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Human skin banks around the world face a serious problem with the high number of allogeneic skins that are discarded and cannot be used for grafting due to persistent bacterial contamination even after antibiotic treatment. The biofilm formation capacity of these microorganisms may contribute to the antibiotic tolerance; however, this is not yet widely discussed in the literature. Thisstudy analyzed bacterial strains isolated from allogeneic human skin samples,which were obtained from a hospital skin bank that had already been discardeddue to microbial contamination. Biofilm formation and susceptibility topenicillin, tetracycline, and gentamicin were evaluated by crystal violetbiomass quantification and determination of the minimum inhibitoryconcentration (MIC), minimum biofilm inhibitory concentration (MBIC), andminimum biofilm eradication concentration (MBEC) by the broth microdilutionmethod with resazurin dye. A total of 216 bacterial strains were evaluated, and204 (94.45%) of them were classified as biofilm formers with varying degrees ofadhesion. MBICs were at least 512 times higher than MICs, and MBECs were atleast 512 times higher than MBICs. Thus, the presence of biofilm in allogeneicskin likely contributes to the inefficiency of the applied treatments as antibiotictolerance is known to be much higher when bacteria are in the biofilmconformation. Thus, antibiotic treatment protocols in skin banks shouldconsider biofilm formation and should include compounds with antibiofilmaction.

Introdução: A emergência de bactérias produtoras de β-lactamases de espetro expandido é um problema mundial, com importância crescente nas infeções adquiridas na comunidade, nomeadamente nas infeções urinárias. Os dados pediátricos de utilização de antimicrobianos não carbapenemos nestas infeções são escassos. O objetivo do estudo foi analisar a terapêutica antibiótica instituída nas infeções urinárias causadas por estes agentes, assim como a evolução clínica e laboratorial.Material e Métodos: Estudo retrospetivo efetuado num hospital pediátrico entre junho de 2007 e dezembro de 2017. Foram incluídas todas as crianças com urocultura positiva para Enterobacteriaceae produtoras de β-lactamases.Resultados: Foram diagnosticadas 175 infeções urinárias causadas por Enterobacteriaceae produtoras de β-lactamases, das quais 34 (19%) foram adquiridas na comunidade: 25 Escherichia coli (74%), 4 Klebsiella pneumoniae (12%), 4 Proteus mirabilis (12%) e 1 Proteus vulgaris (3%). Em 30 (88%) episódios tratou-se da primeira infeção urinária. Após conhecimento do microrganismo e suas suscetibilidades, 33 (97%) crianças foram reavaliadas e 24 (71%) repetiram urocultura, que foi positiva em três (13%). Em seis (18%) casos foi alterado o antimicrobiano. No mês subsequente, quatro (12%) crianças tiveram nova infeção urinária e 30 (88%) crianças realizaram investigação imagiológica, sem deteção de malformações nefro-urológicas.Discussão: Na última década, cerca de 20% das infeções urinárias causadas por Enterobacteriaceae produtoras de β-lactamases foram adquiridas na comunidade, com um número relativamente estável ao longo dos anos. Estas crianças não apresentavam malformações nefro-urológicas.Conclusão: Embora o número de casos seja pequeno, a evolução clínica e microbiológica mostrou que a maioria foi tratada com sucesso com antimicrobianos não carbapenemos, com baixa ocorrência de novos episódios.

La cistitis enfisematosa hace referencia a una entidad infrecuente, generalmente secundaria a infecciones de vías urinarias bajas, que por diferentes mecanismos producen gas alrededor de la vejiga. Esta patología se asocia a gérmenes (E. Coli, Enterobacter Arogenes, y Klebsiella, entre otros), y factores de riesgo como género femenino, edad avanzada y diabetes. Este diagnóstico requiere un manejo oportuno, con antibioticoterapia dirigida y control de comorbilidades asociadas; a continuación, se reporta el caso de un paciente masculino de 81 años, en el hospital de San José de Bogotá, a quien se le diagnostica esta patología, con el respectivo aislamiento microbiológico, factores de riesgo, diagnóstico y manejo instaurado

The infection by Nocardia spp is not common in immunocompetent patients. The empirical antimicrobial treatment directed by anatomical regions does not contemplate the particularities of the germ and the microbiological analysis is necessary for the specific treatment. We present the case of a previously healthy and immunocompetent patient, without known risk factors for Nocardia spp. infection, with evidence of involvement of the pulmonary parenchyma and the skin and subsequent development of multiple brain abscesses.La infección por Nocardia spp. no es común en pacientes inmunocompetentes. El tratamiento antimicrobiano empírico dirigido según las regiones anatómicas, no contempla las particularidades del germen y el análisis microbiológico se hace necesario para el tratamiento específico. A continuación, se presenta el caso de una paciente previamente sana, inmunocompetente y sin factores de riesgo conocidos para la infección por Nocardia spp., con evidencia de compromiso en el parénquima pulmonar y la piel, que posteriormente desarrolló varios abscesos cerebrales.

