Eight quinolone resistant Campylobacter jejuni strains isolated from humans with diarrheal disease were compared with 23 isolates from chicken and from laying hens. Samples were cultured on selective agar in microaerophilia, identified by conventional tests, and conserved in 17% glycerol at -70 °C. Clones were determined by RAPD-PCR employing the 1254 primer (Stern NJ). Five patterns were obtained. Patterns I, II, and V were found in both poultry and human isolates. Pattern I was obtained from poultry in a domestic henhouse. Pattern III was only obtained from humans whereas pattern IV was only obtained from poultry. A 95.3% of clones were found in both, humans and poultry. According to these results colonization by quinolone resistant strains could be the origin of this human infection, acquired by ingestion.

Se compararon 8 aislamientos de Campylobacter jejuni provenientes de humanos con enfermedad diarreica aguda, con 23 aislamientos de cloaca de gallinas y pollos obtenidos de zonas próximas a la ciudad de Rosario, todos resistentes a la ciprofloxacina. Las muestras se sembraron en agar selectivo y se incubaron en microaerofilia a 42 °C. Las colonias se identificaron con el método tradicional. Los aislamientos se conservaron a -70 °C en caldo cerebro corazón con 17% v/v de glicerina. La clonalidad se determinó por RAPD-PCR, utilizando el primer 1254 (Stern NJ). Se interpretaron los aislamientos como clones distintos cuando diferían en una banda de amplificación. Se obtuvieron 5 clones diferentes. Los patrones I, II y V fueron aislados en criaderos industriales de pollos y en humanos (el II también en un establecimiento de gallinas ponedoras de huevos). En un gallinero familiar se obtuvo el patrón I. El patrón III sólo se obtuvo de humanos. El patrón IV se halló en uno de los criaderos pero no en humanos. Se pudo determinar que 93.5% de las cepas se aislaron tanto de animales como de humanos, por lo que se considera posible que la colonización de criaderos con cepas resistentes a los antimicrobianos pudiera ser el origen de la infección de humanos.

Background: To assess the relationship between ciprofloxacin use and the prevalence of extended spectrum betalactamases (ESBL) Klebsiella pneumoniae. Patients and Methods: Semestral mean values regarding use of antibiotic and prevalence of ESBL Kp were compared during 9 semesters using linear regression and coefficient of correlation. Results: The only statistically significant correlation was ciprofloxacin use and ESBL(+) K. pneumoniae prevalence, with a coefficient of correlation of 0.86 and p = 0.0027 using linear regression. Conclusions: Ciprofloxacin use must be taking into account when considering infection control programs due to high prevalence rates of ESBL(+) K. pneumoniae in the hospital setting

Fundamento: Evaluar la correlación entre el consumo de cefalosporinas de tercera generación y ciprofloxacina con la prevalencia de cepas de Klebsiella pneumoniae productoras de ß-lactamasas de espectro extendido (BLEE). Pacientes y Métodos: Los valores promedios semestrales, correspondientes a consumo y prevalencia se compararon durante 9 semestres, usando coeficiente de correlación y regresión lineal. Resultados: La única asociación que resultó estadísticamente significativa, fue la correspondiente al consumo de ciprofloxacina y K. pneumoniae BLEE (+), con un coeficiente de correlación de 0,86 y una p de 0,0027, en el análisis de regresión lineal. Conclusiones: El consumo de ciprofloxacina debe ser tenido en cuenta al momento de establecer programas de control de infecciones frente a elevadas tasas de prevalencia de K. pneumoniae productoras de BLEE en un hospital

Vancomycin-resistant enterococci (VRE) have emerged as important pathogenic bacteria all over the world. The first outbreak of infections due to VRE occurred in Rosario in 2000 due to Enterococcus faecium with the Van-A phenotype. As the use of contact isolation precautions for VRE-colonized and infected patients was recommended in order to prevent the spread of vancomycin resistance, a study to determine the level of fecal colonization among patients hospitalized in critical areas was conducted. Samples of rectal swabs were obtained from patients hospitalized in intensive care units of four hospitals in Rosario looking for VRE. Sixty-four cases of colonized patients with VRE were detected among the 565 patients studied. Sixty E. faecium, and two Enterococcus faecalis with the Van-A phenotype, and two Enterococcus gallinarum with the Van-C phenotype were isolated. All the E. faecium and E. faecalis isolates showed MIC > 256 ug/mL against vancomycin, and were susceptible to Linezolid.

