Assuntos
Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/enzimologia , Seleção Genética , Resistência beta-Lactâmica , beta-Lactamases/metabolismo , Adulto , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/isolamento & purificação , Masculino , Testes de Sensibilidade Microbiana , MutaçãoRESUMO
INTRODUCTION: Knowledge of the etiology and antimicrobial susceptibility patterns of uropathogens is important for determining the best treatment option. This study aimed to determine the distribution and antibiotic susceptibility patterns of bacterial strains isolated from adult male outpatients. METHODOLOGY: Between November 2012 and April 2013, 3,105 community urine samples were analyzed from adult male patients who attended the Laboratorio Hidalgo, Buenos Aires, Argentina. Antimicrobial susceptibility testing was performed by the Kirby-Bauer disc diffusion method. Isolates resistant to third generation cephalosporin were tested for extended-spectrum beta-lactamase (ESBL) production using the double-disk synergy test. RESULTS: Of the 3,105 urine samples analyzed, 791 (25.5%) had significant bacteriuria. The frequency of positive urine cultures increased significantly with patient age. Escherichia coli was isolated most frequently (47.3%), followed by Enterococcus faecalis (13.6%), and Klebsiella pneumoniae (11.9%). Gram-negative organisms represented 78.8% of urinary pathogens. The highest activities against Gram-negative bacteria were found with imipenem (99.0%), amikacin (98.1%), ertapenem (94.2%), fosfomycin (90.7%), and piperacillin-tazobactam (90.1%). The frequencies of ESBLs among E. coli, K. pneumoniae, and P. mirabilis were 15.2 %, 22.3%, and 8%, respectively. Fosfomycin, piperacillin-tazobactam, and nitrofurantoin were most effective against Gram-positive organisms. CONCLUSIONS: Fosfomycin may be an excellent option for cystitis treatment in patients without risk factors, whereas piperacillin-tazobactam is preferred for the treatment of parenchymatous UTIs, complicated UTIs, and UTIs associated with risk factors. To ensure the optimal selection of antibiotics, physicians should have access to up-to-date information about the local prevalence of antimicrobial resistance.
Assuntos
Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/microbiologia , Idoso , Idoso de 80 Anos ou mais , Argentina , Bacteriúria/tratamento farmacológico , Bacteriúria/microbiologia , Países em Desenvolvimento , Farmacorresistência Bacteriana , Infecções por Escherichia coli/tratamento farmacológico , Infecções por Escherichia coli/microbiologia , Humanos , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Pacientes AmbulatoriaisRESUMO
The aim of this study was to determine the prevalence of vaginal Escherichia coli colonization and perianal carriage of Enterobacteriaceae resistant to third generation cephalosporins in pregnant women. Vaginal and perianal samples from 259 pregnant women were studied. Vaginal swabs were inoculated onto MacConkey agar plates and perianal swabs were inoculated onto CHROMagar extended-spectrum beta-lactamase (ESBL) plates. The minimal inhibitory concentration of the isolates was determined using the Epsilometer test method. The phenotypic detection of ESBLs was performed by the combined disc method using cefotaxime versus cefotaxime plus clavulanate. The prevalence of vaginal E. coli colonization during pregnancy was 14.3%. The resistance rate to ampicillin, gentamicin, and cefotaxime was 48.6, 10.8, and 0.8%, respectively. Enterobacteriaceae resistant to third generation cephalosporins were recovered in 7.3% of all perianal specimens. Among them, 5.4% of pregnant women were colonized with E. coli ESBL-producer strains. The present study revealed that colonization with Enterobacteriaceae resistant to third generation cephalosporins is significant in pregnancy. ESBL-producing E. coli were the most prevalent organisms. Screening strategies designed to monitor for ESBL-producing E. coli could be useful in endemic areas to prevent perinatal transmission and the introduction of multiresistant strains to the maternity ward.
