To evaluate the impact of Burkholderia cepacia complex colonization in cystic fibrosis patients undergoing lung transplantation.
We prospectively analyzed clinical data and respiratory tract samples ...(sputum and bronchoalveolar lavage) collected from suppurative lung disease patients between January 2008 and November 2013. We also subtyped different Burkholderia cepacia complex genotypes via DNA sequencing using primers against the recA gene in samples collected between January 2012 and November 2013.
From 2008 to 2013, 34 lung transplants were performed on cystic fibrosis patients at our center. Burkholderia cepacia complex was detected in 13 of the 34 (38.2%) patients. Seven of the 13 (53%) strains were subjected to genotype analysis, from which three strains of B. metallica and four strains of B. cenocepacia were identified. The mortality rate was 1/13 (7.6%), and this death was not related to B. cepacia infection.
The results of our study suggest that colonization by B. cepacia complex and even B. cenocepacia in patients with cystic fibrosis should not be considered an absolute contraindication to lung transplantation in Brazilian centers.
The gold standard for diagnosing invasive candidiasis still relies on blood cultures, which are inefficient and time-consuming to analyze. We developed an in-house qPCR assay to identify the 5 major
...species in 78 peripheral blood (PB) samples from ICU patients at risk of candidemia. Blood cultures and (1,3)-β-D-glucan (BDG) testing were performed concurrently to evaluate the performance of the qPCR. The qPCR was positive for DNA samples from all 20 patients with proven candidemia (positive PB cultures), showing complete concordance with
species identification in blood cultures, except for detection of dual candidemia in 4 patients, which was missed by blood cultures. Additionally, the qPCR detected
species in six DNA samples from patients with positive central venous catheters blood (CB) but negative PB cultures. BDG values were similarly high in these six samples and the ones with proven candidemia, strongly suggesting the diagnosis of a true candidemia episode despite the negative PB cultures. Samples from patients neither infected nor colonized yielded negative results in both the qPCR and BDG testing. Our qPCR assay was at least as sensitive as blood cultures, but with a shorter turnaround time. Furthermore, negative results from the qPCR provided strong evidence for the absence of candidemia caused by the five major
species.
Chronic obstructive pulmonary disease is a current problem for elderly patients due to diffusion, mortality, and other negative outcomes. The most complex management aspects consist of the presence ...of frailty, which increases the risk of complications and adverse drug events and reduces the effectiveness of treatments. In this context, to determine the best individualized treatment, it is crucial to have an excellent understanding of the medical and non-medical treatments available, the use of ventilation systems, combined with in-depth geriatric knowledge.
Acute post-cataract endophthalmitis (APE) is a rare complication potentially causing irreversible visual loss. A 10-year study of APE was conducted to determine its incidence, microbiological spectra ...and antibiotic resistance profile of APE-related pathogens at a major tertiary referral center in Brazil.
APE cases reported between January 2010 and December 2019 were included. Phacoemulsification and extracapsular cataract techniques were eligible; combined procedures, traumatic and congenital cataract were excluded. Vitreous samples were cultured and antimicrobial resistance was compared for the periods of 2010-2014 and 2015-2019. The results were analyzed with Fisher's exact test.
Our sample consisted of 40,491 cataract surgeries and 51 (0.126%) APE cases. Culture was positive in 35 cases (71.4%), of which 31 (88.6%) Gram-positive, 3 (8.6%) Gram-negative, and 1 (2.9%) fungal. The most frequently isolated organism was Staphylococcus epidermidis (n = 17/35, 48.6%), followed by Staphylococcus aureus (n = 4/35, 11.4%). From 2010-2014 to 2015-2019, antimicrobial resistance increased against moxifloxacin (11.1-54.5%, p = 0.07), ciprofloxacin (54.5-72.7%, p = 0.659) and oxacillin (66.7-93.3%, p = 0.13).
The observed incidence and microbial spectra were compatible with previous studies. A trend towards growing moxifloxacin and ciprofloxacin resistance was observed. Surveillance remains crucial to prevent treatment failure from antimicrobial resistance.
To report our experience using conventional culture methods (CM) and pediatric blood culture bottles (PBCBs) for vitreous sample culture of acute postoperative endophthalmitis.
A retrospective study ...was conducted at the Department of Ophthalmology, Hospital das Clinicas, HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, BR, from January 2010 to December 2015, and it included 54 patients with clinically suspected acute postoperative endophthalmitis. Vitreous samples were obtained by vitreous tap or vitrectomy. Samples from January 2010 to December 2011 were cultivated in CM, whereas samples from January 2012 to December 2015 were inoculated in PBCBs. The measured outcome was the yield of positive cultures.
Twenty cases were included in the CM group, and 34 cases were included in the PBCB group. The yield of positive cultures in PBCBs (64.7%) was significantly higher than that in conventional CM (35%, p=0.034). Staphylococcus epidermidis and Streptococcus viridans were the two most commonly found agents.
