RESUMO
BACKGROUND: Previous studies have found that healthcare-associated bacteremia (HAB) by Aeromonas species is associated with mortality. However, there is limited data on this outcome in patients with hematologic malignancies. This study aimed to identify the clinical features of patients with malignant hematologic diseases diagnosed with Aeromonas sobria bacteremia and to evaluate whether the type of bacteremia, community-acquired bacteremia (CAB) or HAB, is associated with mortality. METHODS: We retrospectively reviewed the clinical records of pediatric and adult patients between January 2000 and December 2017. Clinical characteristics were compared between CAB and HAB. Additionally, we stratified based on age group. Survival outcomes were assessed with Kaplan-Meier curves and a multivariate Cox regression analysis. RESULTS: A total of 37 patients (median age 24 years) were identified; 23 (62%) had HAB and 14 (38%) had CAB. Overall, the most common presenting symptom was abdominal pain (41%). Acute lymphoblastic leukemia (n = 12/15, 80%) and acute myeloid leukemia (n = 8/22, 36%) were the primary hematologic malignancies in pediatric and adult patients, respectively. CAB patients had worse overall survival (OS) rates at 30 days in all (43% versus HAB 91%, p = 0.006) and adult patients (30% versus HAB 92%, p = 0.002). Cox regression analysis found that quick Sequential Organ Failure Assessment and CAB were statistically significant factors associated with mortality. Low antimicrobial-resistant was noted, except for ciprofloxacin (n = 5/37, 14%). CONCLUSION: Our study found a worse OS among patients with hematologic malignancies and CAB by Aeromonas sobria. Our results suggest that patients with CAB present with a worse disease severity. These findings should aid clinicians to determine the survival prognosis in this population.
Assuntos
Aeromonas/isolamento & purificação , Bacteriemia/patologia , Neoplasias Hematológicas/patologia , Adolescente , Adulto , Aeromonas/efeitos dos fármacos , Idoso , Bacteriemia/complicações , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Criança , Pré-Escolar , Ciprofloxacina/farmacologia , Infecção Hospitalar/complicações , Infecção Hospitalar/microbiologia , Infecção Hospitalar/mortalidade , Infecção Hospitalar/patologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Feminino , Neoplasias Hematológicas/complicações , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Insuficiência de Múltiplos Órgãos , Peru , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Adulto JovemAssuntos
Coinfecção , Infecções por Coronavirus/patologia , Pulmão/patologia , Pneumonia Viral/patologia , Idoso de 80 Anos ou mais , Betacoronavirus , COVID-19 , Infecções por Coronavirus/complicações , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Enterococcus faecalis , Infecções por Bactérias Gram-Positivas/complicações , Infecções por Bactérias Gram-Positivas/patologia , Humanos , Pulmão/diagnóstico por imagem , Masculino , Pandemias , Pneumonia Bacteriana/patologia , Pneumonia Viral/complicações , SARS-CoV-2RESUMO
Several studies have shown the ubiquitous presence of bacteria in hospital surfaces, staff, and patients. Frequently, these bacteria are related to HAI (healthcare-associated infections) and carry antimicrobial resistance (AMR). These HAI-related bacteria contribute to a major public health issue by increasing patient morbidity and mortality during or after hospital stay. Bacterial high-throughput amplicon gene sequencing along with identification of AMR genes, as well as whole genome sequencing (WGS), are biotechnological tools that allow multiple-sample screening for a diversity of bacteria. In this paper, we used these methods to perform a one-year cross sectional profiling of bacteria and AMR genes in adult and neonatal intensive care units (ICU and NICU) in a Brazilian public, tertiary hospital. Our results showed high abundances of HAI-related bacteria such as S. epidermidis, S. aureus, K. pneumoniae, A. baumannii complex, E. coli, E. faecalis, and P. aeruginosa in patients and hospital surfaces. Most abundant AMR genes detected throughout ICU and NICU were mecA, blaCTX-M-1 group, blaSHV-like, and blaKPC-like. We found that NICU environment and patients were more widely contaminated with pathogenic bacteria than ICU. Patient samples, despite the higher bacterial load, have lower bacterial diversity than environmental samples in both units. Finally, we also identified contamination hotspots in the hospital environment showing constant frequencies of bacterial and AMR contamination throughout the year. Whole genome sequencing (WGS), 16S rRNA oligotypes, and AMR identification allowed a high-resolution characterization of the hospital microbiome profile.
