Acinetobacter baumannii in intensive care unit: A novel system to study clonal relationship among the isolates

<p>Abstract</p> <p>Background</p> <p>The nosocomial infections surveillance system must be strongly effective especially in highly critic areas, such as Intensive Care Units (ICU). These areas are frequently an epidemiological epicentre for transmission of multi-resistant pathogens, like <it>Acinetobacter baumannii</it>. As an epidemic outbreak occurs it is very important to confirm or exclude the genetic relationship among the isolates in a short time. There are several molecular typing systems used with this aim. The Repetitive sequence-based PCR (REP-PCR) has been recognized as an effective method and it was recently adapted to an automated format known as the DiversiLab system.</p> <p>Methods</p> <p>In the present study we have evaluated the combination of a newly introduced software package for the control of hospital infection (VIGI@ct) with the DiversiLab system. In order to evaluate the reliability of the DiversiLab its results were also compared with those obtained using f-AFLP.</p> <p>Results</p> <p>The combination of VIGI@ct and DiversiLab enabled an earlier identification of an <it>A. baumannii </it>epidemic cluster, through the confirmation of the genetic relationship among the isolates. This cluster regards 56 multi-drug-resistant <it>A. baumannii </it>isolates from several specimens collected from 13 different patients admitted to the ICU in a ten month period. The <it>A. baumannii </it>isolates were clonally related being their similarity included between 97 and 100%. The results of the DiversiLab were confirmed by f-AFLP analysis.</p> <p>Conclusion</p> <p>The early identification of the outbreak has led to the prompt application of operative procedures and precautions to avoid the spread of pathogen. To date, 6 months after the last <it>A. baumannii </it>isolate, no other related case has been identified.</p

Characterization of coagulase-negative staphylococcal isolates from blood with reduced susceptibility to glycopeptides and therapeutic options

<p>Abstract</p> <p>Background</p> <p>Coagulase-negative staphylococci (CoNS) are a major cause of nosocomial blood stream infection, especially in critically ill and haematology patients. CoNS are usually multidrug-resistant and glycopeptide antibiotics have been to date considered the drugs of choice for treatment. The aim of this study was to characterize CoNS with reduced susceptibility to glycopeptides causing blood stream infection (BSI) in critically ill and haematology patients at the University Hospital Tor Vergata, Rome, Italy, in 2007.</p> <p>Methods</p> <p>Hospital microbiology records for transplant haematology and ICU were reviewed to identify CoNS with elevated MICs for glycopeptides, and isolates were matched to clinical records to determine whether the isolates caused a BSI. The isolates were tested for susceptibility to new drugs daptomicin and tigecycline and the genetic relationship was assessed using f-AFLP.</p> <p>Results</p> <p>Of a total of 17,418 blood cultures, 1,609 were positive for CoNS and of these, 87 (5.4%) displayed reduced susceptibility to glycopeptides. Clinical review revealed that in 13 cases (7 in haematology and 6 in ICU), CoNS with reduced susceptibility to glycopeptides were responsible for a BSI. <it>Staphylococcus epidermidis </it>was the causative organism in 11 instances and <it>Staphylococcus haemolyticus </it>in 2. The incidence of oxacillin resistance was high (77%), although all isolates remained susceptible to linezolid, daptomycin and tigecycline. Fingerprinting of CoNS identified one clonal relationship between two isolates.</p> <p>Conclusion</p> <p>Multi-resistant CoNS with reduced susceptibility to glycopeptides, although still relatively infrequent in our hospital, are emerging pathogens of clinical concern. Surveillance by antibiotyping with attention to multi-resistant profile, and warning to clinicians, is necessary.</p

Infectious caused by community-acquired Methicillin-Resistant Staphylococcus aureus (CA-MRSA): three-years experience of an universitary hospital in Rome

To date methicillin-resistant Staphylococcus aureus (MRSA) is one of the most common pathogens causing nosocomial infections(1). In Europe the proportion of MRSA is increasing sharply and the distribution varies from country to country. In recent years there has, in various parts of the world, the emergence of infection with strains of S. aureus methicillin-resistant community-acquired (CA-MRSA) than those circulating in hospitals(2). These strains contain a gene that confers resistance to methicillin (mec A SSC mec IV) which is usually associated with the gene for Leukocidin Panton Valentine (PVL) toxin responsible for necrosis of skin and soft tissue (3). In 2006-2008, at the Laboratory of Bacteriology PolyclinicTor Vergata,were isolated a total of 738 strains of S. aureus from biological samples of different nature (oral, vaginal secretions, wound swab, secreted headset, etc ...) of patients related to our surgeries.The identification and study of drug sensitivity of strains were performed with the automatic VITEK2 (bioMérieux). Of the 738 strains of S. aureus identified 212 (28.7%) were resistant to methicillin (MRSA), with an increasing trend over the years: 46 isolates, respectively, in 2006, 76 in 2007 and 90 in 2008. The highest frequency of MRSA (varying between 85% and 95%) was detected in wound swabs from the dispensary and diabetes (diabetic foot)

