Epidemiologia da infecção hospitalar

The Health Care Associated Infection (HCAI) is a consequence of a medical intervention on the patient, whether diagnostic, therapeutic or prophylactic. For its study, the epidemiological concepts are essentials to describe its natural history, since the detection, to the knowledge of the etiology, to the comprehension of its distribution and to the determination of the methods to its prevention or control. On the epidemiological chain, the infection variables to consider are the microorganisms and its reservoirs and/or sources, the host and the route of transfer of microorganism or route of infection. With the knowledge and study of these variables it is possible to implement epidemiological surveillance programs with the main objective of knowing in each moment the reality concerning the HCAI, with direct implications on the definition of preventive measures, whether primary, secondary or tertiary.A Infecção Associada aos Cuidados de Saúde (IACS) é uma afecção que decorre como consequência de uma intervenção médica no doente, seja ela diagnóstica, terapêutica ou profiláctica. Para o seu estudo, os conceitos que nos são facultados pela epidemiologia são essenciais para descrever a sua história natural, desde a sua detecção, ao conhecimento da sua etiologia, à compreensão da sua distribuição e à determinação dos métodos para a sua prevenção ou controlo. Na cadeia epidemiológica, as variáveis da infecção a considerar são os microrganismos e os seus reservatórios e/ou fontes, o hospedeiro e as vias de transmissão. Com o conhecimento e estudo destas variáveis é possível implementar programas de vigilância epidemiológica que têm como principal objectivo conhecer a cada momento a realidade no que respeita às IACS, com implicações directas à definição das medidas de prevenção, quer seja primária, secundária ou terciária.&nbsp

Genomic epidemiological analysis of Klebsiella pneumoniae from Portuguese hospitals reveals insights into circulating antimicrobial resistance.

Klebsiella pneumoniae (Kp) bacteria are an increasing threat to public health and represent one of the most concerning pathogens involved in life-threatening infections and antimicrobial resistance (AMR). To understand the epidemiology of AMR of Kp in Portugal, we analysed whole genome sequencing, susceptibility testing and other meta data on 509 isolates collected nationwide from 16 hospitals and environmental settings between years 1980 and 2019. Predominant sequence types (STs) included ST15 (n = 161, 32%), ST147 (n = 36, 7%), ST14 (n = 26, 5%) or ST13 (n = 26, 5%), while 31% of isolates belonged to STs with fewer than 10 isolates. AMR testing revealed widespread resistance to aminoglycosides, fluoroquinolones, cephalosporins and carbapenems. The most common carbapenemase gene was blaKPC-3. Whilst the distribution of AMR linked plasmids appears uncorrelated with ST, their frequency has changed over time. Before year 2010, the dominant plasmid group was associated with the extended spectrum beta-lactamase gene blaCTX-M-15, but this group appears to have been displaced by another carrying the blaKPC-3 gene. Co-carriage of blaCTX-M and blaKPC-3 was uncommon. Our results from the largest genomics study of Kp in Portugal highlight the active transmission of strains with AMR genes and provide a baseline set of variants for future resistance monitoring and epidemiological studies

Streptococcus pyogenes Causing Skin and Soft Tissue Infections Are Enriched in the Recently Emerged emm89 Clade 3 and Are Not Associated With Abrogation of CovRS

Although skin and soft tissue infections (SSTI) are the most common focal infections associated with invasive disease caused by Streptococcus pyogenes (Lancefield Group A streptococci - GAS), there is scarce information on the characteristics of isolates recovered from SSTI in temperate-climate regions. In this study, 320 GAS isolated from SSTI in Portugal were characterized by multiple typing methods and tested for antimicrobial susceptibility and SpeB activity. The covRS and ropB genes of isolates with no detectable SpeB activity were sequenced. The antimicrobial susceptibility profile was similar to that of previously characterized isolates from invasive infections (iGAS), presenting a decreasing trend in macrolide resistance. However, the clonal composition of SSTI between 2005 and 2009 was significantly different from that of contemporary iGAS. Overall, iGAS were associated with emm1 and emm3, while SSTI were associated with emm89, the dominant emm type among SSTI (19%). Within emm89, SSTI were only significantly associated with isolates lacking the hasABC locus, suggesting that the recently emerged emm89 clade 3 may have an increased potential to cause SSTI. Reflecting these associations between emm type and disease presentation, there were also differences in the distribution of emm clusters, sequence types, and superantigen gene profiles between SSTI and iGAS. According to the predicted ability of each emm cluster to interact with host proteins, iGAS were associated with the ability to bind fibrinogen and albumin, whereas SSTI isolates were associated with the ability to bind C4BP, IgA, and IgG. SpeB activity was absent in 79 isolates (25%), in line with the proportion previously observed among iGAS. Null covS and ropB alleles (predicted to eliminate protein function) were detected in 10 (3%) and 12 (4%) isolates, corresponding to an underrepresentation of mutations impairing CovRS function in SSTI relative to iGAS. Overall, these results indicate that the isolates responsible for SSTI are genetically distinct from those recovered from normally sterile sites, supporting a role for mutations impairing CovRS activity specifically in invasive infection and suggesting that this role relies on a differential regulation of other virulence factors besides SpeB

Streptococcus canis Are a Single Population Infecting Multiple Animal Hosts Despite the Diversity of the Universally Present M-Like Protein SCM

