of certain virulence factors of Escherichia coli in the diagnosis of recurrent UTI. The main objective of this study was to determine if there is an association between phenotypic characteristics of E coli and UTI recurrence in immunocompromised patients. METHODS: A case-control study was performed on immunocompromised patients from Hospital Regional de Alta Especialidad del Bajío, Mexico. E coli strains isolated from these patients were identificated and antimicrobial susceptibility test were performed. Strains with filamented cell morphology, mucoid colonial phenotype, or biofilm production were considered cases. Strains without the characteristics were considered controls. UTI recurrence was identified based on clinical records. The odds ratio (OR) was calculated to quantify the magnitude of the association. RESULTS: An association between filamented cell morphology and UTI recurrence was found (OR = 2.19 95% CI 1.06-4.51; P = .031). No association was found between mucoid colony morphology (P>.05) or biofilm production (P>.05) and UTI recurrence. An association between mucoid colony morphology and extended-spectrum ß-lactamase production was found (OR = 3.09 95% 1.59-5.99; P<.001). CONCLUSIONS: Filamented cell morphology and mucoid colonial phenotype may have a possible diagnostic value for the detection of UTI recurrence and antimicrobial resistance. Further diagnostic test studies are needed to fully assess their clinical utility.

Asunto(s)

Antiinfecciosos , Infecciones por Escherichia coli , Infecciones Urinarias , Humanos , Escherichia coli , Infecciones por Escherichia coli/diagnóstico , Estudios de Casos y Controles , Infecciones Urinarias/diagnóstico , Huésped Inmunocomprometido , Antibacterianos/uso terapéutico , beta-Lactamasas

RESUMEN

Worldwide, Urinary Tract Infections (UTIs) are an important health problem with many cases reported annually, women being the most affected. UTIs are relevant because they can become a recurrent condition, associated with different factors that contribute to the chronicity of the disease (cUTI). cUTI can be classified as persistent (peUTI) when the causative agent is the same each time the infection occurs or as reinfection (reUTI) when the associated microorganism is different. The purpose of this work was to characterize Escherichia coli isolates obtained in two prospective studies of patients with cUTI, to define which of them corresponded to peUTI and which to reUTI. A total of 394 isolates of E. coli were analyzed by agglutination with specific sera, antimicrobial susceptibility by diffusion disc test, and the phylogroups and presence of genes associated with virulence by PCR assays. Additionally, in some characterized strains adherence, invasiveness, and biofilm formation were analyzed by in vitro assays. The results showed that the peUTI strains belonged mainly to the classical UPEC serogroups (O25, O75, O6), were included in the B2 phylogroup, carried a great number of virulence genes, and were adherent, invasive, and biofilm-forming. Meanwhile, reUTI strains showed great diversity of serogroups, belonged mainly in the A phylogroup, and carried fewer virulence genes. Both peUTI and reUTI strains showed extensively drug-resistant (XDR) and multidrug-resistant (MDR) profiles in the antimicrobial susceptibility test. In conclusion, it appears that peUTIs are caused principally by classical UPEC strains, while reUTIs are caused by strains that appear to be a part of the common E. coli intestinal biota. Moreover, although both peUTI and reUTI strains presented different serotypes and phylogroups, their antimicrobial resistance profile (XDR and MDR) was similar, confirming the importance of regulating prophylactic treatments and seeking alternatives for the treatment and control of cUTI. Finally, it was possible to establish the features of the E. coli strains responsible for peUTI and reUTI which could be helpful to develop a fast diagnostic methodology.

Asunto(s)

Antiinfecciosos , Infecciones por Escherichia coli , Infecciones Urinarias , Humanos , Femenino , Escherichia coli/genética , Estudios de Seguimiento , Infecciones por Escherichia coli/diagnóstico , Estudios Prospectivos , Factores de Virulencia/análisis , Factores de Virulencia/genética , Infecciones Urinarias/diagnóstico