Resumen Introducción. La biodiversidad colombiana y los saberes tradicionales permiten la exploración de plantas medicinales con potencial actividad antimicrobiana que podrían usarse para tratamiento de infecciones. Objetivos. Determinar la actividad antibacteriana de extractos etanólicos de Lantana camara L., Petiveria alliacea L. y Lippia dulcis T. sobre Pseudomonas aeruginosa ATCC 9027, Escherichia coli ATCC 25922, Proteus vulgaris ATCC 6380 y Staphylococcus aureus ATCC 25923. Materiales y métodos. Se realizó la adquisición del material vegetal y caracterización botánica, se obtuvieron los extractos etanólicos por percolación y se realizó caracterización fitoquímica preliminar mediante cromatografía en capa delgada (CCD). Se evaluó la actividad antibacteriana, mediante pruebas de difusión con disco y difusión en agar en concentraciones de 1mg/mL y 2mg/mL; para extractos activos se estableció la Concentración Inhibitoria mínima (CIM) y Concentración Mínima Bactericida (CMB). Para análisis estadístico se realizó prueba t de Student. Resultados y discusión. Staphylococcus aureus ATCC 25923 fue sensible con Lantana camara L. y Lippia dulcis T. siendo este último activo también sobre Proteus vulgaris ATCC 6380 con efecto inhibitorio superior al 50%. El extracto de Lippia dulcis T. presentó la mayor actividad inhibitoria sobre S. aureus (CMI: 1,95 mg/mL). Ningún extracto mostró actividad sobre Escherichia coli ni Pseudomonas aeruginosa. Metabolitos secundarios, especialmente terpenoides y cumarinas fueron detectados en L. dulcis. Conclusiones. El estudio muestra que productos naturales derivados de plantas medicinales como los extractos etanólicos de Lantana camara y Lippia dulcis, presentan actividad antibacteriana sobre S. aureus y P. vulgaris y podrían ser alternativa promisoria para tratamiento de infecciones bacterianas. Abstract Introduction. Colombian biodiversity and traditional knowledge allow the exploration of medicinal plants with potential antimicrobial activity, which could be used to treat infections. Objectives. To determine the antibacterial activity of ethanolic extracts of Lantana camara L., Petiveria alliacea L. and Lippia dulcis T. on Pseudomonas aeruginosa ATCC 9027, Escherichia coli ATCC 25922, Proteus vulgaris ATCC 6380 and Staphylococcus aureus ATCC 25923. Materials and methods. Performed the acquisition of plant material and botanical characterization, ethanolic extracts were obtained by percolation and preliminary phytochemical characterization was performed by thin layer chromatography (CCD). The antibacterial activity was evaluated by disc diffusion and agar diffusion tests at concentrations of 1mg/mL and 2mg/mL; for active extracts, the Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (CMB) were established. For statistical analysis, Student's t test was performed. Results and discussion. Staphylococcus aureus ATCC 25923 was sensitive with Lantana camara L. and Lippia dulcis T. The latter being also active on Proteus vulgaris ATCC 6380 with inhibitory effect higher than 50%. The extract of Lippia dulcis T. had the highest inhibitory activity on S. aureus (MIC: 1.95 mg/mL). No extract showed activity on Escherichia coli and Pseudomonas aeruginosa. Secondary metabolites, especially terpenoids and coumarins were detected in L. dulcis. Conclusions. The study shows that natural products derived from medicinal plants such as the ethanolic extracts of Lantana camara and Lippia dulcis have antibacterial activity on S. aureus and P. vulgaris and could be a promising alternative for the treatment of bacterial infections.

