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BACKGROUND: The aim of this study was to summarize existing data and perform technological prospecting on the effect of incorporating antifungal agents into denture base materials in inhibiting Candida spp., as well as to explore the antimicrobial properties of these materials. METHODS: A comprehensive electronic search was carried out in six major bibliographic databases (PubMed, Scopus, Embase, Cochrane Library, Web of Science and Lilacs) until February 2024. In addition, international patent databases were also examined. The search process, study and patent selection, data extraction and risk of bias assessment were carried out independently by researchers. The collected data underwent qualitative analysis. RESULTS: A total of 10 718 articles were identified in the searched databases, of which 40 documents were included for qualitative data analysis (articles: 31; patents: 9). The majority of the studies focused on investigating tissue conditioners (n = 14) and acrylic resins (n = 14). The primary antifungal agents studied were nystatin (n = 15) and fluconazole (n = 13). The most commonly utilized microbiological evaluation methodology was the agar diffusion test (n = 16), followed by the microdilution (n = 7) and biofilm formation assays (n = 7). All of the studies investigated the inhibitory effect of these materials against Candida species. CONCLUSION: The incorporation of antifungal agents into denture base materials has been extensively studied and has shown a significant inhibitory response against Candida spp. across various methodological assays.
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Objetivo: analisar o perfil de micro-organismos presentes e resistência destes aos antimicrobianos em uroculturas de pacientes transplantados renais no período de 2021-2022. Métodos: trata-se de um estudo transversal com análise quantitativa dos dados de uroculturas positivas de pacientes transplantados renais, acompanhados no Hospital Geral de Fortaleza entre janeiro de 2021 a dezembro de 2022. Foi empregado um instrumento de pesquisa elaborado, contendo variáveis classificatórias, e os dados foram obtidos por meio de registros das uroculturas existentes no sistema de prontuário eletrônico utilizado pelo hospital. Resultados: das 534 uroculturas solicitadas, 36,7% apresentaram resultado positivo, sendo 60,4% de mulheres com idades entre 20 e 59 anos. A maioria dos casos foram desenvolvidos por pacientes que receberam acompanhamento ambulatorial (56,2%). Os micro-organismos isolados foram, predominantemente, enterobactérias (81,34%), com prevalência de E.coli (69,30%). Os perfis de sensibilidade antimicrobiana variaram, com a resistência da E.coli a antibióticos como ampicilina, ácido nalidíxico, norfloxacino e ciprofloxacino. Conclusões: essas descobertas fornecem informações importantes sobre métodos clínicos específicos, métodos preventivos e melhorias na qualidade de vida dos transplantados renais.
Objective: to analyze the profile of microorganisms present and their resistance to antimicrobials in urocultures of renal transplant patients in 2021-2022. Methods: it is a cross-sectional study with quantitative data analysis from positive urocultures of renal transplant patients accompanied at the General Hospital of Fortaleza between January 2021 and December 2022. An elaborate research instrument containing classification variables was employed, and the data were obtained through records of the urocultures existing in the electronic checkbook system used by the hospital. Results: of the 534 urocultures requested, 36.7% showed a positive result, of which 60.4% were women aged between 20 and 59. Most cases were developed by patients who received outpatient follow-up (56.2%). The isolated microorganisms were predominantly enterobacteria (81.34%), with the prevalence of E.coli (69.30%). Antimicrobial sensitivity profiles varied, with E.coli resistance to antibiotics such as ampicillin, nalidixic acid, norfloxacin, and ciprofloxacin. Conclusion: these findings provide important information about specific clinical methods, preventive methods, and improvements in the quality of life of renal transplant patients.