RESUMEN

Introduction. The different pathotypes of Escherichia coli can produce a large number of human diseases. Surveillance is complex since their differentiation is not easy. In particular, the detection of Shiga toxin-producing Escherichia coli (STEC) serotype O157 : H7 consists of stool culture of a diarrhoeal sample on enriched and/or selective media and identification of presumptive colonies and confirmation, which require a certain level of training and are time-consuming and expensive.Hypothesis. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) is a quick and easy way to obtain the protein spectrum of a microorganism, identify the genus and species, and detect potential biomarker peaks of certain characteristics.Aim. To verify the usefulness of MALDI-TOF MS to rapidly identify and differentiate STEC O157 : H7 from other E. coli pathotypes.Methodology. The direct method was employed, and the information obtained using Microflex LT platform-based analysis from 60 clinical isolates (training set) was used to detect differences between the peptide fingerprints of STEC O157 : H7 and other E. coli strains. The protein profiles detected laid the foundations for the development and evaluation of machine learning predictive models in this study.Results. The detection of potential biomarkers in combination with machine learning predictive models in a new set of 142 samples, called 'test set', achieved 99.3 % (141/142) correct classification, allowing us to distinguish between the isolates of STEC O157 : H7 and the other E. coli group. Great similarity was also observed with respect to this last group and the Shigella species when applying the potential biomarkers algorithm, allowing differentiation from STEC O157 : H7Conclusion. Given that STEC O157 : H7 is the main causal agent of haemolytic uremic syndrome, and based on the performance values obtained in the present study (sensitivity=98.5 % and specificity=100.0 %), the implementation of this technique provides a proof of principle for MALDI-TOF MS and machine learning to identify biomarkers to rapidly screen or confirm STEC O157 : H7 versus other diarrhoeagenic E. coli in the future.

Asunto(s)

Infecciones por Escherichia coli , Escherichia coli O157 , Escherichia coli Shiga-Toxigénica , Humanos , Escherichia coli O157/metabolismo , Serogrupo , Infecciones por Escherichia coli/diagnóstico , Espectrometría de Masa por Láser de Matriz Asistida de Ionización Desorción , Biomarcadores/metabolismo

RESUMEN

BACKGROUND: Long-term kidney outcomes of non-dialyzed children with Shiga-toxin Escherichia Coli hemolytic uremic syndrome (STEC-HUS) have been scantily studied. Therefore, we aimed to evaluate kidney outcomes and prognostic markers in these patients. METHODS: Non-dialyzed STEC-HUS patients followed for at least 5 years were included. They were grouped and compared according to kidney status at last visit: complete recovery (CR) or chronic kidney disease (CKD). Predictors of CKD evaluated at diagnosis were sex, age, leukocytes, hematocrit, hemoglobin (Hb), and serum creatinine (sCr). Peak sCr and time of follow-up were also analyzed. RESULTS: A total of 122 patients (62 female, median age at diagnosis 1.6 years) with a median follow-up of 11.3 years were included. At last visit, 82 (67%) had CR, 36 (30%) had CKD stage 1, and 4 (3%) had stage 2. No patient developed CKD stage 3-5. Median time to CKD was 5 years (IQR 3.1-8.76 years). Of the 122 patients, 18% evolved to CKD in the first 5 years, increasing to 28% at 10 and 33% at 20 years of follow-up. Serum Cr at diagnosis and peak sCr were significantly higher in patients with CKD than in those with CR. CONCLUSIONS: One third of non-dialyzed STEC-HUS patients evolved to CKD after a median time of 5 years. However, CKD may appear even after 15 years of CR. Serum Cr was significantly higher among patients who evolved to CKD. These data reinforce that all non-dialyzed patients should be followed until adulthood. A higher resolution version of the Graphical abstract is available as Supplementary information.

Asunto(s)

Infecciones por Escherichia coli , Síndrome Hemolítico-Urémico , Insuficiencia Renal Crónica , Escherichia coli Shiga-Toxigénica , Niño , Humanos , Femenino , Adulto , Lactante , Toxina Shiga , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Riñón , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/terapia , Síndrome Hemolítico-Urémico/diagnóstico , Insuficiencia Renal Crónica/complicaciones

