RESUMO
Las betalactamasas de espectro extendido (BLEE) son enzimas producidas por bacilos gram negativos capaces de hidrolizar las cefalosporinas de amplio espectro y los monobactámicos. La mayoría pertenece a la familia de Enterobacteriae, tales como Klebsiella pneumoniae y Escherichia coli: Sin embargo, se asocian también con otras bacterias como Proteus, Serratia, Salmonella, Pseudomonas aeruginosa y Acinetobacter. Las enterobacterias productoras de carbapenemasas no sólo han sido aisladas en el ambiente hospitalario, sino que también provienen de la comunidad. Se presenta una paciente de sexo femenino con antecedentes de sida y osteomielitis secundaria a artritis séptica producida por una Klebsiella pneumoniae BLEE de la comunidad. Un tratamiento oportuno y eficaz puede evitar la opción quirúrgica, disminuyendo la morbimortalidad asociada con esta afección
Extended-spectrum beta-lactamases (ESBL) are enzymes produced by gram-negative rods capable of hydrolyzing broad-spectrum cephalosporins and monobactams. Most belong to the Enterobacteriae family, such as Klebsiella pneumoniae and Escherichia coli. However, they are also associated with other bacteria such as Proteus, Serratia, Salmonella, Pseudomonas aeruginosa and Acinetobacter. Carbapenemase-producing Enterobacteriaceae have not only been isolated from the hospital environment, but also from the community. We present a female patient with a history of AIDS and secondary osteomyelitis to septic arthritis caused by a community Klebsiella pneumoniae ESBL. It is concluded that a timely and effective treatment can avoids the surgical option, reducing the morbidity and mortality of this condition.
Assuntos
Humanos , Feminino , Adulto , Osteomielite/imunologia , Infecções por Klebsiella/terapia , Artrite Infecciosa/terapia , Imipenem/uso terapêutico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Artrocentese , Traumatismos do Joelho/terapiaRESUMO
The taxonomic status, biotechnological and ecological potential of several Micromonospora strains isolated from an extreme hyper arid Atacama Desert soil were determined. Initially, a polyphasic study was undertaken to clarify the taxonomic status of five micromonosporae, strains LB4, LB19, LB32T, LB39T and LB41, isolated from an extreme hyper-arid soil collected from one of the driest regions of the Atacama Desert. All of the isolates were found to have chemotaxonomic, cultural and morphological properties consistent with their classification in the genus Micromonospora. Isolates LB32T and LB39T were distinguished from their nearest phylogenetic neighbours and proposed as new species, namely as Micromonospora arida sp. nov. and Micromonospora inaquosa sp. nov., respectively. Eluted methanol extracts of all of the isolates showed activity against a panel of bacterial and fungal indicator strains, notably against multi-drug resistant Klebsiella pneumoniae ATCC 700603 while isolates LB4 and LB41 showed pronounced anti-tumour activity against HepG2 cells. Draft genomes generated for the isolates revealed a rich source of novel biosynthetic gene clusters, some of which were unique to individual strains thereby opening up the prospect of selecting especially gifted micromonosporae for natural product discovery. Key stress-related genes detected in the genomes of all of the isolates provided an insight into how micromonosporae adapt to the harsh environmental conditions that prevail in extreme hyper-arid Atacama Desert soils.
Assuntos
Anti-Infecciosos/isolamento & purificação , Antineoplásicos/isolamento & purificação , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/fisiologia , Neoplasias Hepáticas/terapia , Metanol/isolamento & purificação , Micromonospora/fisiologia , Anti-Infecciosos/uso terapêutico , Antineoplásicos/uso terapêutico , Extratos Celulares , Chile , Clima Desértico , Descoberta de Drogas , Células Hep G2 , Humanos , Filogenia , Microbiologia do Solo , Streptomyces/fisiologia , Estresse Fisiológico/genéticaRESUMO
The worldwide dissemination of high-risk carbapenemase-producing Klebsiella pneumoniae clones has become a major threat to healthcare facilities. This study describes the successful containment of a hospital outbreak caused by NDM-1-producing K. pneumoniae Sequence Type (ST) 307 using active surveillance. The outbreak began when a patient was transferred from a local hospital. After 48 hours in our hospital, a tracheal aspirate was positive for a meropenem resistant and carbapenemase-producing K. pneumoniae. All patients in the medical intensive care unit (ICU) and the neurology wards were subject to contact precautions. The hospital surfaces and devices, healthcare workers, and patients from these wards were screened by cultures. Fecal swabs were placed into broth and PCR for blaKPC, blaOXA-48, blaIMP, blaVIM, and blaNDM, which were performed directly from the broth after 12 hours. PCRs were also performed on DNA extracted from carbapenemase-producing species from subcultured broths. Five and nine days later, two more patients' rectal swabs tested positive. Molecular assays identified K. pneumoniae blaNDM-1 onto a 130-kb conjugative plasmid (IncY, IncFIIs, and IncFIIY), ST307. After the three patients were discharged, monitoring continued, and after three weeks with negative results, rectal swabbing ended. In conclusion, it was possible to contain a hospital outbreak caused by NDM-1-producing K. pneumoniae ST307 through epidemiological and microbiological surveillance. With the methodology used, the detection of NDM-type genes in fecal samples was obtained in approximately 15 hours after obtaining the fecal sample.