Streptococcus canis is an animal pathogen which occasionally causes infections in humans. The S. canis M-like protein (SCM) encoded by the scm gene, is its best characterized virulence factor but previous studies suggested it could be absent in a substantial fraction of isolates. We studied the distribution and variability of the scm gene in 188 S. canis isolates recovered from companion animals (n = 152), wild animal species (n = 20), and humans (n = 14). Multilocus sequence typing, including the first characterization of wildlife isolates, showed that the same lineages are present in all animal hosts, raising the possibility of extensive circulation between species. Whole-genome analysis revealed that emm-like genes found previously in S. canis correspond to divergent scm genes, indicating that what was previously believed to correspond to two genes is in fact the same scm locus. We designed primers allowing for the first time the successful amplification of the scm gene in all isolates. Analysis of the scm sequences identified 12 distinct types, which could be divided into two clusters: group I (76%, n = 142) and group II (24%, n = 46) sharing little sequence similarity. The predicted group I SCM showed extensive similarity with each other outside of the N-terminal hypervariable region and a conserved IgG binding domain. This domain was absent from group II SCM variants found in isolates previously thought to lack the scm gene, which also showed greater amino acid variability. Further studies are necessary to elucidate the possible host interacting partners of the group II SCM variants and their role in virulence

Urogenital Trichomonas vaginalis infection in males: a case report and retrospective analysis of a 10‐year period in a tertiary hospital

© 2021 the International Society of DermatologyWe report the case of a 31-year-old male who presented to our Venereology Department with dysuria and a 2-year history of a minimal clear urethral discharge. He had been treated with multiple courses of antibiotics, namely, intramuscular ceftriaxone, azithromycin, ciprofloxacin, and doxycycline, even though laboratorial tests for Neisseria gonorrhoeae and Chlamydia trachomatis were consistently negative. The patient had psychological distress due to these persistent symptoms and for the lack of diagnosis as well as abstinence from any kind of sexual activity over the last 2 years. He denied any other complaints and also denied prior history of sexually transmitted diseases, other medical conditions, or current medication.info:eu-repo/semantics/publishedVersio

Extensive dissemination of methicillin-resistant Staphylococcus aureus (MRSA) between the hospital and the community in a country with a high prevalence of nosocomial MRSA.

According to the EARS-Net surveillance data, Portugal has the highest prevalence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) in Europe, but the information on MRSA in the community is very scarce and the links between the hospital and community are not known. In this study we aimed to understand the events associated to the recent sharp increase in MRSA frequency in Portugal and to evaluate how this has shaped MRSA epidemiology in the community. With this purpose, 180 nosocomial MRSA isolates recovered from infection in two time periods and 14 MRSA isolates recovered from 89 samples of skin and soft tissue infections (SSTI) were analyzed by pulsed-field gel electrophoresis (PFGE), staphylococcal chromosome cassette mec (SCCmec) typing, spa typing and multilocus sequence typing (MLST). All isolates were also screened for the presence of Panton Valentine leukocidin (PVL) and arginine catabolic mobile element (ACME) by PCR. The results showed that ST22-IVh, accounting for 72% of the nosocomial isolates, was the major clone circulating in the hospital in 2010, having replaced two previous dominant clones in 1993, the Iberian (ST247-I) and Portuguese (ST239-III variant) clones. Moreover in 2010, three clones belonging to CC5 (ST105-II, ST125-IVc and ST5-IVc) accounted for 20% of the isolates and may represent the beginning of new waves of MRSA in this hospital. Interestingly, more than half of the MRSA isolates (8/14) causing SSTI in people attending healthcare centers in Portugal belonged to the most predominant clones found in the hospital, namely ST22-IVh (n = 4), ST5-IVc (n = 2) and ST105-II (n = 1). Other clones found included ST5-V (n = 6) and ST8-VI (n = 1). None of the MRSA isolates carried PVL and only five isolates (ST5-V-t179) carried ACME type II. The emergence and spread of EMRSA-15 may be associated to the observed increase in MRSA frequency in the hospital and the consequent spillover of MRSA into the community

Evolving epidemiology of carbapenemase-producing Enterobacteriaceae in Portugal: 2012 retrospective cohort at a tertiary hospital in Lisbon

© 2015 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.Despite great efforts to enhance European epidemiological surveillance on carbapenemase-producing Enterobacteriaceae (CPE), information from several countries remains scarce. To address CPE epidemiology in Portugal, we have undertaken a retrospective cohort study of adults with CPE cultures identified in the microbiology laboratory of a tertiary hospital, in 2012. Sixty patients from 25 wards or intensive care units were identified. This is, to the best of our knowledge, the first report of clinical data on CPE in Portugal. It shows a hospital-wide CPE dissemination and alerts us to an evolving epidemiological situation not previously described.info:eu-repo/semantics/publishedVersio

Main characteristics of the 14 MRSA isolates collected in the healthcare centers in 2010/2011.

1<p>Isolates carry the <i>ccrAB1</i>, <i>ccrC</i> and <i>mec</i> complex C2. SCC<i>mec</i> type was confirmed by long-range PCR;</p>2<p><i>spa</i> typing and MLST were only performed on representative isolates of each PFGE type-SCC<i>mec</i> association.</p>3<p>OX, oxacillin; E, erythromycin; CLI, clindamycin; LZD, linezolid; CIP, ciprofloxacin; QD, quinupristin-dalfopristin; SXT, sulfamethoxazole-trimethoprim; TE, tetracycline; FD, fusidic acid; RD, rifampicin; VAN, vancomycin; CN, gentamicin.</p

MRSA population structure in the hospital and community in Portugal.

<p>Schematic representation of the MRSA population structure in the hospital and community settings and the possible dissemination of hospital clones into the community.</p