Los enterococos vancomicina resistentes (EVR) han emergido como importantes patógenos en todo el mundo. En Rosario, se produjo un brote en 2000, luego de lo cual se los ha detectado en distintos centros hospitalarios de la ciudad. La mayoría de los aislados presentaron el fenotipo Van-A y correspondieron a Enterococcus faecium aunque se ha aislado también Enterococcus faecalis. Es posible la trasmisión nosocomial de estas bacterias por las manos o guantes a partir de pacientes infectados o colonizados. El objetivo del trabajo fue determinar el nivel de colonización fecal de pacientes hospitalizados en áreas críticas de cuatro instituciones asistenciales de esta ciudad. Se tomaron muestras de materia fecal o hisopado anal de pacientes con riesgo de colonización, internados en áreas críticas. Se aislaron 60 E. faecium y 2 E. faecalis con el fenotipo Van-A y 2 Enterococcus gallinarum con resistencia constitutiva, con el fenotipo Van-C. Todos los aislamientos de E faecium y E faecalis mostraron CIMs para vancomicina > 256 ug/mL y fueron sensibles a Linezolid.

Campylobacter is an important agent of illness in human beings. Bacteremia occurs principally in the immunocompromissed host and is frequently due to C. fetus. Nevertheless bacteremia also has been observed in patients with enteritis due to C. jejuni. We refer two cases of patients with severe enteritis and bacteremia, both of them with immunosupressive concomitant diseases such as nephrotic syndrome and chronic cirrotic hepatopathy. Both patients presented hemathemesis.

Campylobacter es un importante agente causante de enfermedad en el ser humano en nuestro medio. Los casos de bacteriemia ocurren principalmente en pacientes inmunosuprimidos y son debidos frecuentemente a C. fetus. Sin embargo la bacteriemia es un episodio que también se ha observado en pacientes con enteritis por C. jejuni. Referimos dos pacientes con enteritis grave y bacteriemia, ambos con enfermedades concomitantes compatibles con inmunodepresión: uno con síndrome nefrótico de larga data y otro con hepatopatía crónica con cirrosis. Destacamos que los dos casos presentaron hematemesis y uno de ellos, enterorragia. Sugerimos prestar atención a la coloración de Gram durante el subcultivo de los caldos con hemocultivos, en busca de formas características de esta especie, y en ese caso emplear medios de cultivo en microaerofilia a 37 y 42 °C.

A importância das mãos na transmissão de infecções hospitalares é aceita mundialmente. Todavia, é difícil introduzir este procedimento entre os trabalhadores da saúde. Este trabalho pretendeu evidenciar a colonização das mãos por bactérias e a influência da lavagem de mãos e o exame físico dos pacientes. 100 profisionais de saúde foram divididos, ao acaso em dois grupos: A - sem lavagem de mãos antes do exame físico ou manejo dos pacientes (PPE); B - com lavagem prévia das mãos antes do PPE. Foram obtidas amostras de impressões digitais em agar Columbia antes e depois do PPE. As colônias foram contadas e identificadas por técnicas convencionais e antibiogramas de acordo com NCCLS. Antes do PPE os participantes do grupo A apresentaram elevado número de bactérias em relação ao grupo B (73.9 vs. 20.7; p < 0.001); 44 dos 50 participantes eram portadores potenciais de bactérias patogênicas. Nenhum participante do grupo B era portador de bactéria potencialmente patogênica antes do PPE. Este grupo mostrou um aumento no número de bactérias depois do PPE (20.7 UFC antes vs. 115.9 UFC depois; p < 0.001). 16 participantes do grupo B foram contaminados, depois do PPE, com patógenos potenciais tais como S. aureus (50% dos quais eram resistentes à meticilina), Escherichia coli, Pseudomonas aeruginosa e Enterococcus faecalis, metade dos quais, multiresistentes. Podemos concluir sobre a importância destes resultados para implementar programas educacionais e para prover os trabalhadores da saúde com facilidades para o adequado cumprimento desta prática.