PBCBs can be used successfully in clinically suspected endophthalmitis. The method showed a higher yield of positive cultures than the conventional method. This technique appears to have several advantages over the traditional method: it saves time, as only one medium needs to be inoculated; transportation to a laboratory is easier than in the traditional method, and there is no need to maintain a supply of fresh agar media. The use of PBCBs may be recommended as the primary method for microbiological diagnosis and is especially suitable for office settings and remote clinics.
We report a case of bloodstream infection caused by R. hoagii in a woman with acute myeloid leukemia, 37-years-old, who received an allogeneic hematopoietic stem cell transplant. She developed ...cutaneous and gastrointestinal tract graft versus host disease, respectively on day 29 and day 69. On day 157 she developed to acute severe respiratory failure. Rhodococcus sp was identified by MALDI-TOF and 16S rRNA sequencing from blood culture as Rhodococcus hoagii. The patient was a nurse that lived in urban areas, and stated no recent trips to countryside areas neither contacted with animals. Despite of the treatment with antibiotics with action against R. hoagii such as linezolid and meropenem the patient evolved to multiorgan dysfunction and death. Our case-report emphasizes the importance of early diagnosis and the use of 16S rRNA sequencing to confirmed the identification of species of Rhodococcus infection.
Bergamasco, JGA, Gomes da Silva, D, Bittencourt, DF, Martins de Oliveira, R, Júnior, JCB, Caruso, FC, Godoi, D, Borghi-Silva, A, and Libardi, CA. Low-load resistance training performed to muscle ...failure or near muscle failure does not promote additional gains on muscle strength, hypertrophy, and functional performance of older adults. J Strength Cond Res 36(5): 1209-1215, 2022-The aim of the present study was to compare the effects of low-load resistance training (RT) protocols performed to failure (FAI), to voluntary interruption (VOL), and with a fixed low repetitions (FIX) on muscle strength, hypertrophy, and functional performance in older adults. Forty-one subjects (60-77 years) were randomized into one of the RT protocols (FAI, VOL, or FIX) and completed 12 weeks of RT at 40% of 1 repetition maximum (1RM), twice a week. The assessments included 1RM test, muscle cross-sectional area (CSA), rate of torque development (RTD), and functional performance (chair stand CS, habitual gait speed HGS, maximal gait speed MGS, and timed up-and-go TUG). All protocols significantly increased 1RM values from Pre (FAI: 318.3 ± 116.3 kg; VOL: 342.9 ± 93.7 kg; FIX: 328.0 ± 107.2 kg) to Post (FAI: 393.0 ± 143.1 kg, 23.5%; VOL: 423.0 ± 114.5 kg, 23.3%; FIX: 397.8 ± 94.6 kg, 21.3%; p < 0.0001 for all groups). Regarding CS, all protocols showed significant improvements from Pre (FAI: 11.5 ± 2.4 seconds; VOL: 12.1 ± 2.5 seconds; FIX: 11.3 ± 1.1 seconds) to Post (FAI: 10.5 ± 1.1 seconds, -8.5%, p = 0.001; VOL: 10.3 ± 1.5 seconds, -15.1%, p = 0.001; FIX: 11.0 ± 1.1, -3.2%, p = 0.001). Habitual gait speed values increased significantly from Pre (FAI: 1.3 ± 0.2 m·s-1; VOL: 1.3 ± 0.1 m·s-1; FIX: 1.3 ± 0.1 m·s-1) to Post (FAI: 1.4 ± 0.2 m·s-1, 2.5%, p = 0.03; VOL: 1.4 ± 0.2 m·s-1, 5.2%, p = 0.036; FIX: 1.4 ± 0.1 m·s-1, 5.7%, p = 0.03). No significant differences between protocols were found (p > 0.05). In addition, there were no significant changes in CSA, RTD, MGS, and TUG for any protocols (p > 0.05). In conclusion, low-load RT performed without muscle failure promotes significant improvements in muscle strength and some parameters of functional performance in older adults.
Helicobacter pylori(H. pylori) infection is the most common bacterial infection worldwide. Persistent infection of the gastric mucosa leads to inflammatory processes and may remain silent for decades ...or progress causing more severe diseases, such as gastric adenocarcinoma. The clinical consequences of H. pylori infection are determined by multiple factors, including host genetic predisposition, gene regulation, environmental factors and heterogeneity of H. pylori virulence factors. After decades of studies of this successful relationship between pathogen and human host, various mechanisms have been elucidated. In this review, we have made an introduction on H. pylori infection and its virulence factors, and focused mainly on modulation of host immune response triggered by bacteria, changes in the pattern of gene expression in H. pylori-infected gastric mucosa, with activation of gene transcription involved in defense mechanisms, inflammatory and immunological response, cell proliferation and apoptosis. We also highlighted the role of bacteria eradication on gene expression levels. In addition, we addressed the recent involvement of different microRNAs in precancerous lesions, gastric cancer, and inflammatory processes induced by bacteria. New discoveries in this field may allow a better understanding of the role of major factors involved in the pathogenic mechanisms of H. pylori.