Assuntos
Escherichia coli/isolamento & purificação , Escherichia coli/metabolismo , Vagina/microbiologia , beta-Lactamases/metabolismo , beta-Lactamases/farmacologia , Antibacterianos/farmacologia , Argentina , Cefotaxima/farmacologia , Cefalosporinas/farmacologia , Ácido Clavulânico/farmacologia , Farmacorresistência Bacteriana , Enterobacteriaceae/efeitos dos fármacos , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/epidemiologia , Escherichia coli/efeitos dos fármacos , Feminino , Idade Gestacional , Humanos , Exposição Materna , Testes de Sensibilidade Microbiana , Gravidez , PrevalênciaRESUMO
INTRODUCTION: The aim of this study was to determine the prevalence of intestinal carriage of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae and carbapenem-resistant Gram-negative bacilli in the community in Buenos Aires, Argentina. METHODOLOGY: Faecal samples from 164 non-hospitalized patients were cultured on CHROMagar KPC and CHROMagar ESBL plates. Isolates resistant to third-generation cephalosporins or carbapenems were selected for further study. The minimal inhibitory concentration (MIC) of the isolates was determined using the E-test method. The phenotypic detection of ESBLs and carbapenemases was performed using the double-disc synergy test. RESULTS: The rate of faecal carriage of Enterobacteriaceae resistant to third-generation cephalosporins was 26.8%. Escherichia coli represented a large majority (75%) of the isolates recovered. Thirty-three ESBL-producing isolates were detected from 31 faecal samples (18.9% of the collected specimens). Eight carbapenem-resistant Gram-negative bacilli were recovered from eight specimens (4.9%). CONCLUSIONS: This study revealed a high prevalence of faecal carriage of multidrug-resistant Gram-negative bacteria, including ESBLs, in Buenos Aires. Therefore, the use of surveillance cultures will be helpful for tracking and monitoring the spread of ESBL-producing Enterobacteriaceae within community settings.
Assuntos
Carbapenêmicos/farmacologia , Portador Sadio/microbiologia , Infecções Comunitárias Adquiridas/microbiologia , Bactérias Gram-Negativas/efeitos dos fármacos , Infecções por Bactérias Gram-Negativas/microbiologia , Resistência beta-Lactâmica , beta-Lactamases/metabolismo , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Antibacterianos/farmacologia , Argentina/epidemiologia , Portador Sadio/epidemiologia , Cefalosporinas/farmacologia , Criança , Pré-Escolar , Infecções Comunitárias Adquiridas/epidemiologia , Fezes/microbiologia , Feminino , Bactérias Gram-Negativas/enzimologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Humanos , Lactente , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
INTRODUCTION: Streptococcus agalactiae has become recognized as a cause of serious illness in newborns, pregnant women, and adults with chronic medical conditions. Optimal antimicrobial therapy for serious infections requires the use of synergistic combinations of a cell wall-active agent, such as a penicillin, with an aminoglycoside, which results in bactericidal activity against this organism. The synergistic effect is eliminated by the acquisition of high-level resistance (HLR) to aminoglycosides. The aim of our study was to determine the prevalence of HLR to gentamicin (GEN) and streptomycin (EST).The ability to detect HLR using a standard agar screen plate and high-content discs was investigated. METHODS: This study was conducted with 141 strains of S. agalactiae isolated from vaginal and rectal swabs of pregnant women at term. Minimum inhibitory concentrations (MICs) to GEN and STR were determined by the E-test method. Disks of GEN (120 µg) and STR (300 µg) were used to detect HLR. Agar screening plates were performed with GEN 100 mg/L, GEN 500 mg/L and STR 2000 mg/L. RESULTS: The HLR to GEN and STR was detected in 13.5% and 16.3% of the isolates respectively. Among 141 strains, 7.8% were simultaneously resistant to GEN and STR. With 120-µg GEN and 300-µg STR disks, strains for which MICs were ≥ 512 mg/L and ≥ 1024 mg/L had no zones of inhibition. Isolates with inhibitory zones for GEN and STR of ≥13 mm showed a MICs ≤ 64 mg/L and ≤ 512 mg/L. All the screening plates were negative for these isolates. HLR to aminoglycosides was associated (83.9%) with resistance to erythromycin and/or clindamycin. CONCLUSIONS: This study highlights the emergence of strains with HLR to aminoglycosides. The disk-agar diffusion test performed with high-content aminoglycoside disks and screening plates can provide laboratories with a convenient and reliable method for detecting S. agalactiae isolates that are resistant to aminoglycoside-betalactam synergy.