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Humanos , Masculino , Feminino , Microbiota , Transplantados , Anti-Infecciosos , Pacientes , RimRESUMO
The emergence of resistant fungal species and the toxicity of currently available antifungal drugs are relevant issues that require special consideration. Cyclodextrins inclusion complexes could optimize the antimicrobial activity of such drugs and create a controlled release system with few side effects. This study aimed to assess the in vitro toxicity and antifungal effectiveness of nystatin (Nys) and chlorhexidine (Chx) complexed or not with ß-cyclodextrin (ßCD). First, a drug toxicity screening was performed through the Artemia salina bioassay. Then, the minimum inhibitory concentrations (MICs) against Candida albicans were determined with the broth microdilution test. After MICs determination, the cytotoxicity of the drugs was evaluated through the methyl-thiazolyl-tetrazolium (MTT) and neutral red (NR) assays and through cell morphology analysis. The PROBIT analysis was used to determine the median lethal concentration (LC50), and the cell viability values were submitted to one-way analysis of variance(ANOVA)/Tukey (α = 0.05). Overall, the ßCD-complexed antifungals were less toxic against A. salina than their raw forms, suggesting that inclusion complexes can reduce the toxicity of drugs. The MICs obtained were as follows: Nys 0.5 mg/L; Nys:ßCD 4 mg/L; Chx 4 mg/L; and Chx:ßCD 8 mg/L. Chx showed significant cytotoxicity (MTT: 12.9 ± 9.6%; NR: 10.6 ± 12.5%) and promoted important morphological changes. Cells exposed to the other drugs showed viability above 70% with no cellular damage. These results suggest that antifungals complexed with ßCD might be a biocompatible option for the treatment of Candida-related infections.
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Antifúngicos , beta-Ciclodextrinas , Antifúngicos/toxicidade , Candida , Nistatina/toxicidade , Candida albicans , Clorexidina/farmacologia , beta-Ciclodextrinas/toxicidadeRESUMO
ABSTRACT This study aimed to determine the antibiotic profile of microorganisms isolated from urine samples of patients with community urine tract infections (UTI) admitted to the University Hospital of the Federal University of Sao Carlos to support an appropriate local empirical treatment. A retrospective cross-sectional study was conducted from October 2018 to October 2020. Data from 1,528 positive urine cultures for bacterial pathogens and antibiograms were tabulated. Bacterial species prevalence and their resistance profile were analyzed and compared by sex and age. For Gram-negative fermenting bacteria, resistance rates were compared between patients with previous hospitalization and the total of infections caused by this group. For comparisons, the Chi-square test was performed, using Fisher's exact test when necessary (BioEstat program, adopting p ≤ 0.05). A multivariate analysis was applied to assess the effect of the studied variables in predicting multidrug resistance. Infections were more prevalent in women and older adults. Gram-negative bacteria represented 90.44% of total cultures. In both sexes, E. coli prevalence was significantly higher in adults compared with older adults (p < 0.0001). For several antibiotics, resistance rates were higher in the older adults compared with other ages and in patients with Gram-negative fermenting infections and previous hospitalization compared with the total of infections by this group of bacteria. The closer to the hospitalization, the higher the number of antibiotics with superior resistance rates. Resistance rates for aminoglycosides, carbapenems, ceftazidime, nitrofurantoin, piperacillin+tazobactam, and fosfomycin were less than 20%, considered adequate for empirical treatment. Only hospitalization in the previous 90 days was statistically significant in predicting infections by multidrug-resistant bacteria.
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Background and Objectives: Staphylococcus aureus is a prevalent bacterium capable of inducing various infections, including skin and soft tissue infections, bloodstream infections, pneumonia, and surgical site infections. The emergence of antimicrobial resistance in S. aureus, particularly methicillin-resistant S. aureus, has raised substantial concerns within global healthcare settings. Prior to antibiotic prescription, the ideal approach is antimicrobial susceptibility testing (AST); however, this is frequently perceived as excessively complex and time-intensive. Lab-on-a-chip (LOC) technology holds promise in addressing these challenges and advancing fundamental microbiological research while also aiding in the development of therapeutic strategies. This systematic review aims to evaluate the potential utility of LOC for AST of S. aureus. Materials and Methods: This study adhered to the PRISMA guidelines. Various databases, including SCOPUS, PubMed/MEDLINE, SCIELO, and LILACS, in addition to gray literature sources, were employed in the review process. Results: Sixteen studies were included in this systematic review. All these studies detailed the effectiveness, rapidity, and predictability of LOC systems for assessing S. aureus susceptibility to various antibiotics. When comparing the LOC approach to traditional manual methods, it was evident that LOC requires a minimal quantity of reagents. Furthermore, most studies reported that the entire LOC procedure took 10 min to 7 h, with results being equally accurate as those obtained through traditional AST protocols. Conclusions: The potential application of LOC for AST of S. aureus is emphasized by its ability to provide rapid access to minimum inhibitory concentration data, which can substantially aid in selecting the most suitable antibiotics and dosages for treating challenging infections caused by this microorganism. Moreover, the rapid AST facilitated by LOC holds promise for enhancing the appropriateness and efficacy of therapy in clinical settings.