RESUMEN

BACKGROUND: Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolysis, thrombocytopenia, and thrombus formation leading to tissue injury. HUS is classified according to its etiology as post-diarrheal or atypical HUS. Differential diagnosis of both entities continues to be a challenge for pediatric physicians. METHODS: The aim was to improve the rapid etiological diagnosis of post-diarrheal HUS cases based on the detection of Shiga toxin (Stx)-producing Escherichia coli (STEC) infection by screening of stx1/stx2 and rfbO157 in cultured stools by multiplex PCR, and the additional detection of anti-lipopolysaccharide (anti-LPS) O157, O145, and O121 antibodies by Glyco-iELISA test. In addition, we studied patients' relatives to detect circulating pathogenic strains that could contribute to HUS diagnosis and/or lead to the implementation of measures to prevent dissemination of familial outbreaks. This study describes the diagnosis of 31 HUS patients admitted to Hospital Municipal de Niños Prof Dr Ramón Exeni during the 2017-2020 period. RESULTS: Stool PCR confirmed the diagnosis of STEC associated with HUS in 38.7% of patients (12/31), while anti-LPS serology did in 88.9% (24/27). In those patients in which both methods were carried out (n = 27), a strong association between the results obtained was found. We found that 30.4% of HUS patients had at least one relative positive for STEC. CONCLUSIONS: We could identify 96.3% (26/27) of HUS cases as secondary to STEC infections when both methods (genotyping and serology) were used. The results demonstrated a high circulation of STEC in HUS families and the prevalence of the STEC O157 serotype (83%) in our pediatric cohort. A higher-resolution version of the Graphical abstract is available as Supplementary information.

Asunto(s)

Síndrome Hemolítico Urémico Atípico , Infecciones por Escherichia coli , Escherichia coli Shiga-Toxigénica , Niño , Humanos , Diarrea/diagnóstico , Diarrea/etiología , Diarrea/epidemiología , Serogrupo , Lipopolisacáridos , Anticuerpos Antibacterianos , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/epidemiología

RESUMEN

Enteropatogenic Escherichia coli (EPEC) and shigatoxigenic E. coli (STEC), are generally poultry and poultry product isolate and can cause serious human infections. Many strains may become resistant to various antimicrobials, which can hinder the treatment of bacterial diseases. Organic farming seeks to avoid the selection and frequency of antimicrobial-resistant bacteria. This study aims to verify the resistance of EPEC and STEC from organic and conventional (industrial) broiler isolates to antimicrobials. All isolates were submitted to disk diffusion test with tetracycline, gentamicin, enrofloxacin, ceftriaxone and amoxicillin + clavulanate (TET, GEN, ENO, CTX, AMC) and PCR to detect specific virulence genes for EPEC and STEC. A total of 297 E. coli strains were isolated, 213 from conventional. In organic broiler, 84 strains were isolated. The strains from the conventional broiler isolates were resistant to five antimicrobials tested: TET 48.82% (104/213), ENO 28.17% (60/213), CTX 15.49% (33/213), GEN 14.55% (31/213), and AMC 7.04% (15/213), and 9.86% (21/213) were considered multidrug-resistant. Organic chicken strains were resistant to four of the antimicrobials tested: TET 35.7% (30/84), ENO 9.5% (8/84), CTX 2.4% (2/84), GEN 4.8% (4/84). Of the strains from the organic broiler chicken isolates, only 1.2% (1/84) was considered multidrug-resistant. No EPEC and STEC were found in the organic chicken samples. The multidrug resistance was characterized in 9.52% (2/21) of the EPEC and 4.76% (1/21) of the STEC. The study demonstrated the absence of EPEC and STEC strains in organic broilers and carcasses and a lower frequency of multiresistant strains compared to conventional breeding.(AU)

Asunto(s)

Pollos/inmunología , Infecciones por Escherichia coli/diagnóstico , Escherichia coli Enteropatógena/patogenicidad , Antiinfecciosos

RESUMEN

This study aims to identify relative proportions of beneficial and pathogenic bacteria in the gut of broilers and risk factors that may be contributing to the development of colibacillosis disease in broiler farms of District Kasur, Punjab, Pakistan. For this, 10 healthy and 10 colibacillosis affected broiler farms were surveyed for ileum and blood sample collection along with data regarding farm management, antibiotic use and hygiene practices. Lactobacillus and Escherichia coli number was estimated using Miles and Misra method and colibacillosis was confirmed by Congo red dye assay. Lactobacillus and E. coli were identified biochemically. For risk factors analysis chi-square analysis was performed to find any significant association between the health status of the farm and risk factors. Results showed during disease and healthy conditions Lactobacillus and Escherichia coli counts differ significantly (p<0.05). E. coli counts (106-108 to 107-109) increased (p<0.05) about three folds and Lactobacillus counts decrease (106-108 to 105-107) about four folds in disease conditions. Risk factor analysis showed colibacillosis disease was significantly associated (p<0.05) with non-vaccinated flocks, natural ventilation systems, rodent presence and the lack of outfit disinfection or change by workers when moving between different houses. It is concluded that E. coli and Lactobacillus work antagonistically to each other. However, further research is necessary to determine the exact mechanisms by which E. coli and Lactobacillus influence the development of colibacillosis. While Lactobacillus as probiotic may help with prevention, good hygiene and management practices are still crucial in preventing the spread of disease.(AU)

