Multidrug-resistant gram-negative bacteria, such as carbapenem and colistin-resistant Klebsiella pneumoniae (ColR-CRKP), represent a major problem for health systems worldwide and have high lethality. This study investigated the genetic relationship, antimicrobial susceptibility profile, and resistance mechanisms to ColR-CRKP isolates from patients infected/colonized in a tertiary hospital in Salvador, Bahia/Brazil. From September 2016 to January 2018, 46 patients (56 ColR-CRKP positive cultures) were enrolled in the investigation but clinical and demographic data were obtained from 31 patients. Most of them were men (67.7%) and elderly (median age of 62 years old), and the median Charlson score was 3. The main comorbidities were systemic arterial hypertension (38.7%), diabetes (32.2%), and cerebrovascular disease (25.8%). The average hospitalization stay until ColR-CRKP identification in days were 35.12. A total of 90.6% used mechanical ventilation and 93.7% used a central venous catheter. Of the 31 patients who had the data evaluated, 12 had ColR-CRKP infection, and seven died (58.4%). Previous use of polymyxins was identified in 32.2% of the cases, and carbapenems were identified in 70.9%. The minimum inhibitory concentration (MIC) for colistin was > 16 μg/mL, with more than half of the isolates (55%) having a MIC of 256 μg/mL. The blaKPC gene was detected in 94.7% of the isolates, blaNDM in 16.0%, and blaGES in 1.7%. The blaOXA–48, blaVIM, and blaIMP genes were not detected. The mcr-1 test was negative in all 56 isolates. Alteration of the mgrB gene was detected in 87.5% (n = 49/56) of the isolates, and of these, 49.0% (24/49) had alteration in size probably due to IS903B, 22.4% (11/49) did not have the mgrB gene detected, 20.4% (10/49) presented the IS903B, 6.1% (3/49) had a premature stop codon (Q30*), and 2.1% (1/49) presented a thymine deletion at position 104 – 104delT (F35fs). The PFGE profile showed a monoclonal profile in 84.7% of the isolates in different hospital sectors, with ST11 (CC-258) being the most frequent sequence type. This study presents a prolonged outbreak of ColR-CRKP in which 83.9% of the isolates belonged to the same cluster, and 67.6% of the patients evaluated had not used polymyxin, suggesting the possibility of cross-transmission of ColR-CRKP isolates.
Introduction. In recent years, cholesterol has received interest in the study of infection due to evidence of a relationship between low plasma cholesterol levels and tuberculosis (TB). Hypothesis/Gap Statement. Plasma lipid profiles of serum amyloid A (SAA), apolipoprotein A-I and high-density lipoprotein cholesterol (HDL-C) are biomarkers associated with symptomatic TB patients. Objective. We aimed to evaluate plasma lipid profiles of apolipoprotein A-I, SAA and the size of HDL as biomarkers to diagnose symptomatic TB patients. Methodology. Patients with TB symptoms attending the Instituto Brasileiro para a Investigação da Tuberculose/Fundação José Silveira (IBIT/FJS) between September 2015 and August 2016 for diagnosis of TB were studied. From 129 patients, 97 were classified as pulmonary TB and 32 as negative-bacilloscopy (non-TB group). Medical history, fasting serum and plasma were obtained. Total cholesterol (TC), HDL-C, apolipoprotein A-I and SAA were measured by enzymatic or immunochemical reaction assays. HDL size was measured by laser light-scattering. Results. In TB patients, TC (147.0±37 vs. 168±44 mg dL−1), HDL-C (37±14 vs. 55±18 mg dL−1) and apolipoprotein A-I (102±41 vs. 156±47 mg dL−1) concentrations were lower (P<0.0001), while HDL particle size (10.16±1.02 vs. 9.62±0.67 nm) and SAA levels (280±36 vs. 19±8 mg L−1) were higher (P<0.0001). Using receiver-operating characteristic curve analysis for predicting TB, the cutoff values were <83.85 mg L−1 for SAA (sensitivity=96.88 %, specificity=78.43 %, P<0.0001), >44.50 mg dL−1 for HDL-C (sensitivity=75 %, specificity=72.16 %, P<0.001) and >118.5 mg dL−1 for apolipoprotein A-I (sensitivity=83.83 %, specificity=72.22 %, P<0.001). Conclusion. SAA, HDL-C and apolipoprotein A-I are associated with TB infection and could be used as laboratory biomarkers, especially in patients who are negative for alcohol-acid-resistant bacilli.