BACKGROUNDChronic inflammation due to Helicobacter pylori (H. pylori) infection promotes gastric carcinogenesis. Tumour necrosis factor-α (TNF-α), a key mediator of inflammation, induces cell ...survival or apoptosis by binding to two receptors (TNFR1 and TNFR2). TNFR1 can induce both survival and apoptosis, while TNFR2 results only in cell survival. The dysregulation of these processes may contribute to carcinogenesis. AIMTo evaluate the effects of TNFR1 and TNFR2 downregulation in AGS cells treated with H. pylori extract on the TNF-α pathway. METHODSAGS cell lines containing TNFR1 and TNFR2 receptors downregulated by specific shRNAs and nonsilenced AGS cells were treated with H. pylori extract for 6 h. Subsequently, quantitative polymerase chain reaction with TaqMan® assays was used for the relative quantification of the mRNAs (TNFA, TNFR1, TNFR2, TRADD, TRAF2, CFLIP, NFKB1, NFKB2, CASP8, CASP3) and miRNAs (miR-19a, miR-34a, miR-103a, miR-130a, miR-181c) related to the TNF-α signalling pathway. Flow cytometry was employed for cell cycle analysis and apoptosis assays. RESULTSIn nonsilenced AGS cells, H. pylori extract treatment increased the expression of genes involved in cell survival and inhibited both apoptosis (NFKB1, NFKB2 and CFLIP) and the TNFR1 receptor. TNFR1 downregulation significantly decreased the expression of the TRADD and CFLIP genes, although no change was observed in the cellular process or miRNA expression. In contrast, TNFR2 downregulation decreased the expression of the TRADD and TRAF2 genes, which are both important downstream mediators of the TNFR1-mediated pathway, as well as that of the NFKB1 and CFLIP genes, while upregulating the expression of miR-19a and miR-34a. Consequently, a reduction in the number of cells in the G0/G1 phase and an increase in the number of cells in the S phase were observed, as well as the promotion of early apoptosis. CONCLUSIONOur findings mainly highlight the important role of TNFR2 in the TNF-α pathway in gastric cancer, indicating that silencing it can reduce the expression of survival and anti-apoptotic genes.
The global spread of carbapenemase-producing organisms (CPO) has been considered by international health authorities as a critical public health concern. Brazil has a high CPO prevalence according to ...distinct publications but many routine microbiology laboratories have only phenotypic resources to evaluate this epidemiological situation, which is time-consuming and detects only carbapenem-resistant isolates missing CPO susceptible expressing a slightly decreased susceptibility. New molecular platforms can detect CPO faster but a local evaluation is essential.
To evaluate the performance of CPO detection direct from rectal swabs with the Xpert Carba-R™ assay (Cepheid, Sunnyvale, CA) in the largest Brazilian University Hospital.
A prospective diagnostic accuracy study of CPO was performed with the collection of rectal swabs from patients admitted into the Intensive Care Unit (ICU) and into the Emergency Department (ED) between April and July 2016. The Xpert Carba-R™ assay results were compared with carbapenem-resistant Enterobacterales (CRE) surveillance cultures plus in-house PCR carbapenemase detection (reference method). In case of discordant results between methods, additional tests were performed. The limit of detection (LoD) for the CRE culture and the Xpert Carba-R™ assay were performed with contrived isolates of known carbapenemases genes.
A total of 921 clinical rectal swabs were analyzed being 21% (196/921) from the ICU and 79% (725/921) from the ED. Overall, the Xpert Carba-R™ assay detected 9.9% (91/921) of CPOs being 9.5% (87/921) positive only for blaKPC and 0.4% (4/921) positive only for blaNDM. The reference method detected 9.1% (84/921) CPO being 77 (8.4%) blaKPC, 5 blaVIM (0.5%) and 2 blaNDM (0.2%). No IMP or OXA-48 like gene was detected.
Overall, twelve samples, 1.3% (10 blaKPC, 2 blaNDM) were Xpert Carba-R™ positive but negative by the reference method. Five isolates (0.5%) were positive for blaVIM only by in-house PCR and confirmed to be blaVIM-2 by DNA sequencing. The Kappa value, sensitivity, specificity, positive/negative predictive values and accuracy of the Xpert Carba-R™ assay were; 0.893 (95% confidence interval CI, 0.842–0.944), 94% (86.7–98.0), 98.6% (97.5–99.3), 86.8% (78.1–93.0), 99.4% (98.6–99.8) and 98.2% (97.3–99.1), respectively. The LoD for blaKPC of the Xpert Carba-R™ assay and the CRE cultures were 101 CFU/swab.
The Xpert Carba-R™ assay is an accurate test to detect CPO directly from the rectal swabs with significant lower turnaround time (TAT) when compared to the reference method (CRE culture plus in-house PCR). Xpert Carba-R™ may, therefore, be regarded as a good and fast epidemiological tool.
•Xpert Carba-R™ is an accurate epidemiological tool for carbapenemase gene detection.•Xpert Carba-R™ showed high sensitivity and specificity for KPC detection.•Xpert Carba-R™ can be implemented in routine laboratories with less workload.•Fast detection of carbapenemases genes directly from the rectal swabs.
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