Asunto(s)

Animales , Pollos/microbiología , Escherichia coli/patogenicidad , Infecciones por Escherichia coli/diagnóstico , Lactobacillus/patogenicidad , Pakistán , Factores de Riesgo

RESUMEN

Background: Antimicrobial resistance represents a serious public health problem that has caused an increase in the morbidity and mortality of infections, a greater use of antibiotics and excessive hospitalization costs. Objective: To describe the frequency of Escherichia coli and its pattern of bacterial susceptibility in cultures of blood, urine and other body fluids in a tertiary care hospital. Material and methods: A quantitative and retrospective test was designed to evaluate the sensitivity pattern of the data obtained in the Microbiology Department. Descriptive statistics were obtained from the sensitivity patterns of the microorganism studied in the period of time analyzed. Results: The sensitivity pattern of different samples evaluated in the unit (n = 694) was recovered. In the strains analyzed, it was found that about 50% have a positive phenotype for extended-spectrum beta-lactamases and that the sensitivity pattern shows that penicillins, cephalosporins and fluoroquinolones are not adequate antimicrobials to treat infections derived from this microorganism. Conclusions: The antimicrobial pattern obtained demonstrates the imperative need for rational and well-founded use of antibiotic therapy, highlighted by the great difference with reports in other scientific articles. Investment in mechanisms to confirm these patterns is necessary, which is why no expense should be spared for the identification, typification and classification of disease-causing microorganisms.

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Introducción: la resistencia antimicrobiana representa un grave problema de salud pública que ha provocado un aumento en la morbimortalidad de las infecciones, un mayor uso de antibióticos y el exceso en gastos de hospitalización. Objetivo: describir la frecuencia de Escherichia coli y su patrón de susceptibilidad bacteriana en cultivos de sangre, orina y de otros fluidos corporales en un hospital de tercer nivel. Material y métodos: se diseñó un ensayo cuantitativo y retrospectivo para evaluar el patrón de sensibilidad de los datos obtenidos en el departamento de microbiología. Mediante estadística descriptiva se obtuvieron los patrones de sensibilidad del microorganismo estudiado en el periodo de tiempo analizado. Resultados: se recuperó el patrón de sensibilidad de diferentes muestras evaluadas en la unidad (n = 694). En las cepas analizadas, se encontró que cerca del 50% poseen un fenotipo positivo para betalactamasas de expectro extendido y que el patrón de sensibilidad demuestra que penicilinas, cefalosporinas y fluoroquinolonas no son antimicrobianos adecuados para tratar infecciones por este microorganismo. Conclusiones: el patrón antimicrobiano obtenido demuestra la imperiosa necesidad del uso racional y fundamentado de la terapia antibiótica puesto de manifiesto por la gran diferencia con los reportes en otros artículos científicos. Es necesaria la inversión en mecanismos para la confirmación de estos patrones, por lo que no debe escatimarse en gastos para la identificación, tipificación y clasificación de microorganismos causantes de enfermedades.

Asunto(s)

Infecciones por Escherichia coli , Escherichia coli , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Escherichia coli/genética , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/epidemiología , Humanos , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , beta-Lactamasas/genética

RESUMEN

The agouti (Dasyprocta leporina) is a neotropical rodent which has the potential to be domesticated. As such, some research studies have been done on the biology of this animal. Recently, these animals are being kept in captivity as a source of animal protein. Animals which are kept in captivity may present diseases that would not have been reported in the wild due to lack of observation or the lack of occurrence. The aim of this short communication is to report a case of systemic bacterial infection that affected the lungs and liver of a captive agouti. Bacterial analysis revealed that the infection was caused by Escherichia coli. Bacterial infections have been reported in the mammary tissue as well as the skin of the agouti, but to the authors' knowledge, this is the first report of systemic infection in the agouti affecting several organs. This case was seen in a nine-month-old male agouti that was being housed at the University of the West Indies Field Station (UWI, UFS). The animal showed no apparent sign of disease except for lethargy and subsequently died before any treatment was administered. These findings showed that the agouti may have been under some stress (nutritional or environmental) which predisposed this animal to this infection. Future work has to address the nutritional requirements for the growing agouti as well as some treatment options for managements of similar cases in the future.