Justificativa: O Acinetobacter baumanniitem acometido pacientes imunossuprimidos e pediátricos e está associado a surtos de infecções nosocomiais / hospitalares e por esse motivo deve haver investigação constante e por tais razões o objetivo deste é mostrar os resultados retrospectivos da ocorrência desse patógeno resultados em culturas de pacientes internados em um hospital especializado em doenças infectocontagiosas. Metodologia: pesquisa retrospectiva, descritiva, realizada a partir da coleta de dados de variáveis existentes nas planilhas de notificação de infecção relacionada à assistência à saúde-IRAS existentes no banco de dados da Comissão de Controle de Infecção Hospitalar-CCIH de um hospital referência em infectologia não Amazonas. Resultados: foram notificadas, por meio de culturas e antibiogramas, 4 casos de alterações nosocomial / hospitalar relacionadas a assistência a saude porAcinetobacter baumannii em pacientes internados nas enfermarias e UTI's da instituição de saúde destes, 75% eram de pacientes do gênero masculino sendo 3 pediátrico, e 75% eram provocados do trato respiratório em pacientes sob condições mecânicas e 25% doenças primarias da sanguínea. Tambem evidenciou-se que 26% eram cepas com alta resistência às beta-lactamases (enzima por bactérias que podem inibir a ação das penicilinas). Conclusão: Sabendo-se que o Acinetobacter baurmanii tem ganhado resistencia, vê-se como forma mais eficaz de quebra de cadeia de transmissão, ainda, prevenção por meio da adesão a higienização das mãos.

Background: Antibiotic therapy used to eradicate Helicobacter pylori has been associated with changes in plasma ghrelin and alterations in the gut microbiota. On the other hand, changes in ghrelin levels have been related to changes in gut microbiota composition. Our aim was to evaluate the relationship between changes in the gut microbiota and ghrelin levels in H. pylori infected patients who received antibiotic treatment for its eradication.Methods: A prospective case-control study that included forty H. pylori-positive patients who received eradication therapy (omeprazole, clarithromycin, and amoxicillin) and twenty healthy H. pylori antigen-negative participants. Patients were evaluated, including clinical, anthropometric and dietary variables, before and 2 months after treatment. Gut microbiota composition was analyzed through 16S rRNA amplicon sequencing (IlluminaMiSeq).Results: Changes in gut microbiota profiles and decrease in ghrelin levels were identified after H. pylori eradication treatment. Gut bacteria such as Bifidobacterium longum, Bacteroides, Prevotella, Parabacteroides distasonis, and RS045 have been linked to ghrelin levels fasting and/or post meals. Changes in the abundance of Lachnospiraceae, its genus Blautia, as well as Prevotella stercorea, and Megasphaera have been inversely associated with changes in ghrelin after eradication treatment.Conclusions: Eradication treatment for H. pylori produces changes in the composition of the intestinal microbiota and ghrelin levels. The imbalance between lactate producers such as Blautia, and lactate consumers such as Megasphaera, Lachnospiraceae, or Prevotella, could trigger changes related to ghrelin levels under the alteration of the eradication therapy used for H. pylori. In addition, acetate producing bacteria such as B. longum, Bacteroides, and P. distasonis could also play an important role in ghrelin regulation.

BACKGROUND: Helicobacter pylori infection in Chile remains as a public and private health-care system’s challenge, with a prevalence of the infection over 70%. Nowadays, antibiotic treatment of the infection is mandatory to prevent the arising of severe associated diseases but failures in the eradication therapy mainly due to clarithromycin resistance has been observed worldwide and first line eradication therapy seems to be not effective anymore in several geographical areas. Thus, health-care systems are committed to maintain an epidemiological surveillance upon the evolution of the antibiotic resistance of this priority 2 pathogen. OBJECTIVE: This work reports a 10 years surveillance of the primary antibiotic resistance of H. pylori clinical isolates at the Biobío region-Chile, and the evolution of resistance toward amoxicillin, clarithromycin, levofloxacin, metronidazole, and tetracycline among the species. METHODS: H. pylori strains were investigated during the periods 2005-2007 (1435 patients analysed) and 2015-2017 (220 patients analysed) by inoculating a saline homogenate biopsy onto the surface of Columbia agar (Oxoid, Basingstoke, UK) - supplemented with 7% horse red blood cells plus DENT inhibitor (Oxoid, Basingstoke, UK) - following by incubation at 37ºC under 10% CO2 atmosphere for five days. Antibiotic resistance pattern of the isolates was assessed using the disk diffusion test in Müeller-Hinton agar supplemented with 7% horse red blood cells followed by incubation for further three days under 10% CO2 atmosphere. Statistical analysis was done using the SPSS v22 software and P values