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Staphylococcus aureus Resistente à Meticilina , Infecções Estafilocócicas , Humanos , Staphylococcus aureus , Antibacterianos/farmacologia , Antibacterianos/uso terapêutico , Infecções Estafilocócicas/tratamento farmacológico , Dispositivos Lab-On-A-ChipRESUMO
INTRODUCTION: Malassezia is a lipophilic and lipid-dependent yeast genus belonging to the skin microbiota of humans and other animals. However, due to dysbiosis processes or other factors in the host, this yeast can cause different pathologies, ranging from skin diseases, such as seborrheic dermatitis, to fungemia. Isolation of Malassezia furfur has been reported in HIV-positive patients with or without skin lesions. Due to its opportunistic nature and its variable resistance to antifungal compounds, it is relevant to know the Malassezia sensitivity profiles. OBJECTIVE: To determine the sensitivity to different antifungal agents, of clinical isolates of M. furfur obtained from HIV-positive or negative patients, with or without seborrheic dermatitis. MATERIALS AND METHODS: Assessment of isolates sensitivity to itraconazole, voriconazole, fluconazole, and amphotericin B was performed by two techniques: (1) Broth microdilution using Clinical and Laboratory Standards Institute (CLSI) protocol M27-A3 with modifications; and (2) agar tests using Etest®. RESULTS: Isolates obtained from HIV patients showed an increase in the minimum inhibitory concentration of fluconazole, voriconazole, and amphotericin B, compared with those of non-HIV patients. Itraconazole was the antifungal with the lowest minimum inhibitory concentration (MIC) in most isolates. CONCLUSION: We observed differences in the sensitivity profiles of M. furfur isolates according to the context of the patient. High MIC of antifungals like fluconazole, commonly used for treating pathologies caused by Malassezia, were identified.
Introducción: Malassezia es un género de levaduras lipofílicas que dependen de los lípidos y hacen parte de la microbiota de la piel de humanos y otros animales. No obstante, debido a procesos de disbiosis u otros factores en el huésped, esta levadura puede llegar a causar diferentes enfermedades: desde cutáneas (como dermatitis seborreica) hasta fungemias. Se han reportado aislamientos de Malassezia furfur en pacientes positivos para HIV, con lesiones cutáneas o sin ellas. Por su carácter oportunista y sensibilidad variable a los compuestos antifúngicos, es relevante conocer los perfiles de sensibilidad. Objetivo: Determinar la sensibilidad a diferentes antifúngicos de aislamientos clínicos de M. furfur obtenidos de pacientes positivos o negativos para HIV, con dermatitis seborreica o sin ella. Materiales y métodos: La sensibilidad de los aislamientos a itraconazol, voriconazol, fluconazol y anfotericina B, se determinó mediante dos técnicas: microdilución en caldo según el protocolo M27-A3 del Clinical & Laboratory Standards Institute (CLSI), con modificaciones, y pruebas en agar mediante Etest®. Resultados: Los aislamientos obtenidos de pacientes con HIV mostraron aumento de la concentración inhibitoria mínima a fluconazol, voriconazol y anfotericina B, en comparación con los de pacientes sin HIV. Por otro lado, al evaluar la mayoría de los aislamientos, el itraconazol fue el antifúngico con la menor concentración inhibitoria mínima. Conclusión: Se evidencian diferencias en los perfiles de sensibilidad de los aislamientos de M. furfur, según el contexto del paciente, y elevadas concentraciones inhibitorias mínimas de antifúngicos como el fluconazol, usados comúnmente para el tratamiento de las enfermedades causadas por Malassezia spp.
