Fatores associados à mortalidade de pacientes com enterobactéria resistente aos carbapenêmicos

As Enterobactérias resistentes aos carbapenêmicos (ERC) tornaram-se uma grave ameaça à saúde pública. Devido à produção de enzimas como a Klebsiella pneumoniae carbapenemase (KPC), essas bactérias desenvolveram uma alta taxa de resistência e elevada mortalidade aos pacientes infectados. Diante disso, o objetivo do presente estudo foi analisar os fatores associados à mortalidade de pacientes com ERC. Foi avaliado o histórico de 591 pacientes que apresentaram cultura positiva para bactérias resistentes aos carbapenêmicos internados no período entre Janeiro de 2012 e Julho de 2013. Os fatores associados à mortalidade dos pacientes com ERC foram: sexo, faixa etária, sítio de isolamento do microrganismo, unidade e tempo de internação, e característica clínica (infectados e colonizados). A normalidade dos dados foi testada pelo teste de Shapiro-Wilk. Os dados foram apresentados em mediana (amplitude interquartílica). As associações foram feitas por meio do teste Qui-quadrado 2x2 e Quiquadrado de tendência. O nível de significância foi pré-estabelecido em P<0,05. O aumento da idade se associou com maior frequência de óbitos. Os sítios de isolamento: secreção traqueal e sangue foram os mais frequentes em pacientes que evoluíram a óbito. A internação em UTI também se associou com óbitos em pacientes com ERC, bem como um maior tempo de internação e a característica clínica de infectado. Por outro lado, sexo não foi um fator associado à mortalidade dos pacientes. Em conclusão, o presente estudo demonstrou haver associação entre faixa etária, sítio de isolamento do microrganismo, unidade e tempo de internação e característica clínica com a mortalidade de pacientes com ERC. Sugere-se que futuros estudos investiguem as mudanças na prevalência de casos de colonização e infecção por ERC em hospitais universitários e possam estabelecer estratégias de prevenção e controlerecord of 591 patients that presented positive culture for CRE admitted from January 2012 to July 2013. Other factors associated with mortality of patients with CRE were: sex, age, microorganism isolation site, unit and length of stay, and clinical feature (infection and colonization). Data normality was tested by Shapiro-Wilk. Quantitative data was presented as median (interquartile range). The associations were made through 2x2 and tendency Chi-square test. Significance level was set at P<0.05. The increase of age was associated with a high frequency of not survivors. The isolation site: lower respiratory tract and blood were more frequent in not survivor’s patients. ICU inpatients also were associated with CRE not survivors, as well as longer length of stay and the clinical feature of infection. On the other hand, sex was not a factor associated with the mortality of patients. In conclusion, the present study noted an association between age, microorganism isolation site, patient unit, length of stay and clinical feature with the mortality of CRE patients. It is suggested that future studies investigate the rate of prevalence changes of cases of colonization or infection for CRE in university hospitals and establish prevention and control strategie

Gilthead Seabream Liver Integrative Proteomics and Metabolomics Analysis Reveals Regulation by Different Prosurvival Pathways in the Metabolic Adaptation to Stress

The study of the molecular mechanisms of stress appraisal on farmed fish is paramount to ensuring a sustainable aquaculture. Stress exposure can either culminate in the organism’s adaptation or aggravate into a metabolic shutdown, characterized by irreversible cellular damage and deleterious effects on fish performance, welfare, and survival. Multiomics can improve our understanding of the complex stressed phenotype in fish and the molecular mediators that regulate the underlying processes of the molecular stress response. We profiled the stress proteome and metabolome of Sparus aurata responding to different challenges common to aquaculture production, characterizing the disturbed pathways in the fish liver, i.e., the central organ in mounting the stress response. Label-free shotgun proteomics and untargeted metabolomics analyses identified 1738 proteins and 120 metabolites, separately. Mass spectrometry data have been made fully accessible via ProteomeXchange, with the identifier PXD036392, and via MetaboLights, with the identifier MTBLS5940. Integrative multivariate statistical analysis, performed with data integration analysis for biomarker discovery using latent components (DIABLO), depicted the 10 most-relevant features. Functional analysis of these selected features revealed an intricate network of regulatory components, modulating different signaling pathways related to cellular stress, e.g., the mTORC1 pathway, the unfolded protein response, endocytosis, and autophagy to different extents according to the stress nature. These results shed light on the dynamics and extent of this species’ metabolic reprogramming under chronic stress, supporting future studies on stress markers’ discovery and fish welfare research