Resumen Introducción. La resistencia a los antibióticos es la principal causa del fracaso del tratamiento contra Helicobacter pylori; la claritromicina y el metronidazol son los antibióticos que generan mayor resistencia. En Colombia, la resistencia primaria a estos dos antibióticos y el uso excesivo de levofloxacina han alcanzado los límites aceptados (13,6, 83 y 16 %, respectivamente). A pesar de ello, se usa el tratamiento empírico combinando estos antibióticos en pacientes en los que ha fallado anteriormente. Objetivo. Determinar la resistencia a los antibióticos en pacientes previamente tratados para H. pylori en Bogotá, Colombia. Materiales y métodos. Se llevó a cabo un estudio descriptivo en el que se evaluó mediante dilución en agar la resistencia a la amoxicilina, la claritromicina, la levofloxacina y el metronidazol en 10 aislamientos provenientes de 5 pacientes con tres o cuatro tratamientos fallidos para H. pylori. La resistencia a los antibióticos se confirmó mediante secuenciación de ADN (Magrogen, Korea). Resultados. Ocho de los aislamientos presentaron resistencia a dos o más antibióticos y todos fueron resistentes a la levofloxacina. Los patrones de sensibilidad de los aislamientos provenientes del antro pilórico y del cuerpo del estómago, fueron diferentes en tres de los pacientes. Conclusión. Hasta donde se sabe, esta es la primera evidencia de resistencia múltiple de H. pylori en Colombia en pacientes previamente tratados. Los resultados evidenciaron las consecuencias del uso de un esquema ineficaz de tratamiento antibiótico y la necesidad de evaluar la sensibilidad a los antibióticos en diferentes sitios anatómicos del estómago. La resistencia múltiple limita el número de antibióticos útiles para erradicar H. pylori. Abstract Introduction: The main cause for Helicobacter pylori infection treatment failure is antibiotic resistance, where clarithromycin and metronidazole play the main role. In Colombia, primary resistance as a consequence of the use of these two antibiotics and excessive levofloxacin use is above the accepted limit (13.6%, 83%, and 16%, respectively). Despite this fact, empirical therapies that include the combination of these antibiotics are used in patients with previous therapeutic failure. Objective: To determine antibiotic resistance in patients previously treated for H. pylori in Bogotá, Colombia. Materials and methods: We conducted a descriptive study that included ten isolates obtained from five patients with three or four previous failed treatments for H. pylori. Antibiotic resistance to amoxicillin, clarithromycin, levofloxacin, and metronidazole was investigated by agar dilution and confirmed by DNA sequencing (Magrogen, Korea). Results: Eight isolates were resistant to two or more antibiotics. All isolates were resistant to levofloxacin. Susceptibility patterns in isolates from the gastric antrum and the body of the stomach were different in three patients. Conclusion: As far as we know, this is the first evidence of multiple H. pylori resistance in Colombia in previously treated patients. Results demonstrated the consequences of using an ineffective antibiotic scheme and the need to assess antibiotic susceptibility in different anatomical sites of the stomach. The consequences of multiple resistance decrease possible antibiotic effectiveness to eradicate H. pylori in the future.

Enteropathogenic E. coli (EPEC) are recognized as one of the leading bacterial causes of infantile diarrhea worldwide. Weaned C57BL/6 mice pretreated with antibiotics were challenged orally with wild-type EPEC or escN mutant (lacking type 3 secretion system) to determine colonization, inflammatory responses and clinical outcomes during infection. Antibiotic disruption of intestinal microbiota enabled efficient colonization by wild-type EPEC resulting in growth impairment and diarrhea. Increase in inflammatory biomarkers, chemokines, cellular recruitment and pro-inflammatory cytokines were observed in intestinal tissues. Metabolomic changes were also observed in EPEC infected mice with changes in tricarboxylic acid (TCA) cycle intermediates, increased creatine excretion and shifts in gut microbial metabolite levels. In addition, by 7 days after infection, although weights were recovering, EPEC-infected mice had increased intestinal permeability and decreased colonic claudin-1 levels. The escN mutant colonized the mice with no weight loss or increased inflammatory biomarkers, showing the importance of the T3SS in EPEC virulence in this model. In conclusion, a murine infection model treated with antibiotics has been developed to mimic clinical outcomes seen in children with EPEC infection and to examine potential roles of selected virulence traits. This model can help in further understanding mechanisms involved in the pathogenesis of EPEC infections and potential outcomes and thus assist in the development of potential preventive or therapeutic interventions.