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Dermatite Seborreica , Infecções por HIV , Malassezia , Animais , Humanos , Antifúngicos/farmacologia , Fluconazol/farmacologia , Anfotericina B/farmacologia , Itraconazol , Voriconazol/farmacologia , Saccharomyces cerevisiaeRESUMO
Introducción: Staphylococcus aureus (SA) puede ocasionar cuadros infecciosos severos y muerte. La emergencia de cepas resistentes a meticilina constituye un desafío terapéutico. Objetivos: determinar el perfil de resistencia antimicrobiana de: Staphylococcus aureus adquirido en la comunidad (SA-CA), obtenidos de muestras biológicas de niños, entre 2015 a 2020. Material y Método: estudio descriptivo, observacional y retrospectivo. Las muestras para cultivos se extrajeron al ingreso hospitalario del paciente. Para determinación de resistencia y sensibilidad se utilizó normas de CSLI. Resultados: 244 aislamientos de SA-CA. Masculinos 99 (59%), menores de un año: 42 (25%), de 2 a 5 años: 34 (20%), de 6 a 11 años: 50 (30%) y entre 12 a 15 años: 42 (25%). De los aislados, 72% fueron SAMR (121/168) y 28% SAMS (47/168). Se observó un incremento de tasas anuales de aislamientos SAMR en infecciones de la comunidad desde el 2015 al 2020. Los aislamientos se originaron en piel y partes blandas 53,2 %; sangre 37,4%, orina 3,5%, LCR 2,4%, liquido articular 1,7%, abscesos profundos 1,2% y liquido pleural 0,6%. La prevalencia de SAMR-CA fue de 60,5 en el 2015, 59,6 %, 61,5%, 72,2 %, 67,3% y 75,5 % en los años sucesivos. No se aisló ninguna cepa resistente a la vancomicina. El 10,1% de las cepas estudiadas presentó resistencia inducida a la clindamicina. Conclusión: El SAMR se ha establecido como patógeno de la comunidad. La resistencia inducida por clindamicina fue del 10,1%. Un tercio de las infecciones fueron causadas por SAMS. Las prevalencias de SAMS muestran tendencia a la disminución.
Introduction: Staphylococcus aureus (SA) can cause severe infectious conditions and death. The emergence of methicillin-resistant strains constitutes a therapeutic challenge. Objectives: to determine the antimicrobial resistance profile of: Staphylococcus aureus acquired in the community (SA-CA), obtained from biological samples of children, between 2015 and 2020. Material and Method: descriptive, observational and retrospective study. The samples for cultures were extracted upon hospital admission of the patient. To determine resistance and sensitivity, CSLI standards were used. Results: 244 isolates of SA-CA. Males 99 (59%), under one-year-old: 42 (25%), from 2 to 5 years old: 34 (20%), from 6 to 11 years old: 50 (30%) and between 12 and 15 years old: 42 (25%). Of the isolates, 72% were SAMR (121/168) and 28% SAMS (47/168). An increase in annual rates of MRSA isolates in community infections was observed from 2015 to 2020. The isolates originated in skin and soft parts 53.2 %; blood 37.4%, urine 3.5%, CSF 2.4%, joint fluid 1.7%, deep abscesses 1.2% and pleural fluid 0.6%. The prevalence of MRSA-CA was 60.5 in 2015, 59.6%, 61.5%, 72.2%, 67.3%, and 75.5% in subsequent years. No vancomycin resistant strain was isolated. 10.1% of the strains studied presented induced resistance to clindamycin. Conclusion: MRSA has been established as a community pathogen. The resistance induced by clindamycin was 10.1%. One third of the infections was caused by SAMS. The prevalence of SAMS shows a downward trend.
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Objective: To describe antimicrobial resistance profiles of Escherichia coli and Salmonella spp. isolated from chicken carcasses and the antimicrobials commonly used in animals in Ecuador and provide information on antimicrobial resistance patterns for implementing evidence-based corrective measures. Methods: Meat samples were collected from chicken carcasses in 199 slaughterhouses across Ecuador as part of a national pilot study for monitoring antimicrobial resistance in agricultural sources in 2019. Samples were tested for E. coli and Salmonella spp. Sensitivity to 10 critically important and three highly important antimicrobials (from a human health perspective) was assessed. The country report submitted to the World Organization for Animal Health was accessed to extract the quantity of antimicrobials produced or imported for use in animals. Results: Of 383 samples, E. coli was isolated from 148 (39%) and Salmonella spp. from 20 (5%) samples. Ninety percent of the isolates were resistant to at least one critically important antimicrobial. Resistance was highest to erythromycin (E. coli 76%; Salmonella spp. 85%) and tetracycline (E. coli 71%; Salmonella spp. 90%). Critically or highly important antimicrobials (colistin, tetracycline, trimethoprim/sulfamethoxazole) formed the bulk (87%) of antimicrobials used in animals as per the World Organization for Animal Health report. Conclusions: High prevalence of antimicrobial resistance in poultry in Ecuador calls for the development of guidelines and regulations on the use of antimicrobials and for engagement with livestock producers. The existing surveillance system needs to be strengthened to improve the monitoring of antimicrobial use and evolving resistance patterns.