Assuntos
Antibacterianos/farmacologia , Gentamicinas/farmacologia , Infecções Estreptocócicas/epidemiologia , Infecções Estreptocócicas/microbiologia , Streptococcus agalactiae/efeitos dos fármacos , Estreptomicina/farmacologia , Adulto , Argentina/epidemiologia , Farmacorresistência Bacteriana , Feminino , Humanos , Testes de Sensibilidade Microbiana , GravidezRESUMO
Objetivo: Comparar la calidad de vida (CDV) de los egresados de una Escuela de Medicina peruana que migraron al extranjero y de los que permanecieron en el país. Material y método: Se utilizó un cuestionario basado en una combinación de dos herramientas para medir la CDV de proveedores de salud previamente validadas, para evaluar auto-satisfacción (grupo A), las relaciones interpersonales y sociales (grupo B) y los niveles de satisfacción personal (grupo C). Es cuestionario se envió por correo electrónico a los graduados de la Universidad Peruana Cayetano Heredia. Resultados: La tasa de respuesta fue 35%. Los niveles de ingreso económico fueron significativamente menores en los médicos que permanecieron en el Perú en comparación con los que migraron. En muy pocas preguntas se encontró diferencia significativa. En el grupo A, los médicos que migraron percibieron una CDV significativamente mayor solo en la expectativa de futuro. En el grupo B, esto se alcanzó diferencias sólo en el grado de apoyo y el nivel de conflicto entre colegas , y en el grupo C, en el nivel de información recibida acerca de los resultados de su trabajo (ôfeedbackõ), el esfuerzo físico del trabajo diario (estrés físico), las oportunidades de expresar lo que se piensa y necesita, el esfuerzo del hospital para mejorar la CDV de sus trabajadores, el entrenamiento necesario para realizar el trabajo diario, y la variedad en el trabajo. Los médicos que migraron percibieron una mayor aceptación en la profesión, en la sociedad en general y dentro de la comunidad donde viven. De manera significativa más médicos que migraron no tenían intenciones de cambiar sus niveles actuales de vida. Conclusiones: La CDV percibida de los médicos estudiados fue similar en la mayoría de preguntas examinadas entre ambos grupos, a pesar de la marcada diferencia encontrada en los niveles de ingreso económico.
Objective: To compare the quality of life (QOL) of the graduated from a Peruvian medical school who migrated abroad and those who remained in the country. We also intended to address the level of integration of Peruvian international medical graduates (IMGs) into the United States (US). Material and methods: A combination of two previously validated tools designed to measure QOL of health care practitioners (HCPs) was used to create a survey, including questions that analyzed self-satisfaction (group A), interpersonal/social relationships (Group B) and professional satisfaction (Group C), which was e-mailed to graduates from a Peruvian Medical School. Results: The response rate was 35%. Income levels were significantly lower for HCPs practicing in Peru than those practicing abroad. Very few question items reached statistical significant differences between groups. In group A, IMGs who migrated perceived a significantly higher QOL only in the perception of their future. In group B, was achieved only in the peer support and the conflict level with coworkerÆs categories. In group C, only in the work feedback, job physical discomfort, expression opportunities, hospital attempts to improve the QOL of their position, necessary training for job performance and work variety categories. However, of 41/44 items showed a better (more satisfied) response from the abroad group, of which 13 achieve statistical significance (8 at the 1% level). IMGs practicing abroad perceived a high acceptance into the foreign profession, society and living community. Significantly most IMGs do not intend to change their current status. Conclusions: Very few significant differences were noted in the perceived QOL of physicians between groups, in spite of a marked income discrepancy. However, there was a clear trend for dissatisfaction in the Peru group on several important items that, without reaching statistical significance, may indicate the adverse effect of Peruvian...
Assuntos
Humanos , Masculino , Feminino , Qualidade de Vida , Educação Médica , Emigração e Imigração , MédicosRESUMO
Pulmonary disease, due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlying other diseases. In our country, there is no updated information on the prevalence of this pulmonary disease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary disease due to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment and evolution.
Assuntos
Soronegatividade para HIV , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Pneumonia Bacteriana/microbiologia , Adulto , Idoso , Argentina/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/imunologia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/terapiaRESUMO
La enfermedad provocada por micobacterias ambientales es sospechada fundamentalmente en pacientesHIV positivos o con otras enfermedades de base. En nuestro país no hay información actualizadaacerca de la prevalencia, tratamiento y evolución de esta enfermedad en pacientes inmunocompetentes.Presentamos 10 casos de enfermedad pulmonar por micobacterias ambientales en pacientes inmunocompetentes:diagnóstico clínico-bacteriológico, tratamiento y evolución.
