Data from culture studies have revealed that Enterococcus faecalis is occasionally isolated from primary endodontic infections but frequently recovered from treatment failures. This molecular study was undertaken to investigate the prevalence of E. faecalis in endodontic infections and to determine whether this species is associated with particular forms of periradicular diseases. Samples were taken from cases of untreated teeth with asymptomatic chronic periradicular lesions, acute apical periodontitis, or acute periradicular abscesses, and from root-filled teeth associated with asymptomatic chronic periradicular lesions. DNA was extracted from the samples, and a 16S rDNA-based nested polymerase chain reaction assay was used to identify E. faecalis. This species occurred in seven of 21 root canals associated with asymptomatic chronic periradicular lesions, in one of 10 root canals associated with acute apical periodontitis, and in one of 19 pus samples aspirated from acute periradicular abscesses. Statistical analysis showed that E. faecalis was significantly more associated with asymptomatic cases than with symptomatic ones. E. faecalis was detected in 20 of 30 cases of persistent endodontic infections associated with root-filled teeth. When comparing the frequencies of this species in 30 cases of persistent infections with 50 cases of primary infections, statistical analysis demonstrated that E. faecalis was strongly associated with persistent infections. The average odds of detecting E. faecalis in cases of persistent infections associated with treatment failure were 9.1. The results of this study indicated that E. faecalis is significantly more associated with asymptomatic cases of primary endodontic infections than with symptomatic ones. Furthermore, E. faecalis was much more likely to be found in cases of failed endodontic therapy than in primary infections.

Results: One hundred seventy-five patients (20.9%) were diagnosed with SCI clinical syndromes. CCS was the most common (44.0%), followed by CES (25.1%) and BSS (17.1%). Significant differences (P 0.01) were found between groups with regard to age, race, etiology, total admission FIM, motor admission FIM, self-care admission and discharge FIM, and LOS. Statistical analysis between tetraplegic BSS and CCS revealed significant differences (P 0.01) with respect to age (39.7 vs 53.2 years) and a trend toward significance (P 0.05) with regard to self-care admission and discharge FIM. No significant differences (P 0.01) were found when comparing CMS to CES.Conclusions: SCI clinical syndromes represent a significant proportion of admissions to acute SCI rehabilitation, with CCS presenting most commonly and representing the oldest age group with the lowest admission functional level of all SCI clinical syndromes. Patients with cervical BSS seem to achieve higher functional improvement by discharge compared with patients with CCS. Patients with CMS and CES exhibit similar functional outcomes. Patients with ACS and PCS show functional gains with inpatient rehabilitation, with patients with ACS displaying the longest LOS of the SCI clinical syndromes. These findings have important implications for the overall management and outcome of patients with SCI.J Spinal Cord Med. 2007;30:215-224

