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PubMed | Hospital Universitario Of Bellvitge, Hospital Universitari Mutua Terrassa, Hospital Germans Trias i Pujol, Servicio de Medicina Interna and Microbiologia
Type: Journal Article | Journal: Enfermedades infecciosas y microbiologia clinica | Year: 2016

VINCat is a nosocomial infection surveillance program in hospitals in Catalonia. The aim of the study was to determine the surveillance and control measures of methicillin-resistant Staphylococcus aureus (MRSA) in these centres.An e-mail survey was carried out from January to March 2013 with questions related to the characteristics of the hospitals and their control measures for MRSA.A response was received from 53 hospitals (>500 beds: 7; 200-500 beds: 14;<200 beds: 32; had ICU: 29). Computer alert of readmissions was available in 63%. There was active surveillance of patients admitted from another hospital (46.2%) or a long-term-care centre (55.8%), both being significantly more common measures in hospitals with a rate of MRSA22% (global median). Compliance with hand hygiene was observed in 77.4% of the centres, and was greater than 50% in 69.7% of them. All hospitals had contact precautions, although 62.3% did not have exclusive frequently used clinical material in bedrooms. The room cleaning was performed more frequently in 54.7% of hospitals, and 67.9% of them had programs for the appropriate use of antibiotics.This study provides information on the implementation of measures to prevent MRSA in hospitals participating in the VINCat program. Most of the centres have an MRSA protocol, however compliance with it should be improved, especially in areas such as active detection on admission in patients at risk, hand hygiene adherence, cleaning frequency and optimising the use of antibiotics.

Cordero-Ampuero J.,Autonomous University of Madrid | Esteban J.,Microbiologia | Garcia-Rey E.,Hospital Universitario La Paz
Clinical Orthopaedics and Related Research | Year: 2010

Background Previous studies of knee arthroplasty infections caused by high-virulence organisms suggest poor outcomes. Polymicrobial and Gram-negative infections are less studied. Questions/purposes This study compared the results of treatment of knee arthroplasty infections by single versus polymicrobial isolates, Gram-positive versus Gram-negative, and methicillin-resistant versus -sensitive Staphylococci. Methods We prospectively followed 47 patients with late knee arthroplasty infections. The mean age was 72 years (range, 20-87 years). The treatment protocol included twostage exchange and a combination of two oral antibiotics given for 6 months. Minimum followup was 1 year (average, 4.8 ± 3 years; range, 1-12 years). Control of the infection was judged by absence of clinical, serologic, and radiologic signs of infection. The functional outcome was evaluated by Knee Society score at the last followup. Results Infection was controlled in all 15 patients with polymicrobial and in 28 of 32 (88%) with monomicrobial infections, in eight of nine patients with Gram-negative and in 35 of 38 (92%) with Gram-positive isolates. Control was also achieved in 22 of 25 patients (88%) infected by methicillin-resistant Staphylococci and in 14 of 14 by methicillin-sensitive Staphylococci. The Knee Society scores averaged 81-63 in patients with polymicrobial infections and were higher than in monomicrobial infections (75-52). The mean KSS was 85-59 in Gram-negative infections compared to 75-55 in Gram-positive infections. The mean KSS was similar in methicillin-resistant (78-54) and methicillin-sensitive Staphylococci (73-56) infections. Conclusions Polymicrobial and Gram-negative infections can be controlled in late knee arthroplasty infections. On the other hand, infections by methicillin-resistant Staphylococci are less likely to be controlled by the regimens we used. Level of Evidence Level II, prognostic study. See Guidelines for Authors for a complete description of levels of evidence. © The Association of Bone and Joint Surgeons® 2010.

Campana G.A.,Patologia Clinica | Oplustil C.P.,Microbiologia | De Faro L.B.,Medica Patologista Clinica
Jornal Brasileiro de Patologia e Medicina Laboratorial | Year: 2011

Clinical pathology/laboratory medicine, a specialty focused on performing complementary tests to aid diagnosis, has impact upon several stages of health care: prevention, diagnosis, prognosis, and therapeutic management. There are several factors that will foster the use of laboratory medicine in the future. In order to discuss the main trends in laboratory medicine, this article describes the major factors that have promoted growth in this market, which herein are referred to as growth drivers. The major trends that will cause substantial impact on laboratory medicine are: management tools, inclusion of new tests and procedures, service quality, operational models, automation, consolidation and integration, information technology, personalized and genetic medicine. Laboratory medicine occupies a pivotal role in 70% of all clinical decisions with minimal healthcare costs of approximately 10%. All trends discussed herein sustain an increase in the use of laboratory tests as well as its importance in health care. Both this new model and the expectation of optimal solutions have led the market to search for changes and new management strategies.