Pulmonary disease,due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlyingother diseases. In our country, there is no updated information on the prevalence of this pulmonarydisease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary diseasedue to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment andevolution.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções por HIV/imunologia , Soronegatividade para HIV , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Pneumonia Bacteriana/microbiologia , Argentina/epidemiologia , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/imunologia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/terapia , Tomografia Computadorizada por Raios XRESUMO
La enfermedad provocada por micobacterias ambientales es sospechada fundamentalmente en pacientesHIV positivos o con otras enfermedades de base. En nuestro país no hay información actualizadaacerca de la prevalencia, tratamiento y evolución de esta enfermedad en pacientes inmunocompetentes.Presentamos 10 casos de enfermedad pulmonar por micobacterias ambientales en pacientes inmunocompetentes:diagnóstico clínico-bacteriológico, tratamiento y evolución. (AU)
Pulmonary disease,due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlyingother diseases. In our country, there is no updated information on the prevalence of this pulmonarydisease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary diseasedue to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment andevolution. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Pneumonia Bacteriana/microbiologia , Infecções por HIV/imunologia , Soronegatividade para HIV , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/imunologia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/terapia , Argentina/epidemiologia , Tomografia Computadorizada por Raios XRESUMO
La enfermedad provocada por micobacterias ambientales es sospechada fundamentalmente en pacientesHIV positivos o con otras enfermedades de base. En nuestro país no hay información actualizadaacerca de la prevalencia, tratamiento y evolución de esta enfermedad en pacientes inmunocompetentes.Presentamos 10 casos de enfermedad pulmonar por micobacterias ambientales en pacientes inmunocompetentes:diagnóstico clínico-bacteriológico, tratamiento y evolución. (AU)
Pulmonary disease,due to Mycobacteria other than tuberculosis, is mainly suspected in HIV + patients, or underlyingother diseases. In our country, there is no updated information on the prevalence of this pulmonarydisease, its treatment and evolution in immucocompetent patients. We present 10 cases of pulmonary diseasedue to Mycobacteria other than tuberculosis in non HIV patients: clinical-bacteriological diagnosis, treatment andevolution. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Complexo Mycobacterium avium/isolamento & purificação , Infecção por Mycobacterium avium-intracellulare/epidemiologia , Pneumonia Bacteriana/microbiologia , Infecções por HIV/imunologia , Soronegatividade para HIV , Infecção por Mycobacterium avium-intracellulare/complicações , Infecção por Mycobacterium avium-intracellulare/imunologia , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/terapia , Argentina/epidemiologia , Tomografia Computadorizada por Raios XRESUMO
Beta hemolytic streptococci, particulary group A, are the most frequently isolated pathogens in cases of pharyngoamigdalitis. Other beta hemolytic streptococci also produce this pathology. An increase of positive cultures for group A streptococci was detected during 2004 in relation to previous years. The aim of this study was to determine the isolation rates of beta hemolytic streptococci groups A, C and G during a period of 5 years. Pharyngeal exudates were obtained from children (aged 6 months to 18 years) and adults. Swabs were cultured on Columbia agar plates containing 5% sheep blood. Lancefield grouping was performed using a latex immunoagglutination test. Group A beta hemolytic streptococci were isolated significantly more frequently from pediatric population than from adults. Groups A, C and G beta hemolytic streptococci were isolated significantly more frequently during 2004 than in previous years. Group G beta hemolytic was more prevalent in adult population than in patients less than 18 years of age. Among the isolated beta hemolytic streptococci, in adults and children, 18.9% and 5.8% were non-group A streptococci, respectively. Therefore special attention should be paid not only to group A beta hemolytic streptococci but also to other groups. Throat culture is the most reliable method for detecting the presence of the beta hemolytic streptococci and should also be indicated in adult patients.
Assuntos
Faringite/microbiologia , Faringe/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificação , Adolescente , Adulto , Argentina , Criança , Pré-Escolar , Humanos , Lactente , Faringite/complicações , Infecções Estreptocócicas/complicações , Streptococcus/classificação , Streptococcus pyogenes/isolamento & purificaçãoAssuntos
Política , Sistemas de Saúde , Regionalização da Saúde , Programas Médicos Regionais , UruguaiRESUMO
Beta hemolytic streptococci, particulary group A, are the most frequently isolated pathogens in cases of pharyngoamigdalitis. Other beta hemolytic streptococci also produce this pathology. An increase of positive cultures for group A streptococci was detected during 2004 in relation to previous years. The aim of this study was to determine the isolation rates of beta hemolytic streptococci groups A, C and G during a period of 5 years. Pharyngeal exudates were obtained from children (aged 6 months to 18 years) and adults. Swabs were cultured on Columbia agar plates containing 5
sheep blood. Lancefield grouping was performed using a latex immunoagglutination test. Group A beta hemolytic streptococci were isolated significantly more frequently from pediatric population than from adults. Groups A, C and G beta hemolytic streptococci were isolated significantly more frequently during 2004 than in previous years. Group G beta hemolytic was more prevalent in adult population than in patients less than 18 years of age. Among the isolated beta hemolytic streptococci, in adults and children, 18.9
and 5.8
were non-group A streptococci, respectively. Therefore special attention should be paid not only to group A beta hemolytic streptococci but also to other groups. Throat culture is the most reliable method for detecting the presence of the beta hemolytic streptococci and should also be indicated in adult patients.