Bacteriological diagnostic of urinary tract infections: A technical revision

Urinary tract infection is one of the most common diseases and it can affect more than one site or one single place like urethra (urethritis), prostate (prostatitis), urinary bladder (cystitis) or kidney (pielonephritis). Urine is considered sterile and may suffer bacterial contamination from skin, clothes or external genitals, so it should be collected, kept and transported appropriately, to avoid false results in laboratory analysis. Urethritis and cistitis non gonococcal are commonly caused by members of Enterobacteriacea family but Escherichia coli is the casual agent of approximately 80% of the cases between fertile age women without urinary tract leison. Other microrganisms including Klebsiella sp., Enterobacter sp., Proteus sp., Pseudomonas sp and the Enterococcus sp are frequently found in patients with obstructive leisons or paralytical diseases affecting the renal function. Staphylococcus saprophyticus is an important opportunistic pathogenin human urinary tract infections, especially in young, sexually active females. The patient must be informed about the recommended procedures related to the collect time, way of obyaining and all the necessary asepsis, such as the professional must be up to date about the techniques utilized for the isolation, identification and susceptibility test of the microrganism. Currently, there are chemical and authomatical methods and excelent kits for laboratorial diagnosis of urinary infections, helping and accelerating the process of identification and efficient treatment to the infected patient.Entre as doenças mais comuns está a infecção do trato urinário, afetando mais de um sítio ou um único local como a uretra (uretrite), próstata (prostatite), bexiga (cistite) ou rins (pielonefrite). A urina é considerada estéril e pode sofrer contaminação de bactérias da pele, da roupa ou da genitália. Por isso, se não colhida, armazenada e transportada adequadamente, pode-se obter falsos resultados em exames bacteriológicos. Bactérias da família Enterobacteriacea estão envolvidas em quase todas as uretrocistites não gonocócicas, sendo a Escherichia coli o agente causal de aproximadamente 80% dos casos entre mulheres na idade fértil, sem lesões do trato urinário. Outros microrganismos, incluindo Klebsiella sp., Enterobacter sp., Proteus sp., Pseudomonas sp. e Enterococcus sp., são freqüentemente encontrados em pacientes com lesões obstrutivas ou doenças paralíticas, afetando a função renal. Staphylococcus saprophyticus é um importante patógeno oportunista na infecção do trato urinário em humanos, especialmente em mulheres jovens, sexualmente ativas. O paciente deve ser informado quanto aos procedimentos recomendados, relacionados com o horário da colheita, modo de obtenção e toda a assepsia necessária, assim como o profissional deve estar bem atualizado quanto às técnicas utilizadas para o isolamento, identificação e antibiograma. Atualmente, existem métodos químicos automatizados e kits excelentes para o diagnóstico presuntivo de infecções urinárias, auxiliando e agilizando os processos de identificação e de tratamento eficaz ao paciente infectado

Antimicrobial Resistance of Enterococcus sp. Isolated from the Intestinal Tract of Patients from a University Hospital in Brazil

This study reports the results about antimicrobial resistance of Enterococcus spp. isolated from intestinal tract of patients from a university hospital in Brazil. The identification of strains at species level was performed by conventional biochemical tests, API 20 Strep (bioMérieux), and polymerase chain reaction assay. The specie distribution was E. faecium (34%), followed by E. faecalis (33%), E. gallinarum (23.7%), E. casseliflavus (5.2%), E. avium (1%), and E. hirae (1%). Intrinsic resistance to vancomycin characterized by presence of vanC genes was found in E. gallinarum and E. casseliflavus. The high prevalence of VanC phenotype enterococci is very important because these species have been reported as causing a wide variety of infections. Vancomycin-resistant E. faecium or E. faecalis were not found and no one isolate of these species was a b-lactamase producer. Thirteen clinical isolates of enterococci (13.4%) showed multiresistance patterns, which were defined by resistance to three classes of antibiotics plus resistance to at least one aminoglycoside (gentamicin and/or streptomycin). The resistance to several antimicrobials shown by enterococcal strains obtained in this study is of concern because of the decrease in the therapeutic options for treatment of infections caused by enterococci