Martins A.C.,University Feevale | Picoli S.U.,Microbiologia | Picoli S.U.,University Feevale
Jornal Brasileiro de Patologia e Medicina Laboratorial | Year: 2011

Introduction: Antimicrobial resistance has increased apace in Brazil and worldwide in the last years, even though there is a great variety of resistance mechanisms and extended spectrum beta-lactamases (ESBL) is among the main ones. These enzymes are plasmid mediated, which causes resistance to some beta-lactam antimicrobials and are inhibited by compounds such as clavulanic acid, sulbactam and tazobactam. Objective: The objective of this study was to compare alternative methods to the standard ESBL detection technique recommended by the Clinical and Laboratory Standards Institute (CLSI). Material and method: Tests with 36 isolates (26 E. coli and 10 K. pneumoniae) were performed by means of CLSI disk diffusion method and alternative techniques designated as half disk (HD) and disk substitution (SD). Conclusion: Both methods yielded satisfactory results with higher sensitivity (90%) and lower costs in comparison with the reference one (CLSI disk diffusion method), which corroborates its use in ESBL investigation.

PubMed | Federal University of Rio de Janeiro, Instituto Nacional Of Metrologia Normalizacao E Qualidade Industrial and Microbiologia
Type: Journal Article | Journal: Pathogens and disease | Year: 2016

The obligate intracellular protozoan parasite Toxoplasma gondii actively invades virtually all warm-blooded nucleated cells. This process results in a non-fusogenic vacuole, inside which the parasites replicate continuously until egress signaling is triggered. In this work, we investigated the role of the large GTPase dynamin in the interaction of T. gondii with the host cell by using laser and electron microscopy during three key stages: invasion, development and egress. The detection of dynamin during invasion indicates the occurrence of endocytosis, while T. gondii egress appeared to be independent of dynamin participation. However, the presence of dynamin during T. gondii development suggests that this molecule plays undescribed roles in the tachyzoites cell cycle.

Mineo G.,Radiologia Cardio Toracica | Ciccarese F.,Radiologia i | Modolon C.,Radiologia Pediatrica | Landini M.P.,Microbiologia | And 2 more authors.
Radiologia Medica | Year: 2012

Purpose. Our aim was to evaluate the evolution of 20 patients with H1N1 pneumonia, focusing our attention on patients with severe clinical and radiological findings who developed post-acute respiratory distress syndrome (postARDS) pulmonary fibrosis. Materials and methods. Twenty adult patients (nine women and 11 men; mean age 43.5±16.4 years) with a diagnosis of H1N1 infection confirmed by pharyngeal swab came to our attention from September to November 2009 and were followed up until September 2010. All patients were hospitalised in consideration of the severity of clinical findings, and all underwent chest X-ray. Twelve of them underwent at least one computed tomography (CT) scan of the chest. Results. In 75% of cases (15/20), there was complete resolution of the clinical and radiological findings. Twenty-five percent of patients (5/20) developed acute respiratory distress syndrome (ARDS), which progressed to predominantly peripheral pulmonary fibrosis in 10% (2/20; one died and one had late-onset pulmonary fibrosis, documented on day 68). Moreover, in one patient with a CT diagnosis of pulmonary fibrosis, we observed progressive regression of radiological findings over 4 months of follow-up. Conclusions. In patients with H1N1 pneumonia, postARDS pulmonary fibrosis is not a rare complication. Therefore, a CT scan should be performed in all patients with severe clinical findings. Our study demonstrated that in these patients, fibrosis could present a different spatial distribution and a different temporal trend, with delayed late onset; moreover, in one case, the signs of interstitial lung disease partially regressed over time. Therefore, CT should be considered not only in the diagnostic stage, but also during the follow-up. © 2011 Springer-Verlag.