CulinArtes - Cultura e Resiliência: Do meio digital às conexões humanas

This article aims to present the experience of the CulinARTES - Culture and Resilience project, carried out in 2020 by professors and students at the Federal University of São Carlos, as a strategy to encourage the permanence of indigenous and foreign students during the COVID-19 pandemic. The project was carried out in two stages. In the first, the cookbook material was produced, based on synchronous meetings in large and small groups, and asynchronous activities to elaborate the content individually. In the second stage, the group had the opportunity to collaboratively complete the production of the cookbook. From this experience, it was possible to broaden the discussion about interculturality, affection, well-being, belonging and also the different realities faced by foreign and indigenous academics during this period.Este artículo tiene como objetivo presentar la experiencia del proyecto CulinARTES - Cultura y Resiliencia, realizado en 2020 por profesores y estudiantes de la Universidad Federal de São Carlos, como una estrategia para incentivar la permanencia de estudiantes indígenas y extranjeros durante la pandemia COVID-19. . El proyecto se llevó a cabo en dos etapas. En el primero, se produjo el material del recetario, basado en reuniones sincrónicas en grupos grandes y pequeños, y actividades asincrónicas para elaborar el contenido de forma individual. En la segunda etapa, el grupo tuvo la oportunidad de completar de manera colaborativa la producción del libro de cocina. A partir de esta experiencia fue posible ampliar la discusión sobre la interculturalidad, el afecto, el bienestar, la pertenencia y también las diferentes realidades que enfrentaron los académicos extranjeros e indígenas durante este período.O presente artigo tem como objetivo apresentar a experiência do projeto CulinARTES - Cultura e Resiliência, realizado no ano de 2020 por professores e estudantes da Universidade Federal de São Carlos, como uma estratégia para incentivo à permanência de estudantes indígenas e estrangeiros durante a pandemia COVID-19. O projeto foi realizado em duas etapas. Na primeira, foi produzido o material do livro de receitas, a partir de encontros síncronos em grande grupo e em pequenos grupos, e atividades assíncronas para elaboração do conteúdo de forma individualizada. Na segunda etapa do projeto o grupo teve a oportunidade de concluir a produção do livro de receitas de forma colaborativa. A partir desta experiência, foi possível ampliar a discussão a respeito da interculturalidade, afetividade, bem estar, pertencimento e, também, as diferentes realidades enfrentadas por acadêmicos estrangeiros e indígenas durante este período

Klebsiella pneumoniae KPC: first isolations in Italy

Klebsiella pneumoniae carbapenemase (KPC) was detected in two isolates of carbapenem-resistant K. pneumoniae in an italian teaching hospital. This is the first report of a KPC-producing isolates in our country. The first strain was isolated from a urine sample collected from a indwelling urinary catheter in a ICU-patient with subdural haematoma, while the second was from the culture of the central venous catheter (CVC) in a patient affected by Crohn’s disease admitted in gastroenterology ward. Both were resistant to all ß-lactams, susceptible to imipenem and meropenem and resistant to ertapenem.They were resistant to other classes of non-ß-lactams antibiotics such as quinolones, aminoglycosides (with the exception of amikacin), trimethoprim-sulfamethoxazole (TMP-SMX) as well as to nitrofurantoin.The isolates were not associated with travel abroad.They were found to contain the plasmid encoded carbapenemase gene blaKPC and were also positive to the Hodge’s test.The detection of KPC-producing bacteria has important implications in infection control and public health. The K. pneumoniae carbapenemase (KPC) belong to class A ß-lactamases of the functional group 2f. Reported for the first time in U.S. in 2001, these agents were subsequently identified in Europe. KPC strains are typically resistant to penicillins, extended-spectrum cephalosporin and aztreonam and present a peculiar behavior against carbapenems in that MIC is close to the susceptibility value or is borderline (except for ertapenem).This pattern is often associated with resistance to quinolones.The information is conveyed by the resistance plasmids, thus explaining their diffusion and implication in outbreaks of KPC. Despite this, to date there are few reports concerning the isolation of this phenotype in Italy.The purpose of this paper is to present two clinical cases related to the isolation of KPC in our hospital. The KPC-producing strains have been respectively isolated: the first in a patient with Crohn’s disease, and the second in a patient with a subdural haematoma. Nono of these patient had a recent history of travel abroad. The strains were characterized by Vitek 2 and E-test (bioMérieux). The phenotype was confirmed through the execution of the Hodge’s test and by PCR blaKPC. The genetic relationship between isolates was determined by Rep-PCR. Both isolates were resistant to ß-lactams, quinolones and ertapenem, and were susceptible to imipenem, meropenem, tigecycline and colistin. The Hodge’s test was positive and the sequence analysis of the blaKPC gene revealed a KPC gene type 2. The fingerprinting showed that the isolates were clonally related. Both patients were successfully treated with tigecycline. KPC represents a real challenge either for the clinicians, who have limited therapeutic options to treat infections due to this microorganism, and for the laboratory, since their correct identification is necessary to reduce the dissemination of the pathogen