Asunto(s)

Dasyproctidae/microbiología , Infecciones por Escherichia coli/veterinaria , Animales , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/patología , Resultado Fatal , Hepatopatías/microbiología , Hepatopatías/patología , Hepatopatías/veterinaria , Enfermedades Pulmonares/microbiología , Enfermedades Pulmonares/patología , Enfermedades Pulmonares/veterinaria , Masculino , Enfermedades Cutáneas Bacterianas/microbiología , Enfermedades Cutáneas Bacterianas/patología , Enfermedades Cutáneas Bacterianas/veterinaria

Asunto(s)

Infecciones por Escherichia coli , Síndrome Hemolítico-Urémico , Escherichia coli Shiga-Toxigénica , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/diagnóstico , Femenino , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/diagnóstico , Humanos , Masculino , Pronóstico

RESUMEN

Urinary tract infections are commonly diagnosed in dogs, accounting for 2 to 3% of cases in the clinical routine, as cystitis being the most reported condition. Dogs of all ages and breeds can be affected, and early diagnosis is an important tool for therapeutic success. Urine culture and antibiogram are gold-standard tests for the diagnosis of bacterial cystitis, allowing correct therapy and better recovery of the patient, since currently there is great resistance to antimicrobials used in the veterinary clinics. Thus, the aim of this study was to determine the main etiological agents isolated in dog urine cultures, as well as the resistance and sensitivity profile of the isolated agents in relation to antibiotics, in order to assist the clinician ́s choice of the most appropriate antimicrobial, aiming at the patient's therapeutic success. For this study, a retrospective study was performed of 49 samples of urine cultures of male and female dogs, collected between 2012 and 2021, which were positive for bacterial growth. From this analysis, it was observed that Escherichia coli, Enterococcus spp. and Staphylococcus spp. were the most isolated agents, presenting higher antimicrobial resistance to cephalexin, sulfadiazine plus trimethoprim, ampicillin, enrofloxacin and ciprofloxacin, respectively.(AU)

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s infecções do trato urinário são comumente diagnosticadas em cães, representando de 2 a 3% dos casos na rotina clínica, sendo a cistite a afecção mais relatada. Cães de todas as idades e raças podem ser acometidos, sendo o diagnóstico precoce uma ferramenta importante para o sucesso terapêutico. A urocultura e o antibiograma são exames padrão-ouro para o diagnóstico das cistites bacterianas, permitindo a terapêutica correta e melhor recuperação do paciente, já que atualmente há grande resistência aos antimicrobianos empregados na rotina clínica veterinária. Desta forma, o objetivo deste estudo foi determinar os principais agentes etiológicos isolados nas uroculturas de cães, bem como o perfil de resistência e sensibilidade dos agentes isolados frente aos antibióticos, de modo a auxiliar o médico veterinário na eleição do antimicrobiano mais adequado, visando sucesso terapêutico do paciente. Para realização deste estudo foi feita uma análise retrospectiva de 49 uroculturas de cães machos e fêmeas, coletadas entre os anos de 2012 e 2021, as quais apresentaram crescimento bacteriano positivo. A partir desta análise foi observado que Escherichia coli, Enterococcus spp. e Staphylococcus spp. foram os agentes mais isolados nas uroculturas, apresentando maior resis-tência aos antimicrobianos cefalexina, sulfazotrim ampicilina, enrofloxacina e ciprofloxacina, respectivamente.(AU)

Asunto(s)

Animales , Sistema Urinario/microbiología , Cistitis/diagnóstico , Perros , Infecciones por Escherichia coli/diagnóstico , Fenómenos Fisiológicos Bacterianos , Escherichia coli/inmunología , Antiinfecciosos/orina