Frente a lacuna formativa dos profissionais da atenção básica e da educação para o manejo e acompanhamento adequados das pessoas que vivem com a Doença Falciforme, considerada a doença genética de maior prevalência no Brasil, este trabalho teve como objetivo capacitar profissionais das áreas da saúde e da educação em nove municípios da região do Recôncavo do estado da Bahia, entre 2014 e 2015. As capacitações ocorreram com equipe multidisciplinar, envolvendo enfermeiros, médicos, dentistas, discentes e docentes da Universidade Federal do Recôncavo da Bahia, membros da Secretaria de Saúde do Estado da Bahia, Secretarias Municipais de Saúde, Núcleo Regional de Saúde Leste e apoio financeiro da Fundação de Amparo à Pesquisa do Estado da Bahia. Os resultados indicaram a participação de 702 profissionais no programa: 29 (4,1%) médicos, 101 (14,4%) enfermeiros, 43 (6,1%) dentistas, 69 (9,8%) outros profissionais graduados (psicólogos, fisioterapeutas, nutricionistas, professores) e 460 (65,5%) agentes comunitários de saúde e técnicos. No curso de manejo clínico compareceram 80 (46%) enfermeiros, 56 (32,2%) médicos e 38 (21.8%) dentistas, totalizando 174 participantes. Concluiu-se que, mediante o número expressivo de participantes das diferentes áreas do conhecimento que atuam na atenção básica e nas escolas da região, o tema possuiu extrema relevância para os profissionais, apesar da pouca visibilidade demonstrada pelas políticas de saúde pública e de educação. Não obstante, a estratégia utilizada mostrou-se eficiente e contribuiu de forma eficaz para a capacitação dos profissionais. Palavras-chave: Doença falciforme. Educação continuada. Capacitação profissional.
Urinary tract infection (UTI) is one of the most common bacterial infections among humans. Urine culture is the gold standard diagnostic method for UTI; however, the dipstick test for nitrite is a widely used method signalling the presence of urinary nitrate-reducing bacteria. Unlike the gold standard, the dipstick test is easy to perform, while it is also less time-consuming and less expensive, and produces a result in a few minutes. This study investigates the sensitivity of the dipstick test for nitrite compared with the Griess test in urine samples from UTI caused by Enterobacterales species. We used the Griess test, which is the gold standard in nitrite measurement, to determine the sensitivity of the nitrite dipstick test. Semiquantitative urine culture was performed using standard procedures, and Enterobacterales identification was performed by manual conventional biochemical tests. In the first sample selection, 3 % (8/267) of urine samples suspected of UTI, analysed from March to April 2016, were nitrite-negative by dipstick test but positive for Enterobacterales in the urine culture. In the second sample selection, 5 % (2/44) of urine samples from October to December 2022 were also nitrite-negative but showed urine Enterobacterales isolation. All nitrite-negative dipstick results were consistent with the Griess test. Escherichia coli was the most prevalent bacterium, followed by Klebsiella pneumoniae, independent of sample selection. The dipstick test is a safe alternative for investigating nitrite in urine samples. We believe that the cause of nitrite-negative results is a lack of dietary nitrate, dilution of urine and exogenous interference (e.g. ascorbic acid). These findings support the idea that standard urine culture is necessary to rule out UTI.
Este estudo utilizou o método de análise de conteúdo para investigar a abordagem sobre a doença falciforme (DF) em livros didáticos (LDs) de Biologia do ensino médio publicados no Brasil. Os resultados mostraram a necessidade de reavaliar informações disponibilizadas pelos LDs para evitar estigmatização e a perpetuação de conceitos que interferem no patrimônio cultural dessas pessoas. Apesar da frequência elevada do alelo que codifica a hemoglobina S em todo o Brasil, dados sobre a epidemiologia desta mutação não foram encontrados nos livros. Além disso, conceitos sobre o autocuidado, a qualidade e a expectativa de vida das pessoas com DF precisam ser revisitados. Uma vez que os LDs constituem um dos meios de disseminação de informações mais utilizados pelos estudantes nas escolas públicas brasileiras, a atualização das informações fornecidas torna-se necessária à luz de novos conhecimentos que têm impactos no entendimento da DF e na percepção das pessoas a seu respeito, tanto aquelas que vivem quanto as que não vivem com DF.
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