Ceftazidime/Avibactam-Resistant Klebsiella pneumoniae subsp. pneumoniae Isolates in a Tertiary Italian Hospital: Identification of a New Mutation of the Carbapenemase Type 3 (KPC-3) Gene Conferring Ceftazidime/Avibactam Resistance

Several Klebsiella pneumoniae carpabenemase (KPC) gene mutations are associated with ceftazidime/avibactam (CAZ-AVI) resistance. Here, we describe four Klebsiella pneumoniae subsp. pneumoniae CAZ-AVI-resistant clinical isolates, collected at the University Hospital of Tor Vergata, Rome, Italy, from July 2019 to February 2020. These resistant strains were characterized as KPC-3, having the transition from cytosine to thymine (CAC-TAC) at nucleotide position 814, with histidine that replaces tyrosine (H272Y). In addition, two different types of KPC gene mutations were detected. The first one, common to three strains, was the D179Y (G532T), associated with CAZ-AVI resistance. The second mutation, found only in one strain, is a new mutation of the KPC-3 gene: a transversion from thymine to adenine (CTG-CAG) at nucleotide position 553. This mutation causes a KPC variant in which glutamine replaces leucine (Q168L). None of the isolates were detected by a rapid immunochromatographic assay for detection of carbapenemase (NG Biotech, Guipry, France) and were unable to grow on a selective chromogenic medium Carba SMART (bioMerieux, Firenze, Italy). Thus, they escaped common tests used for the prompt detection of Klebsiella pneumoniae KPC-producing

Antimicrobial resistance in the times of COVID-19 in a roman teaching hospital

Objective: A troublesome implication of the COVID-19 pandemic has been an increased incidence of antimicrobial resistance. Implementation of containment measures, surveillance and monitoring of multiresistant microorganisms and/or alert organisms (MDROs_AL) should be strengthened. Here, we present the results of our observational study in which the isolation trend of MDROs_AL was compared over several quarters before and during the SARS-CoV-2 pandemic (2019-2020). Results: Although in our hospital the number of hospital admissions decreased significantly during the SARS-CoV-2 pandemic (due to the conversion of our hospital to a COVID hospital), the incidence rate of MDRO_AL infection increased from 18.0–34.6. (incidence rate) Among the MDROs_AL, A. baumannii, carbapenem-resistant enterobacteria, staphylococci/streptococci-MLSB, intermediate/glycopeptide-resistant coagulase-negative staphylococci and vancomycin-resistant enterococci were the most represented

In intensive care unit: A novel system to study clonal relationship among the isolates-0

Ts.<p><b>Copyright information:</b></p><p>Taken from "in intensive care unit: A novel system to study clonal relationship among the isolates"</p><p>http://www.biomedcentral.com/1471-2334/8/79</p><p>BMC Infectious Diseases 2008;8():79-79.</p><p>Published online 8 Jun 2008</p><p>PMCID:PMC2443154.</p><p></p

In intensive care unit: A novel system to study clonal relationship among the isolates-2

4 = environmental-sub clone 5; 5 = patient's sub clone 5; 6 = patient's sub clone 6; 7 = patient's sub clone 7; 8 = patient's sub clone 8; 9 = environmental-sub clone 7; 10 = patient's sub clone 1; 11 = patient's sub clone 2; 12 = patient's sub clone 3; 13 = patient's sub clone 4; 14 = patient's sub clone 10; 15 = patient's sub clone 11; 16 = environmental-sub clone 9; 17 = environmental-sub clone 8; 18 = environmental-sub clone 10; 19 = environmental-sub clone 11; 20 = environmental-sub clone 12; 21 = environmental-sub clone 3; 22 = environmental-sub clone 4; 23 = environmental-sub clone 2; 24 = patient's sub clone 12; 25 = patient's sub clone 13; 26 = environmental-sub clone 13; 27 = environmental-sub clone 14; 28 = environmental-sub clone 15.<p><b>Copyright information:</b></p><p>Taken from "in intensive care unit: A novel system to study clonal relationship among the isolates"</p><p>http://www.biomedcentral.com/1471-2334/8/79</p><p>BMC Infectious Diseases 2008;8():79-79.</p><p>Published online 8 Jun 2008</p><p>PMCID:PMC2443154.</p><p></p