RESUMEN

OBJECTIVE: To analyze the results of an enhanced laboratory-surveillance protocol for bloody diarrhea aimed at identifying children with Shiga toxin-producing Escherichia coli (STEC) infection early in the course of the disease toward the early identification and management of patients with hemolytic uremic syndrome (HUS). STUDY DESIGN: The study (2010-2019) involved a referral population of 2.3 million children. Stool samples of patients with bloody diarrhea were screened for Shiga toxin (Stx) genes. Positive patients were rehydrated and monitored for hemoglobinuria until diarrhea resolved or STEC-HUS was diagnosed. RESULTS: A total of 4767 children were screened; 214 (4.5%) were positive for either Stx1 (29.0%) or Stx2 (45.3%) or both Stx1+2 (25.7%); 34 patients (15.9%) developed STEC-HUS (0.71% of bloody diarrheas). Hemoglobinuria was present in all patients with HUS. Patients with Stx2 alone showed a greater risk of STEC-HUS (23.7% vs 12.7%) and none of the patients with Stx1 alone developed HUS. During the same period of time, 95 other patients were diagnosed STEC-HUS but were not captured by the screening program (26 had nonbloody diarrhea, 11 came from areas not covered by the screening program, and 58 had not been referred to the screening program, although they did meet the inclusion criteria). At HUS presentation, serum creatinine of patients identified by screening was significantly lower compared with that of the remaining patients (median 0.9 vs 1.51 mg/dL). CONCLUSIONS: Nearly 1% of children with bloody diarrhea developed STEC-HUS, and its diagnosis was anticipated by the screening program for Stx. The screening of bloody diarrhea for Stx is recommended, and monitoring patients carrying Stx2 with urine dipstick for hemoglobinuria is suggested to identify the renal complication as early as possible.

Asunto(s)

Diarrea/microbiología , Infecciones por Escherichia coli/diagnóstico , Hemorragia Gastrointestinal/microbiología , Síndrome Hemolítico-Urémico/microbiología , Tamizaje Masivo/métodos , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Adolescente , Niño , Preescolar , Diagnóstico Precoz , Infecciones por Escherichia coli/complicaciones , Femenino , Hemorragia Gastrointestinal/diagnóstico , Genes Bacterianos , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/terapia , Humanos , Lactante , Recién Nacido , Italia , Masculino , Toxinas Shiga/genética , Escherichia coli Shiga-Toxigénica/genética , Resultado del Tratamiento , Adulto Joven

RESUMEN

OBJECTIVE: To assess the performance of a hemolytic uremic syndrome (HUS) severity score among children with Shiga toxin-producing Escherichia coli (STEC) infections and HUS by stratifying them according to their risk of adverse events. The score has not been previously evaluated in a North American acute care setting. STUDY DESIGN: We reviewed medical records of children <18 years old infected with STEC and treated in 1 of 38 participating emergency departments in North America between 2011 and 2015. The HUS severity score (hemoglobin [g/dL] plus 2-times serum creatinine [mg/dL]) was calculated using first available laboratory results. Children with scores >13 were designated as high-risk. We assessed score performance to predict severe adverse events (ie, dialysis, neurologic complication, respiratory failure, and death) using discrimination and net benefit (ie, threshold probability), with subgroup analyses by age and day-of-illness. RESULTS: A total of 167 children had HUS, of whom 92.8% (155/167) had relevant data to calculate the score; 60.6% (94/155) experienced a severe adverse event. Discrimination was acceptable overall (area under the curve 0.71, 95% CI 0.63-0.79) and better among children <5 years old (area under the curve 0.77, 95% CI 0.68-0.87). For children <5 years, greatest net benefit was achieved for a threshold probability >26%. CONCLUSIONS: The HUS severity score was able to discriminate between high- and low-risk children <5 years old with STEC-associated HUS at a statistically acceptable level; however, it did not appear to provide clinical benefit at a meaningful risk threshold.

Asunto(s)

Reglas de Decisión Clínica , Servicio de Urgencia en Hospital , Infecciones por Escherichia coli/diagnóstico , Síndrome Hemolítico-Urémico/diagnóstico , Índice de Severidad de la Enfermedad , Escherichia coli Shiga-Toxigénica , Adolescente , Niño , Preescolar , Infecciones por Escherichia coli/complicaciones , Infecciones por Escherichia coli/mortalidad , Femenino , Síndrome Hemolítico-Urémico/complicaciones , Síndrome Hemolítico-Urémico/mortalidad , Humanos , Lactante , Recién Nacido , Masculino , América del Norte , Pronóstico , Estudios Retrospectivos , Medición de Riesgo , Sensibilidad y Especificidad