Assuntos
Bactérias/genética , Farmacorresistência Bacteriana/genética , Adulto , Antibacterianos/farmacologia , Anti-Infecciosos/farmacologia , Bactérias/efeitos dos fármacos , Bactérias/isolamento & purificação , Carga Bacteriana , Brasil , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Estudos Transversais , Farmacorresistência Bacteriana/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Escherichia coli/isolamento & purificação , Humanos , Recém-Nascido , Unidades de Terapia Intensiva , Unidades de Terapia Intensiva Neonatal , RNA Ribossômico 16S/química , RNA Ribossômico 16S/genética , RNA Ribossômico 16S/metabolismo , Staphylococcus aureus/efeitos dos fármacos , Staphylococcus aureus/genética , Staphylococcus aureus/isolamento & purificação , Centros de Atenção Terciária , Sequenciamento Completo do GenomaRESUMO
Background: The use of antimicrobials and myeloablative chemotherapy regimens has promoted multiresistant microorganisms to emerge as nosocomial pathogens, such as vancomycin-resistant Enterococcus faecium (VREfm). We described a polyclonal outbreak of bloodstream infection caused by Efm in a hemato-oncological ward in Mexico. Our aim was to describe the clonal complex (CC) of the Efm strains isolated in the outbreak in comparison with commensal and environmental isolates. Methodology: Sixty Efm clinical, environmental, and commensal strains were included. We constructed a cladogram and a phylogenetic tree using Vitek and Multilocus sequence typing data, respectively. Results: We reported 20 new sequence types (ST), among which 17/43 clinical isolates belonged to CC17. The predominant ST in the clinical strains were ST757, ST1304, ST412, and ST770. Neither environmental nor commensal isolates belonged to CC17. The phylogeny of our collection shows that the majority of the clinical isolates were different from the environmental and commensal isolates, and only a small group of clinical isolates was closely related with environmental and commensal isolates. The cladogram revealed a similar segregation to that of the phylogeny. Conclusions: We found a high diversity among clinical, environmental, and commensal strains in a group of samples in a single hospital. Highest diversity was found between commensal and environmental isolates.
Assuntos
Bacteriemia/epidemiologia , Infecção Hospitalar/epidemiologia , Enterococcus faecium/genética , Infecções por Bactérias Gram-Positivas/epidemiologia , Filogenia , Enterococos Resistentes à Vancomicina/genética , Adulto , Antibacterianos/uso terapêutico , Bacteriemia/tratamento farmacológico , Bacteriemia/microbiologia , Bacteriemia/patologia , Técnicas de Tipagem Bacteriana , Células Clonais , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Enterococcus faecium/classificação , Enterococcus faecium/efeitos dos fármacos , Enterococcus faecium/isolamento & purificação , Feminino , Variação Genética , Genótipo , Infecções por Bactérias Gram-Positivas/tratamento farmacológico , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/patologia , Neoplasias Hematológicas/microbiologia , Neoplasias Hematológicas/patologia , Humanos , Masculino , México/epidemiologia , Tipagem de Sequências Multilocus , Fenótipo , Simbiose/fisiologia , Centros de Atenção Terciária , Enterococos Resistentes à Vancomicina/classificação , Enterococos Resistentes à Vancomicina/efeitos dos fármacos , Enterococos Resistentes à Vancomicina/isolamento & purificaçãoRESUMO
Chryseobacterium indologenes is an emerging nosocomial pathogen that produces IND-type chromosomal metallo-beta-lactamase. The phenotype and molecular aspects of two multidrug resistant C. indologenes strains and the analysis of the tertiary structure of the IND enzyme were studied. Identification of species and susceptibility tests were performed using the Vitek-2 compact. Chromosomal and plasmid DNA were extracted using PureLink™ Genomic DNA Mini Kit and PureLink Quick Plasmid Miniprep Kit, and the sequencing was performed using ABI 3130 genetic analyzer. Two strains were isolated and are registered as P-23 and P-113. Of the two, P-113 was sensitive to ciprofloxacin and cefepime only, whereas the P-23 showed reduced sensitivity to ceftazidime, ciprofloxacin, and tigecycline. The genetic analysis of both isolates identified the presence of the blaIND-like gene, with similarity to IND-3 and IND-8 alleles. The IND-3 identified in the P-133 sample presented a single mutation at position T355G, which corresponds to a nonsynonymous substitution of the amino acid at position 119 (SerâAla). The phylogenetic analysis of INDs showed lineages that are circulating in Asian and European countries. These results emphasize the need for effective preventive actions to avoid the dissemination of this type of pathogen in the hospital environment.