Assuntos
Surtos de Doenças , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/prevenção & controle , Klebsiella pneumoniae , Idoso , Monitoramento Epidemiológico , Fezes/microbiologia , Seguimentos , Hospitais de Ensino , Humanos , Unidades de Terapia Intensiva , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/enzimologia , Masculino , Transferência de Pacientes , beta-Lactamases/metabolismoRESUMO
This study reports the efficacy of maggot therapy in the treatment of diabetic foot ulcer infected with multidrug resistant microorganisms. A 74 year old female patient with diabetes for over 30 years, was treated with maggot therapy using larvae of Chrysomya megacephala. The microbiological samples were collected to evaluate aetiology of the infection. The therapy done for 43 days resulted in a reduction of necrosis and the ulcer's retraction of 0.7 cm [2] in area. Analysis of the bacteriological swabs revealed the presence of Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Further studies need to be done to confirm the role of maggot therapy in wound healing using a large sample and a proper study design.
Assuntos
Pé Diabético/terapia , Infecções por Klebsiella/terapia , Larva , Úlcera/terapia , Idoso , Animais , Brasil , Pé Diabético/microbiologia , Pé Diabético/fisiopatologia , Dípteros , Feminino , Humanos , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/patogenicidade , Pseudomonas aeruginosa/patogenicidade , Úlcera/microbiologia , Úlcera/fisiopatologia , CicatrizaçãoRESUMO
INTRODUCTION: The administration of parenteral infusates is a frequent intervention that is considered innocuous; moreover, the risk of this procedure which offers a direct access to the bloodstream is minimized. OBJECTIVE: To evaluate the epidemiology of nosocomial pediatric bacteremias after implementing a control program. METHODS: Analysis of pediatric bacteremias was made in 3 periods: 1) 1990-1992, prior to establishing strategies to avoid contamination of parenteral infusions; 2) 1996, the phase after establishing these strategies; and 3) 2005-2006, the recent situation in the hospital. RESULTS: The proportion of gram-negative rods isolated in blood cultures dropped from 82.9 to 35.1% (p = 0.004) during the 17-year study period. There was no significant difference in the proportion of gram-negative rods isolated from intravascular catheters. The proportion of contaminated parenteral infusions dropped from 22.2% to 0.4% (p < 0.001). DISCUSSION: The strategies established to avoid the contamination of parenteral infusions were associated with a reduction in the proportion of gram-negative rods in blood cultures, although the proportion is still higher than that in developed countries, probably related to catheter contamination. We suggest establishing similar strategies in other hospitals from developing countries.
Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/prevenção & controle , Infecções Relacionadas a Cateter/prevenção & controle , Infecção Hospitalar/prevenção & controle , Hospitais Gerais/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Controle de Infecções/métodos , Antibacterianos/administração & dosagem , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/transmissão , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/transmissão , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Infecção Hospitalar/transmissão , DNA Bacteriano/genética , Surtos de Doenças , Eletroforese em Gel de Campo Pulsado , Infecções por Bactérias Gram-Negativas/epidemiologia , Infecções por Bactérias Gram-Negativas/microbiologia , Infecções por Bactérias Gram-Negativas/prevenção & controle , Infecções por Bactérias Gram-Negativas/transmissão , Infecções por Bactérias Gram-Positivas/epidemiologia , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/prevenção & controle , Infecções por Bactérias Gram-Positivas/transmissão , Hospitais Gerais/organização & administração , Hospitais de Ensino/organização & administração , Humanos , Controle de Infecções/organização & administração , Infusões Intravenosas , Infecções por Klebsiella/epidemiologia , Infecções por Klebsiella/prevenção & controle , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , México/epidemiologia , Avaliação de Programas e Projetos de Saúde , Estudos RetrospectivosRESUMO
Psoas abscess (PA) is an infrequent clinical entity and presents diagnostic and therapeutic challenges. Six cases are reported concerning diagnostic and therapeutic considerations. Clinical diagnosis is difficult because of non-specific symptoms. The primary psoas abscess has no definite etiology and is spread by hematogeneous route from a distant occult site. The PA can also be secondary to gastrointestinal pathology through direct infection of adjacent structures. The most common causes are Crohn's disease, appendicitis, diverticulitis and carcinoma. Routine laboratory evaluation is seldom useful for localizing the disease process. Conventional radiological techniques are often unhelpful. Modern imaging diagnosis techniques such as ultrasound and computerized tomography have allowed for a refinement in both the etiologic diagnosis and the treatment by means of CT-guided or ultrasound-guided percutaneous drainage of the abscess, thus avoiding surgical drainage in many cases. Immediately on diagnosis of PA prompt treatment is necessary. Percutaneous drainage should be performed whenever possible and in case of failure, surgical drainage should be practiced as well as intestinal resection, whenever indicated.