RESUMEN

OBJECTIVES: This study aimed to evaluate practice patterns during prodromal phase of hemolytic uremic syndrome related to Shiga toxin-producing Escherichia coli (STEC-HUS). METHODS: Trajectories of children from first symptoms until STEC-HUS admitted consecutively at our center (period 2000-2017) were retrospectively reviewed. Early recommended practices include identification of STEC infections, antibiotics and antiperistaltic avoidance, and administration of anticipatory intravenous fluids; therefore, implementation and changes over time (before and after 2011) of such interventions were assessed. In addition, early management was correlated with acute disease outcomes. RESULTS: Of 172 patients, 98 (57%) had early consults, 75 of them visit the pediatric emergency department. Those seen with watery diarrhea (n = 74) were managed as outpatients, whereas 27 of the 45 assisted with bloody diarrhea were hospitalized for diagnosis other than STEC-HUS. Stool cultures were performed in 13.4% (23/172), 18% (31/172) received antibiotics, and 12.8% (22/172) received endovenous fluids; none received antiperistaltic agents. Shiga toxin-producing E. coli infection was proven in 4% (7/172) before HUS. Rate of cultured patients and treated with intravenous fluids remained unchanged over time (P = 0.13 and P = 0.48, respectively), whereas antibiotic prescription decreased from 42.8% to 16.6% (P = 0.005). Main acute outcomes (need for dialysis, pancreatic compromise, central nervous system involvement, and death) were similar (P > 0.05) regardless of whether they received antibiotics or intravenous fluids. CONCLUSIONS: During the diarrheal phase, 57% of patients consulted; three-quarters of them consulted to the pediatric emergency department. Shiga toxin-producing E. coli detection was poor, antibiotic use remained high, and anticipatory volume expansion was underused. These findings outline the critical need to improve the early management of STEC-HUS.

Asunto(s)

Infecciones por Escherichia coli , Síndrome Hemolítico-Urémico , Escherichia coli Shiga-Toxigénica , Niño , Diarrea , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/epidemiología , Síndrome Hemolítico-Urémico/diagnóstico , Síndrome Hemolítico-Urémico/epidemiología , Síndrome Hemolítico-Urémico/terapia , Humanos , Estudios Retrospectivos

RESUMEN

Haemolytic uremic syndrome often affects children causing a relevant morbidity and mortality. We compared the time to diagnosis by multiplex-PCR and stool culture in 15 children from two centres. Multiplex-PCR accelerated the time to diagnosis by 94 (95% confidence interval, 80-119; P = 0.0007) hours. Multiplex-PCR offers a time advantage of stool culture that may aid in earlier identification of outbreak clusters.

Asunto(s)

Heces/microbiología , Síndrome Hemolítico-Urémico/diagnóstico , Reacción en Cadena de la Polimerasa Multiplex , Pruebas en el Punto de Atención , Niño , Preescolar , Diagnóstico Precoz , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/microbiología , Síndrome Hemolítico-Urémico/microbiología , Humanos , Lactante , Estudios Retrospectivos , Escherichia coli Shiga-Toxigénica/genética , Escherichia coli Shiga-Toxigénica/aislamiento & purificación

RESUMEN

PURPOSE: To report the outcomes of using scleral contact lenses as antibiotic reservoirs as a therapeutic approach in a case series of severe infectious keratitis and to discuss the clinical potential. METHODS: This was a prospective consecutive case series study of 12 eyes treated for infectious keratitis at the "Conde de Valenciana" Institute of Ophthalmology. A scleral lens (SL) filled with 0.5% moxifloxacin was used as a reservoir and replaced every 24 hours until epithelization was complete or the culture report and/or antibiogram demonstrated either a microorganism not susceptible to or resistant to moxifloxacin. RESULTS: The study included 12 eyes of 12 patients (7 women; 58.33%; average age of 63 ± 20.11 years). All patients completed at least 1 month of follow-up. Patients had a diagnosis of infectious keratitis, and the SL was fitted on initial consultation. Of the 12 eyes, 7 had culture-positive bacterial infection, 2 eyes were mycotic, and 3 eyes had no culture growth. In 3 eyes, SL was discontinued because of the lack of response (one eye) and to the presence of mycotic infection (2 eyes). All infections resolved favorably at the final follow-up. CONCLUSIONS: The use of SLs could be an alternative for antibiotic impregnation and treatment of infectious keratitis. No complications or side effects were observed related to the use of the scleral contact lens as a reservoir for the antibiotic. This treatment modality could offer a comfortable treatment for the patient, ensuring good impregnation and maintenance of antibiotic concentrations during the 24-hour wear periods.