Zanol F.M.,Biomedicina | Picoli S.U.,Microbiologia | Morsch F.,Microbiologia | Morsch F.,Hospital Nossa Senhora Medianeira
Jornal Brasileiro de Patologia e Medicina Laboratorial | Year: 2010

Introduction; Non-fermenting Gram-negative bacilli, such as Pseudomonas aeruginosa, feature among the main microorganisms that cause nosocomial infections. The development of resistance mechanisms, such as the production of metallo-beta-lactamases (MBL), is a major concern in hospitals. Objectives; To determine the prevalence of MBL phenotype in samples of P. aeruginosa isolates from hospitals in Caxias do Sul (RS) and compare some phenotypic methods applied in this enzyme detection. Material and methods; A total of 50 samples of P. aeruginosa with decreased susceptibility to ceftazidime were phenotypically evaluated as to MBL production by three tests: double-disk synergy, combined disk and MBL E-test, using different substrates and metallo-enzyme inhibitors. Results; The production of MBL was detected in 15 samples (30%). The method showing higher percentage of positive results was the MBL E-test, followed by ceftazidime-EDTA disk method. Conclusion: The presence of MBL is an important resistance mechanism found in the studied hospitals, which substantiate the need for the detection of these enzymes in order to control the spread of resistance genes and provide appropriate therapy to the patient.

PubMed | HU Puerta de Hierro., Medicina Preventiva, Enfermedades Infecciosas MI, Enfermedades Infecciosas and Microbiologia
Type: Journal Article | Journal: Revista espanola de enfermedades digestivas : organo oficial de la Sociedad Espanola de Patologia Digestiva | Year: 2016

Clinical features of Clostridium difficile infection (CDI) cases diagnosed by detection of polymerase chain reaction (PCR), with negative toxin enzyme immunoassay results (EIA) have not been fully elucidated. The purpose of this study was to determine the magnitude of CDI patients who had negative EIA toxin determinations but positive PCR tests, and their differences in clinical presentation.We performed a retrospective study comparing the clinical features of CDI cases detected by EIA (toxins A + B) with cases detected by PCR (toxin negative, PCR positive) over a 16-month period. Only patients with an initial Clostridium difficile infection episode that fulfilled a standardized definition were included.During the study period, 107 episodes of CDI were detected. Seventy-four patients (69%) had positive glutamate dehydrogenase (GDH) antigen and EIA determinations (EIA positive patients). Thirty-three patients (31%) had GDH positive, negative toxin EIA and positive PCR determination (PCR positive patients). PCR positive patients were younger, 57 (27) years (mean [SD]), than EIA positive patients, 71 (16) years, (p < 0.001). Fewer PCR positive patients were receiving proton pump inhibitors (21 patients, 64%) than EIA positive patients (61 patients, 82%, p = 0.034). The clinical presentation was similar in both groups. In the multivariate analysis, lower age was identified as the only independent variable associated with PCR positive patients.One third of Clostridium difficile infection patients present negative toxin EIA and PCR positive tests. Performing PCR determination after the negative EIA test is more relevant in younger patients.

Lozano M.C.,Microbiologia | Garcia-Agudo L.,Microbiologia | Moreno R.,Microbiologia | Chozas N.,Hospital Universitario Puerta del Mar | Garcia-Martos P.,Microbiologia
Revista Medica de Chile | Year: 2010

Background: Tuberculous spondylodiscitis is relatively uncommon but represents the most common location of osseous tuberculosis. Aim: To describe clinical features, imaging studies and laboratory tests to establish the diagnosis in a group of patients living in Cádiz (Spain). Material and Methods: Retrospective analysis of medical records of patients with tuberculous spondylodiscitis diagnosed between 2000 and 2009. The diagnosis was based on microorganism recovery from vertebral samples obtained by imaging guided biopsies. Results: Six patients with positive Mycobacterium tuberculosis cultures from vertebral samples, were identified (10% of extra-pulmonary tuberculosis). In only 2 patients the Ziehl-Nielsen stain was positive, and histology was compatible in 4 cases. Four patients were females, their mean age was 54.3 years and the mean duration of symptoms was 7.3 months. Three patients had lumbar location and a positive Mantoux test. A soft tissue abscess was present in 4 cases. None of these patients had neurological complications. The treatment with four tuberculostatic agents (isoniazid, rifampicin, pyrazinamide and ethambutol) was effective in 5 patients. Conclusions: Tuberculous spondylodiscitis may become a serious disease due to diagnostic and treatment delays. The main examinations to establish diagnosis are magnetic resonance imaging and biopsy with microbiological culture. Generally, antituberculous therapy is effective in this clinical situation.

Bacterial resistance is a frequent and major issue in nosocomial environment. In accordance with the standards proposed by the Clinical and Laboratory Standards Institute (CLSI, 2009), eight strains of Klebsiella pneumoniae (KPC) were isolated from eight distinct patients at Júlia Kubitschek Hospital (JKH), located in the city of Belo Horizonte, Brazil, between April 2009 and January 2011. As far as KPC emergence is concerned, its monitoring in Enterobacteriaceae isolates with decreased susceptibility to ertapenem has become highly important.

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