Assuntos
Antibacterianos , Quimioterapia Combinada/administração & dosagem , Infecções por Klebsiella/diagnóstico , Abscesso do Psoas/diagnóstico , Abscesso do Psoas/terapia , Infecções Estafilocócicas/diagnóstico , Adolescente , Adulto , Idoso , Brasil , Terapia Combinada , Drenagem/métodos , Feminino , Seguimentos , Humanos , Infecções por Klebsiella/terapia , Masculino , Infecções Estafilocócicas/terapia , Resultado do TratamentoRESUMO
Se trata de un lactante menor masculino de 10 meses de edad, desnutrido, sin vacunas, hijo de una madre de 16 años, analfabeta, viviendo en condiciones de pobreza crítica, el cual inicia su enfermedad actual una semana antes de su ingreso a ese hospital con cuadro respiratorio y diarréico severo, sin recibir tratamiento médico y cuando decide consultar sus condiciones eran graves; y a pesar de los múltiples tratamientos, su evolución fue muy tórpida y para sorpresa nuestra en el hemocultivo, coprocultivo y cultivo de secreción bronquial, creció Klebsiella Pneumoniae muy resistente a los antibióticos usuales, afortunadamente respondió al Cloramfenicol+Amikacina y en la Rx de Toráx se apreciaban imágenes en panal de abeja, lo que nos ayudó a sospechar la presencia de esta bacteria.
Assuntos
Lactente , Humanos , Masculino , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/terapia , Pneumonia/terapiaRESUMO
La infección urinaria (ITU) en pediatria es frecuente y el tratamiento antibiotico inicial es empirico, basada en la sensibilidad conocida de las bacterias del medio. Para averiguar dicha sensibilidad, se seleccionaron 61 pacientes entre 4 meses y 13 años, que acudieron al Servicio de Emergencia Pediátrica del Hospital Nacional Cayetano Heredia, con cuadro clínico de ITU y urocultivo positivo. Las bacterias aisladas fueron: E. coli, en 49 cultivos(80.3 por ciento), Klebsiella sp. en 10 cultivos (16.4 por ciento) y Proteus mirabilis en 2 casos (3.3 por ciento). La sensibilidad in vitro fue de un 100 por ciento a la Gentamicina, ceftriaxone, ceftazidime, y norfloxacina; 95.9 por ciento a amikacina, 94.1 por ciento a nitrofurantoina, 91.4 por ciento a acido nalidixico, 81.7 por ciento a cefalotina, 46.6 por ciento a cotrimoxazole y 18.8 por ciento a ampicilina
Assuntos
Humanos , Masculino , Feminino , Lactente , Pré-Escolar , Pediatria , Infecções Urinárias/etiologia , Infecções Urinárias/terapia , Infecções por Proteus/diagnóstico , Urina/microbiologia , Infecções por Klebsiella/diagnóstico , Infecções por Klebsiella/terapia , Testes de Sensibilidade Microbiana , Testes de Sensibilidade Microbiana , Infecções por Escherichia coli/diagnóstico , Infecções por Escherichia coli/terapiaRESUMO
Nestes experimentos, estudou-se a atividade protetora da vacina produzida a partir da bactéria Klebsiella pneumoniae, em camundongos infectados com K. pneumoniae. A vacina foi administrada imediatamente após a injeçäo da bactéria, sendo portanto usada como adjuvante da quimioterapia. Os resultados mostram que a vacina, nestas circunstâncias, näo apresenta efeito protetor. Investigou-se a seguir o desenvolvimento da resposta imune tipo humoral nas condiçöes acima descritas, usando-se o método de formaçäo de placa de Jerne para detecçäo do número de células formadoras de anticorpos
Assuntos
Camundongos , Animais , Imunoterapia , Infecções por Klebsiella/terapia , Klebsiella pneumoniae/imunologiaRESUMO
A therapeutic trial of transfusions with polymorphonuclear leukocyte concentrates was performed in newborn infants with bacterial sepsis proven by blood culture. With each transfusion, 20 ml/kg of a preparation obtained by continuous flow filtration leukapheresis, and containing 0.5 to 1 x 10(9) WBC, with less than 6% lymphocytes, was administered. Twenty newborn infants with sepsis received from 2 to 15 PMN transfusions. Results were compared with findings in 18 newborn infants with sepsis admitted during the trial period, and not treated because of unavailability of the PMN preparation (Group B). Infants with fulminant illness were excluded from both groups. Groups A and B were similar with respect to clinical characteristics and to etiology (in the majority cases a highly antibiotic-resistant Klebsiella). The mortality rate was significantly lower in Group A than in Group B in the whole series (10% vs 72%, P < 0.001), and also in the subgroups with birth weight equal or below 1,500 gm (10% vs 91%, P < 0.001). Major complications and associated conditions (i.e., necrotizing enterocolitis, meningitis, pneumonia, peritonitis, osteoarthritis, disseminated intravascular coagulation) were observed in 12 patients of Group B, and in only three infants of Group A. Untoward effects attributable to PMN transfusions were never observed. PMN transfusion was a highly effective therapeutic tool in our population of infected newborn infants.