The importance of hands in the transmission of nosocomial infection has been world wide admitted. However, it is difficult to induce this behavior in health-care workers. The aim of the present work was to point out the importance of hand bacteria colonization, the influence of hand washing and of patient physical examination. One hundred health-care workers were randomly divided in two groups: Group A without hand washing previous to patient physical examination or handling (PPE); group B with hand washing previous to PPE. Direct fingerprint samples in Columbia agar before and after PPE were obtained. The colonies were counted and identified by conventional techniques, and antibiograms according to NCCLS were performed. Before PPE group A participants showed a high number of bacteria regarding group B participants (73.9 Vs 20.7; p < 0.001); 44 out of 50 participants were carriers of potentially pathogen bacteria. No group B participants were carriers of potential pathogen bacteria before PPE. The latter group showed an increase in number of bacteria after PPE (20.7 CFU (before) Vs 115.9 CFU (after); p < 0.001). Sixteen group B participants were contaminated after PPE with potential pathogens such as S. aureus (50% of them meticillin resistant); Escherichia coli, Pseudomonas aeruginosa and Enterococcus faecalis, half of them multiresistant. We can conclude on the importance of these results to implement educational programs and to provide the health-care workers with the proper commodities to fulfill this practice.

Apresentamos as espécies e serovars mais frequentes dos microorganismos enteropatógenos entre 1985 e 1990 em Rosario. Escherichia coli enteropatogênica (EPEC) foi a que predominou, afetando 144/570 (25,2%) crianças; 0111 representou 41,8%, 055 13,6%, 0119 12,7%. Entre as E. coli enterotoxigênicas (ETEC), ETEC-ST 0128:H21 e 0153:H45 foram as mais frequentes. Entre os 570 pacientes, Shigella spp. foi diagnosticada em 50 (8,8%); S. flexneri 7%, principalmente do tipo 2 (59,5%), S. sonnei 1,6% e S. dysenteriae tipo 2 (1%). Foram encontrados Campylobacter spp em 6,1% dos pacientes; C. jejuni 4,6%, C. coli 1,4% e C. lari 0,2%; exceto os grupos 0 13/50 e 0 4 (dois de cada um), não foram encontrados serogrupos predominantes. Salmonella foi encontrada em 2,8% dos casos, sendo o serovar S. typhimurium o predominante até 1986, mas desde 1987, foi observado um aumento importante de casos por S. enteritidis. Houve 1,9% de Aeromonas spp e dois casos por Vibrio cholerae não 01. Não se encontrou Yersinia spp. Nos pacientes com gastroenteritis por Shigella, Campylobacter, Salmonella e EPEC como único patógeno, foram observados leucocitos nas feses de 70%, 50%, 20% e 10% dos casos respectivamente.

We report the most frequent species and serovars of enteropathogenic organisms in Rosario from 1985 to 1993. Enteropathogenic Escherichia coli was the most prevalent agent affecting 144/570 (25.2%) children; 0111 represented 41.8%, 055: 13.6%, 0119: 12.7%. Among enterotoxigenic E. coli (ETEC) the most frequent were ETEC-ST 0128:H21 and 0153:H45. Shigella spp were isolated in 8.8%; S.flexneri: 7%, principally type 2 (59.5%); S. sonnei: 1.6%, and S. dysenteriae type 2: 0.2%. Campylobacter spp were found in 6.1% of patients; C.jejuni: 4.6%; C. coli: 1.4% and C. lari: 0.2%; except groups 0 13,50 and 0 4 (2 cases each), no predominant serogroups were found. Salmonella was isolated in 2.8% of cases, being the predominant serovar S. typhimurium until 1986, but a dramatically increase of cases due to S. enteritidis was observed since 1987. There was 1.9% of Aeromonas spp and 2 cases due to Vibrio cholerae non 0-1. No Yersinia was found. In patients with gastroenteritis due to Shigella, Campylobacter, Salmonella, or EPEC as the unique pathogen, leukocytes were observed in the faeces in 70%, 50%, 20%, and 10% of cases respectively.