Aislamientos de Enterococcus en muestras clínicas

In recent years, the genus Enterococcus has become extremely important as an etiologic agent of nosocomial infections and the acquisition of resistance to many antibiotics. A descriptive, retrospective and longitudinal study was conducted in order to characterize the isolates of Enterococcus in clinical samples grown in the Microbiology Laboratory of the Arnaldo Milian Castro Provincial University Hospital in 2009. To gather the information, the results of laboratory cultures at this stage were reviewed. This search was made in the Record Books of daily work. The isolates that were considered were those that met the following criteria: all lab-grown sample in this period whose result in the culture showed the isolation of Enterococcus and which had undergone a susceptibility study. The universe was formed by 32500 samples, and this organism was isolated in only 31 of them. The 31 cultures that were positive for the genus of interest were separated in number and according to the different categories of body fluids: secretions –18 isolates; urine –four; blood –four; bile –four; and catheter –one. They were predominant in secretions (58.06% of total). Enterococcus faecalis and Enterococcus faecium were the most isolated species. Susceptibility testing showed increased resistance to erythromycin (58.06%) and tetracycline (51.62%) and only one strain of Enterococcus faecium was diagnosed as resistant to vancomycin (3.24% of strains tested).En los últimos años el género Enterococcus ha cobrado gran importancia como agente etiológico de infecciones nosocomiales y por la adquisición de resistencia a muchos antimicrobianos. Se realizó un estudio descriptivo, retrospectivo y longitudinal con el objetivo de caracterizar los aislamientos de Enterococcus en muestras clínicas cultivadas en el Laboratorio de Microbiología del Hospital Provincial Universitario “Arnaldo Milián Castro” en el año 2009; para recopilar la información se revisaron los resultados de los cultivos del laboratorio en esta etapa, búsqueda que fue efectuada en los Libros de Registro de trabajo diario. Los aislamientos que se tuvieron en cuenta fueron los que cumplieron con los siguientes criterios: toda muestra cultivada en el laboratorio en esta etapa cuyo resultado en el cultivo informara el aislamiento de Enterococcus y a la que se le hubiera realizado estudio de susceptibilidad. El universo de estudio constituyó un total de 32 500 muestras, de las que, en solo 31, se aisló este microorganismo. Los 31 cultivos positivos al género de interés se distribuyeron en número y según las diferentes categorías de fluidos corporales en: secreciones -18 aislamientos-, orina -cuatro-, sangre -cuatro-, bilis -cuatro- y catéter -uno-; predominaron en secreciones (58,06% del total); el Enterococcus faecalis y el Enterococcus faecium fueron las especies más aisladas; las pruebas de susceptibilidad mostraron mayor resistencia a la eritromicina (58.06%) y a la tetraciclina (51.62%) y se diagnosticó solo una cepa de Enterococcus faecium resistente a la vancomicina (3,24% del total de cepas estudiadas)

Tratamiento de la infección por Helicobacter pylori: Comentario al respecto

Se realizó una revisión bibliográfica sobre las pautas de tratamiento recomendadas en la infección causada por Helicobacter pylori. Las altas tasas de erradicación logradas por los esquemas triple y cuádruple, hacen que éstos sean utilizados como primera y segunda línea de tratamiento respectivamente. Se relacionan las afecciones asociadas con la infección, en las que se debe utilizar el tratamiento erradicador. El uso de antimicrobianos, en zonas donde la resistencia era elevada, redujo la eficacia del esquema utilizado. La vacuna anti-H. pylori constituyó una novedosa opción de tratamiento. La utilización de diferentes sitios mucosos de vacunación con adyuvantes de baja toxicidad, también se trataron en este trabajo. La efectividad terapéutica de la vacuna, según los autores, resultó alta en modelos experimentales y alcanzó 100 % de protección frente a la infección por esta bacteria gramnegativa.A bibliographic review on the schedules of treatment recommended in the infection caused by Helicobacter pylori was made. The high rates of erradication attained by the triple and quadruple therapies allow their use as first and second line treatment, respectively. Those affections associated with the infection, in which the erradicating treatment should be applied, are related. The utilization of antimicrobials in areas where the resistance was high reduced the efficacy of the therapy used. The anti-H. pylori vaccine became a new option of treatment. The use of different mucous sites of vaccination with adjuvants of low toxicity was also dealt with in this paper. The therapeutic effectiveness of the vaccine according to the authors proved to be high in experimental models and achieved 100 % of protection against the infection caused by this gramnegative bacterium

Multicenter Study of Carbapenemase-Producing Enterobacterales in Havana, Cuba, 2016–2021

Surveillance of carbapenem resistance is particularly important for Enterobacterales, mainly in countries with limited healthcare resources. We conducted a cross-sectional study to detect carbapenem-resistant Enterobacterales at 10 sentinel hospitals in Havana, Cuba for a six year-period (2016–2021) by the National Reference Laboratory for Health Care-Associated Infections in the Pedro Kourí Institute. A total of 152 isolates were collected with phenotypic production of metallo-β-lactamase. NDM-type carbapenemase was detected in all the 152 isolates, and KPC-type enzyme gene was simultaneously identified in four NDM-positive isolates. The most abundant carbapenemase-producing Enterobacterales (CPE) species was Klebsiella pneumoniae (69.7%), followed by Enterobacter cloacae complex (13.2%), and Escherichia coli (5.9%). Over the study period, among CPE, prevalence of K. pneumoniae was almost constant, while Enterobacter spp. showed slightly increasing tendency. The urinary tract (36.2%) was the most prevalent source of infection with CPE, followed by bloodstream (26.3%) and surgical wound (17.1%), being frequently derived from Intensive Care Units (35.5%) and urology wards (21.7%). This study revealed the present situation of CPE in hospitals in Havana, Cuba, showing the emergence and dissemination of Enterobacterales producing NDM-type carbapenemase, mainly K. pneumoniae