Phenotypic and molecular methods were used to characterize the antibiotic resistance of 64 clinical isolates of Staphylococcus haemolyticus. By PCR of the mecA gene, 87% were found to be methicillin resistant. Approximately 55% harbored staphylococcal cassette chromosome mec element (SCCmec) type V, and only one SCCmec type IV. Many isolates (75%) displayed multiresistance, and pulsotype analysis showed a high diversity.A mong coagulase-negative staphylococci (CoNS), Staphylococcus haemolyticus is the second most frequently isolated from human blood cultures (18) and has the highest level of antimicrobial resistance (3,8). Methicillin resistance is conferred by the mecA gene, carried on the staphylococcal cassette chromosome mec element (SCCmec) (12). Eight types (I to VIII) of SCCmec have been assigned for Staphylococcus aureus (11), and SCCmec type V has already been found in CoNS, particularly in S. haemolyticus (13). The increase in the frequency of methicillinresistant S. haemolyticus as the causal agent of hospital infections and the possibility of emergence of resistance to other antibiotics demand trustworthy characterization of the isolates and an investigation of clonal spreading within hospitals.In the studies reported here, 64 clinical strains were isolated from patients at Hospital Naval Marcílio Dias, Rio de Janeiro, Brazil, between 2006 and 2008. The strains were isolated from the following clinical infections or sources in 31 males and 33 females: bacteremia (n ϭ 45), skin (n ϭ 2), urine (n ϭ 13), and unknown source (n ϭ 4). The isolates were identified at the hospital laboratory as S. haemolyticus by using the MicroScan WalkAway PC21 panel, and their identification was confirmed by specific PCR (17).The resistance profiles of the strains for the main antibiotics used in Brazil were determined by disc diffusion tests according to CLSI guidelines (5). However, the mupirocin susceptibility testing was not preconized by CLSI, so the results for this antibiotic were interpreted as previously described (7, 9). The methicillin resistance was also evaluated by other phenotypic methods, such as the MIC for oxacillin (5), the MicroScan, and PCR of the mecA gene (6). The SCCmec type was determined in a multiplex PCR as previously described (14), except that the pair of primers mecI P2 and mecI P3 used as the internal control were replaced by MRS1 and MRS2 (6), which amplify a 154-bp fragment of the mecA gene.Analysis of genetic relatedness and characterization of isolates using pulsed-field gel electrophoresis (PFGE) of genomic DNA digested with SmaI were carried out as previously described (20). Banding patterns were determined by visual inspection and by using Bionumerics software, version 6.0 (Applied Maths) using the Dice index and the unweighted-pair group method with arithmetic average. Similar PFGE genotypes were defined using a coefficient of similarity of up to 80%, and the subtypes were those with less than five-band variants, as recommended by van Belkun et al. (19).As shown in Table 1, there wa...

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In only a few instances has the clonal composition of Staphylococcus aureus collections that include methicillinsusceptible S. aureus (MSSA) been extensively characterized. In order to investigate the clonal composition of MSSA and methicillin-resistant S. aureus (MRSA) and examine whether the infections diagnosed at our hospital were related to internationally distributed S. aureus lineages, we collected 89 clinical S. aureus isolates from patients at a public university hospital in Rio de Janeiro, Brazil, from September 1999 to June 2000. All S. aureus isolates were genotyped by pulsed-field gel electrophoresis and multilocus restriction fragment typing (MLRFT), and a subset (n ‫؍‬ 17) was further characterized by multilocus sequence typing (MLST). The 34 MRSA isolates were additionally characterized by SCCmec typing. The MSSA population (n ‫؍‬ 55) was grouped into 18 restriction fragment types (RFTs); of these, five RFTs accounted for 67% (37) of the MSSA isolates. MRSA isolates were clustered into only three RFTs (P ‫؍‬ 0.02). The majority of MSSA RFTs were related to sequence type 30 (ST30) (12 isolates, 22%), ST1, ST188, and ST432 (6 isolates, 11% each). The predominant MRSA RFT comprised 31 (91%) of 34 isolates; four randomly selected isolates of this RFT were ST239, the previously described widely disseminated Brazilian clone. However, a fifth isolate belonging to this RFT was the ST644, a new single locus variant of ST239. By applying MLRFT and MLST, we found evidence for a clonal structure in MSSA isolates and detected the dissemination of MSSA clonal complexes 1, 5, 8, 30, and 45.

A 16S rDNA-directed polymerase chain reaction method was used to assess the occurrence of four black-pigmented anaerobic rods in root canal infections. Samples were obtained from 54 infected teeth. Ten cases were diagnosed as acute periradicular abscesses. DNA was extracted from the samples and analyzed using a polymerase chain reaction-based identification assay. The method allowed detection of black-pigmented bacteria anaerobes in 59.3% of the examined teeth. Twelve cases yielded more than one black-pigmented species. In general Porphyromonas endodontalis was found in 42.6%, Porphyromonas gingivalis in 27.8%, Prevotella nigrescens in 7.4%, and Prevotella intermedia in 5.6% of the cases. P. endodontalis was found in 70% of the pus samples, P. gingivalis in 40%, and P. intermedia in 10%. P. gingivalis was always found associated with P. endodontalis in abscessed teeth. P. nigrescens was not found in any pus sample. The high prevalence of P. endodontalis and P. gingivalis suggests that they can play an important role in the pathogenesis of periradicular diseases.

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