Assuntos
Antibacterianos/farmacologia , Chryseobacterium/genética , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla/genética , Infecções por Flavobacteriaceae/microbiologia , beta-Lactamases/genética , Idoso de 80 Anos ou mais , Substituição de Aminoácidos , Brasil , Cefepima/farmacologia , Ceftazidima/farmacologia , Cromossomos Bacterianos/química , Cromossomos Bacterianos/metabolismo , Chryseobacterium/classificação , Chryseobacterium/efeitos dos fármacos , Chryseobacterium/isolamento & purificação , Ciprofloxacina/farmacologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/patologia , Feminino , Infecções por Flavobacteriaceae/tratamento farmacológico , Infecções por Flavobacteriaceae/patologia , Expressão Gênica , Humanos , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Modelos Moleculares , Filogenia , Plasmídeos/química , Plasmídeos/metabolismo , Mutação Puntual , Estrutura Secundária de Proteína , Tigeciclina/farmacologiaRESUMO
Candida auris emerged as a pathogen resistant to multiple antifungal and has been associated with nosocomial outbreaks with high transmission capacity between hospitalized individuals. C. auris was first described in 2009, after being isolated from the external ear canal discharge of a patient in Japan. The difficulty in identification, incorrect use of antifungal drugs, and treatment failure are causes of high mortality. Since then, C. auris has been increasingly reported from East Asia to North America, with substantial fatalities and misidentification. This review aims at describing the epidemiology, virulence, risk factors, resistance, and therapeutic options in C. auris infections.
Assuntos
Candida/isolamento & purificação , Candidíase/epidemiologia , Candidíase/microbiologia , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Ásia/epidemiologia , Candida/efeitos dos fármacos , Candida/patogenicidade , Candidíase/tratamento farmacológico , Candidíase/patologia , Infecção Hospitalar/tratamento farmacológico , Infecção Hospitalar/patologia , Farmacorresistência Fúngica , Humanos , América do Norte/epidemiologia , Fatores de Risco , Análise de Sobrevida , VirulênciaRESUMO
BACKGROUND: Healthcare-associated infection (HAI) represents a major problem for patient safety worldwide. AIM: To provide an up-to-date picture of the extent, aetiology, risk factors and patterns of infections in intensive care units (ICUs) in 28 Brazilian hospitals of different sizes. METHODS: A one-day point prevalence survey in 2016 enrolled the ICUs of hospitals from the 12 meso-regions in Minas Gerais state, south-east Brazil. Hospitals were classified as university or non-university hospitals. All patients with >48 h of admission to the study ICUs at the time of the survey were included. FINDINGS: In total, 303 patients were studied; of these, 155 (51.2%) were infected and 123 (79.4%) had at least one ICU-acquired infection. The most common ICU-acquired infections were pneumonia (53.0%) and bloodstream infection (27.6%). One hundred and nineteen bacterial isolates were cultured; the most common were Acinetobacter baumannii (27.1%), Pseudomonas aeruginosa (27.1%) and Staphylococcus aureus (39.0%). According to type of infection, the most common pathogens were P. aeruginosa (30.4%) in pneumonia, coagulase-negative staphylococci (23.4%) and Enterobacteriaceae (23.4%) in bloodstream infections, and Enterobacteriaceae (47.6%) in urinary tract infections. CONCLUSION: This study found that the overall prevalence of ICU-acquired infections in surveyed Brazilian hospitals was higher than that reported in most European countries and the USA. A greater proportion of infections were caused by non-fermenting Gram-negative bacteria. These observations, along with a high rate of antimicrobial use, illustrate the urgent need for HAIs to be a priority in the public health agenda of Brazil.