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Introduction. The M. abscessus molecular identification and its drug-resistance profile are important to choose the correct therapy.Aim. This work developed a multiplex real-time PCR (mqPCR) for detection of clarithromycin resistance genes for the Mycobacterium abscessus group.Methodology. Isolates received by Adolfo Lutz Institute from 2010 to 2012, identified by PCR restriction enzyme analysis of a fragment of the hsp65 gene (PRA-hsp65) as M. abscessus type 1 (n=135) and 2 (n=71) were used. Drug susceptibility test (DST) for CLA were performed with reading on days 3 and 14. Subespecies identification by hsp65 and rpoB genes sequencing and erm(41) and rrl genes for mutation detection and primer design were performed. erm(41) gene deletion was detected by conventional PCR. Primers and probes were designed for five detections: erm(41) gene full size and with deletion; erm(41) gene T28 and C28; rrl gene A2058.Results. In total, 191/206 (92.7â%) isolates were concordant by all methods and 13/206 (6.3â%) were concordant only between molecular methods. Two isolates (1.0â%) were discordant by mqPCR compared to rrl gene sequencing. The mqPCR obtained 204/206 (99.0â%) isolates in agreement with the gold standard, with sensitivity and specificity of 98 and 100â%, respectively, considering the gold standard method and 92 and 93â% regarding DST.Conclusion. The mqPCR developed by us proved to be an easy-to-apply tool, minimizing time, errors and contamination.
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Infecções por Mycobacterium não Tuberculosas , Mycobacterium abscessus , Humanos , Claritromicina/farmacologia , Antibacterianos/farmacologia , Mycobacterium abscessus/genética , Reação em Cadeia da Polimerase em Tempo Real , Testes de Sensibilidade Microbiana , Infecções por Mycobacterium não Tuberculosas/microbiologia , Farmacorresistência Bacteriana/genéticaRESUMO
SUMMARY OBJECTIVE: The aim of this study was to evaluate the demographic data, molecular epidemiology, and in vitro antifungal susceptibility results of patients with Aspergillus isolated from various clinical specimens. METHODS: A total of 44 Aspergillus strains were studied. The definition of invasive aspergillosis in patients was made according to European Organization for Research and Treatment of Cancer/Invasive Fungal Infections Cooperative Group and the National Institute of Allergy and Infectious Diseases Mycoses Study Group (EORTC/MSG) criteria. Strains were phenotypically and molecularly identified. Demographic characteristics of patients and genotypes of strains were evaluated. Phylogenetic analysis was done by the The Unweighted Pair-Group Method with Arithmetic Mean (UPGMA). Antifungal susceptibility of strains was determined according to The Clinical and Laboratory Standards Institute (CLSI)-M61-Ed2 and The European Committee on Antimicrobial Susceptibility Testing (EUCAST). RESULTS: A total of 11 patients were classified as proven and 33 as probable invasive aspergillosis. There was a statistically significant difference in age groups, subdisease, neutropenic, and receiving chemotherapy between groups. A total of 23 strains were identified as Aspergillus fumigatus, 12 as Aspergillus niger, 6 as Aspergillus flavus, and 3 as Aspergillus terreus. Phylogenetic analysis revealed five different genotypes. No statistical difference was found in the comparisons between patients groups and genotype groups. There was a statistically significant difference between genotype groups and voriconazole, posaconazole, and itraconazole Minimum Inhibition Concentration (MIC). CONCLUSION: Accurate identification of strains and antifungal susceptibility studies should be performed due to azole and amphotericin B resistance. Genotyping studies are important in infection control due to identifying sources of infection and transmission routes.