Multicenter Study of Carbapenemase-Producing <i>Enterobacterales</i> in Havana, Cuba, 2016–2021

Surveillance of carbapenem resistance is particularly important for Enterobacterales, mainly in countries with limited healthcare resources. We conducted a cross-sectional study to detect carbapenem-resistant Enterobacterales at 10 sentinel hospitals in Havana, Cuba for a six year-period (2016–2021) by the National Reference Laboratory for Health Care-Associated Infections in the Pedro Kourí Institute. A total of 152 isolates were collected with phenotypic production of metallo-β-lactamase. NDM-type carbapenemase was detected in all the 152 isolates, and KPC-type enzyme gene was simultaneously identified in four NDM-positive isolates. The most abundant carbapenemase-producing Enterobacterales (CPE) species was Klebsiella pneumoniae (69.7%), followed by Enterobacter cloacae complex (13.2%), and Escherichia coli (5.9%). Over the study period, among CPE, prevalence of K. pneumoniae was almost constant, while Enterobacter spp. showed slightly increasing tendency. The urinary tract (36.2%) was the most prevalent source of infection with CPE, followed by bloodstream (26.3%) and surgical wound (17.1%), being frequently derived from Intensive Care Units (35.5%) and urology wards (21.7%). This study revealed the present situation of CPE in hospitals in Havana, Cuba, showing the emergence and dissemination of Enterobacterales producing NDM-type carbapenemase, mainly K. pneumoniae

A Retrospective Study of Risk Factors, Mortality, and Treatment Outcomes for Infections with Carbapenemase-Producing Enterobacterales in a Tertiary Hospital in Havana, Cuba

(1) Background: The spread of carbapenem-resistant Enterobacterales in hospitals constitutes an important epidemiological and therapeutic problem that especially affects vulnerable patients such as perioperative patients. (2) Methods: We conducted a descriptive, observational, retrospective case-control study of patients infected with carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) and carbapenem-susceptible Enterobacterales during the perioperative period in a tertiary hospital. (3) Results: Metallo-&beta;-lactamase was detected in all 124 CRE isolates, with NDM-type carbapenemase being dominant, while 3 isolates coproduced KPC-type enzyme and showed high resistance rates against all antibiotics except colistin (25.2%). By analyzing the risk factors for infection, steroid use (OR: 3.22, p &lt; 0.01), prior use of two or more antibiotics (OR: 4.04, p = 0.01), prior use of broad-spectrum cephalosporins (OR: 2.40, p = 0.04), and prior use of carbapenem (OR: 4.77, p = 0.03) were found to be independent risk factors for CP-CRE infection. In addition, in this study, we observed that the clinical outcomes of bloodstream infections and pneumonia associated with CP-CRE posed higher mortality risks. However, by analyzing the associations between treatment options and mortality, it was found that, in bloodstream infections caused by CP-CRE, colistin-based regimens showed a significant advantage (PR = 0.40, p = 0.03). (4) Conclusions: High mortality is associated with nosocomial infections in the perioperative period caused by carbapenemase-producing Enterobacterales, the dissemination of which in health care settings in Cuba remains a public health challenge

Comprehensive molecular, genomic and phenotypic analysis of a major clone of Enterococcus faecalis MLST ST40

Background: Enterococcus faecalis is a multifaceted microorganism known to act as a beneficial intestinal commensal bacterium. It is also a dreaded nosocomial pathogen causing life-threatening infections in hospitalised patients. Isolates of a distinct MLST type ST40 represent the most frequent strain type of this species, distributed worldwide and originating from various sources (animal, human, environmental) and different conditions (colonisation/infection). Since enterococci are known to be highly recombinogenic we determined to analyse the microevolution and niche adaptation of this highly distributed clonal type. Results: We compared a set of 42 ST40 isolates by assessing key molecular determinants, performing whole genome sequencing (WGS) and a number of phenotypic assays including resistance profiling, formation of biofilm and utilisation of carbon sources. We generated the first circular closed reference genome of an E. faecalis isolate D32 of animal origin and compared it with the genomes of other reference strains. D32 was used as a template for detailed WGS comparisons of high-quality draft genomes of 14 ST40 isolates. Genomic and phylogenetic analyses suggest a high level of similarity regarding the core genome, also demonstrated by similar carbon utilisation patterns. Distribution of known and putative virulence-associated genes did not differentiate between ST40 strains from a commensal and clinical background or an animal or human source. Further analyses of mobile genetic elements (MGE) revealed genomic diversity owed to: (1) a modularly structured pathogenicity island; (2) a site-specifically integrated and previously unknown genomic island of 138 kb in two strains putatively involved in exopolysaccharide synthesis; and (3) isolate-specific plasmid and phage patterns. Moreover, we used different cell-biological and animal experiments to compare the isolate D32 with a closely related ST40 endocarditis isolate whose draft genome sequence was also generated. D32 generally showed a greater capacity of adherence to human cell lines and an increased pathogenic potential in various animal models in combination with an even faster growth in vivo (not in vitro). Conclusion: Molecular, genomic and phenotypic analysis of representative isolates of a major clone of E. faecalis MLST ST40 revealed new insights into the microbiology of a commensal bacterium which can turn into a conditional pathogen