Assuntos
Infecções Bacterianas/epidemiologia , Candidíase/epidemiologia , Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bactérias/classificação , Bactérias/isolamento & purificação , Infecções Bacterianas/microbiologia , Infecções Bacterianas/patologia , Brasil/epidemiologia , Candida/isolamento & purificação , Candidíase/microbiologia , Candidíase/patologia , Criança , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Adulto JovemRESUMO
Fusarium species have emerged as responsible for a broad spectrum of infections, including superficial, locally invasive and disseminated ones, especially in the hospital environment. Since there are few reports of invasive and disseminated fusariosis in children, the aim of this study was to report four cases of nosocomial infection caused by this microorganism in children with cancer hospitalized in a public children's hospital located in Brazil. Two of these patients were female and two were male. All patients presented febrile neutropenia, while three patients had acute lymphocytic leukemia and one patient had Wilms' tumor as underlying disease. In two cases, fungi were isolated from blood and identified as Fusarium oxysporum species complex after phenotypic and genotypic studies, while in two other cases fungi were isolated from skin biopsies and identified as Fusarium solani species complex. One patient died 12 days after the onset of cutaneous lesions. All isolates, after susceptibility testing, presented high levels of minimum inhibitory concentration for itraconazole, voriconazole and amphotericin B. Considering the emergence of filamentous fungi as etiologic agents of nosocomial infections, health professionals should be aware of the problems these infections, especially fungal ones, may cause to debilitated patients.
Assuntos
Infecção Hospitalar/diagnóstico , Infecção Hospitalar/patologia , Fusariose/diagnóstico , Fusariose/patologia , Fusarium/isolamento & purificação , Leucemia Linfoide/complicações , Tumor de Wilms/complicações , Antifúngicos/farmacologia , Antifúngicos/uso terapêutico , Brasil , Criança , Infecção Hospitalar/tratamento farmacológico , Feminino , Fusariose/tratamento farmacológico , Fusarium/classificação , Fusarium/efeitos dos fármacos , Fusarium/genética , Genótipo , Hospitais Pediátricos , Humanos , Masculino , Testes de Sensibilidade MicrobianaRESUMO
Staphylococci produce a large number of extracellular proteases, some of which are considered as potential virulence factors. Staphylococcus epidermidis is a causative agent of nosocomial infections in medical devices by the formation of biofilms. It has been proposed that proteases contribute to the different stages of biofilm formation. S. epidermidis secretes a small number of extracellular proteases, such as serine protease Esp, cysteine protease EcpA, and metalloprotease SepA that have a relatively low substrate specificity. Recent findings indicate a significant contribution of extracellular proteases in biofilm formation through the proteolytic inactivation of adhesion molecules. The objective of this work is to provide an overview of the current knowledge of S. epidermidis' extracellular proteases during pathogenicity, especially in the different stages of biofilm formation.
Assuntos
Proteínas de Bactérias/metabolismo , Biofilmes/crescimento & desenvolvimento , Cisteína Proteases/metabolismo , Metaloendopeptidases/metabolismo , Serina Proteases/metabolismo , Staphylococcus epidermidis/enzimologia , Moléculas de Adesão Celular/metabolismo , Infecção Hospitalar/microbiologia , Infecção Hospitalar/patologia , Humanos , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/patologia , Staphylococcus epidermidis/metabolismo , Staphylococcus epidermidis/patogenicidade , Fatores de Virulência/metabolismoRESUMO
There is scarce data pertaining to acute hepatitis C (aHC) infection in South America. We aimed to describe clinical characteristics and evolution of aHC in a South American cohort. A retrospective survey was conducted at 13 hepatology units. All patients ≥16 years old with aHC diagnosis were included. Demographic, clinical and outcome information were registered in a standardized ad hoc questionnaire. Sixty-four patients were included. The majority were middle-aged (median age: 46 years) and female (65.6%); most of them were symptomatic at diagnosis (79.6%). HCV-1 was the most prevalent genotype (69.2%). Five patients had liver failure: three cases of severe acute hepatitis, one case of fulminant hepatitis and one case of acute-on-chronic liver failure. Nosocomial exposure was the most prevalent risk factor. Evolution was assessed in 46 patients. In the untreated cohort, spontaneous resolution occurred in 45.8% and was associated with higher values of AST/ALT and with the absence of intermittent HCV RNA viremia (P = 0.01, 0.05, and 0.01, respectively). In the treated cohort, sustained virological response was associated with nosocomial transmission and early treatment initiation (P = 0.04 each). The prevalence of nosocomial transmission in this South-American cohort of aHC stresses the importance of following universal precautions to prevent HCV infection. J. Med. Virol. 89:276-283, 2017. © 2016 Wiley Periodicals, Inc.