Asunto(s)

Antibacterianos/administración & dosificación , Lentes de Contacto , Úlcera de la Córnea/tratamiento farmacológico , Portadores de Fármacos/administración & dosificación , Infecciones Bacterianas del Ojo/tratamiento farmacológico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Moxifloxacino/administración & dosificación , Adulto , Anciano , Anciano de 80 o más Años , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Úlcera de la Córnea/diagnóstico , Úlcera de la Córnea/microbiología , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/tratamiento farmacológico , Infecciones por Escherichia coli/microbiología , Infecciones Bacterianas del Ojo/diagnóstico , Infecciones Bacterianas del Ojo/microbiología , Infecciones Fúngicas del Ojo/microbiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Infecciones por Pseudomonas/diagnóstico , Infecciones por Pseudomonas/tratamiento farmacológico , Infecciones por Pseudomonas/microbiología , Esclerótica , Infecciones Estafilocócicas/diagnóstico , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Agudeza Visual , Adulto Joven

RESUMEN

The latex agglutination test using single-chain antibody fragments (scFvStx1 and scFvStx2) coupled to latex particles, was compared with the gold standard Vero cell assay for Shiga toxin (Stx) detection, aiming to estimate the diagnosis potential of these scFv fragments in a rapid and straightforward test. The latex complexes identified the presence of the toxins up to a 1:8 dilution in the majority of the evaluated strains. Moreover, the Stx concentration was indirectly determined in Stx-producing Escherichia coli (STEC) strains, allowing detection limit inference. A Stx dilution curve was constructed, and the data was analyzed in a non-linear model by second-order polynomial regression for prediction (p-value of 0.001 and a R2 above 0.98 were considered for correlations). The detection limit was 30 ng/mL for Stx1 and 10 ng/mL for Stx2. The scFvStx1 and scFvStx2 coupled to latex nanoparticles provide a toxin assay with a competitive Stx detection limit, which has a low cost and short execution time. The diagnostic method proposed here, using, for the first time, recombinant antibody fragments, raises the possibility of developing a more affordable test to be used in the routine detection and surveillance of STEC infections.

Asunto(s)

Infecciones por Escherichia coli/diagnóstico , Pruebas de Fijación de Látex , Toxina Shiga I/aislamiento & purificación , Toxina Shiga II/aislamiento & purificación , Escherichia coli Shiga-Toxigénica , Anticuerpos de Cadena Única/inmunología , Animales , Chlorocebus aethiops , Proteínas Recombinantes/inmunología , Escherichia coli Shiga-Toxigénica/aislamiento & purificación , Células Vero

RESUMEN

INTRODUCTION: We evaluated the presence of sIgA in saliva, versus Escherichia coli secreted proteins (Esp) related to the type III secretion system (T3SS), and its semi-quantitative concentration in children under 2 years-old (no longer breastfed) who were previously colonized or infected with enteropathogenic E. coli (EPEC). METHODS: We analyzed the presence of sIgA in 40 children, who previously had positive cultures for EPEC associated (n=17) or not associated (n=23) with diarrhea, using the Western Blot technique versus E. coli secreted proteins: EspABCD. A semi-quantitative measurement of the reaction for each protein was made by its density peaks (OD). RESULTS: We found sIgA versus all or some EspABCD proteins in both groups. However, the ill patients had higher concentrations of these antibodies than colonized patients. DISCUSSION: The presence of sIgA in saliva could reflect an intestinal immune response and their levels could be related to a greater exposure and/or bacterial load.

Asunto(s)

Escherichia coli Enteropatógena , Infecciones por Escherichia coli , Proteínas de Escherichia coli , Inmunoglobulina A Secretora/análisis , Factores de Virulencia/análisis , Escherichia coli Enteropatógena/inmunología , Infecciones por Escherichia coli/diagnóstico , Infecciones por Escherichia coli/inmunología , Proteínas de Escherichia coli/análisis , Humanos , Lactante , Saliva/inmunología , Sistemas de Secreción Tipo III/análisis