Resumen La infección por Helicobacter pylori (H. pylori), es la infección bacteriana crónica más frecuente de la raza humana, afecta al 50 % de la población mundial y, por lo menos, al 80 % de la población colombiana. Esta bacteria es reconocida desde hace más de 15 años como un carcinógeno tipo I. De acuerdo con las indicaciones del Consenso de "Maastricht V" esta infección debe ser buscada y tratada en los pacientes con úlcera péptica activa, linfoma MALT (por sus siglas en inglés, mucosa associated lymphoid tissue), cáncer gástrico temprano, púrpura que presenten síntomas dispépticos crónicos y usuarios crónicos de AINES. Debido al papel que tiene en la fisiopatología del cáncer gástrico, nace la iniciativa de realizar una búsqueda activa del H. pylori y erradicarlo en todas las personas, incluyendo aquellas asintomáticas en países con alta incidencia de esta neoplasia. Existen diversas publicaciones alrededor del mundo que así lo sugieren, mostrando resultados con impacto positivo en el curso y progresión de la enfermedad, sobre todo en las etapas más tempranas de la infección. Sin embargo, otros autores resaltan la creciente problemática de la resistencia bacteriana, y demuestran que el peso estadístico y los diferentes análisis de los estudios disponibles en la actualidad tienen poca validez para dar una recomendación extendida al paciente asintomático. Se cuestiona que tal vez, estamos utilizando las estrategias inadecuadas para manejar una situación de salud pública, ya que estamos enfocados en impactar a cada individuo con terapias antibióticas complejas, en vez de a la población en general con políticas de salud pública. Abstract Helicobacter pylori (H. pylori) infection is the most frequent chronic bacterial infection in humans, affecting 50% of the world population, and at least 80% of the Colombian population. This bacteria has been recognized for more than 15 years as a type I carcinogen. According to the indications of the "Maastricht V" consensus, this infection should be sought and treated in patients with: active peptic ulcer, MALT lymphoma (for its acronym Mucosa associated lymphoid tissue), early gastric cancer, purpura who present with chronic dyspeptic symptoms and chronic users of NSAIDs. Due to the role it plays in the pathophysiology of gastric cancer, the initiative was born to carry out an active search for H. pylori and eradicate it in all people, including those asymptomatic in countries with a high incidence of this neoplasia. There are various publications around the world that suggest the effectiveness of this treatment and the positive impact on the course and progression of the disease, especially in the earliest stages of the infection, since the more advanced stages have less encouraging results regarding progression to malignancy. However, other authors highlight the growing problem of bacterial resistance that we are currently facing and demonstrate that the statistical weight and the different analyzes of the currently available studies have little validity to give an extended recommendation to the asymptomatic patient. It is suggested that perhaps inappropriate strategies to manage this public health situation are being used, since we are focused on impacting each individual with complex antibiotic therapies, instead of the general population with public health policies.

espanolIntroduccion. La resistencia a los antibioticos de bacterias Gram positivas es un grave problema de salud publica donde algunas medidas paliativas pueden encontrarse en los principios antimicrobianos de hongos filamentosos. Objetivo. Evaluar la actividad antimicrobiana de metabolitos secundarios de un aislamiento clinico de Aspergillus fumigatus sobre cepas clinicas de Staphylococcus aureus y Streptococcus pneumoniae. Metodos. La fermentacion liquida de A. fumigatus se realizo en un caldo liquido sulfato, papa y dextrosa, utilizando acetato de etilo para la extraccion de metabolitos. Mediante la metodologia de disco difusion se evaluo la actividad antimicrobiana considerada como un halo mayor de 6 mm. Resultados. Se obtuvo una media de 24,02 ± 2,51 mm y 23,62 ± 4,68 mm de halo de inhibicion sobre Staphylococcus aureussensible y resistente oxacilina, respectivamente. Para Streptococcus pneumoniae sensibles y no sensibles a penicilina las medias fueron de 25,82 ± 4,05 mm y 26,5 ± 5,39 mm, respectivamente. Conclusiones. El extracto crudo de A. fumigatus posee metabolitos secundarios de naturaleza alcaloide y esteroles insaturados con actividad antimicrobiana. EnglishIntroduction. The antibiotic resistance of Gram positive bacteria is a serious public health problem where some palliative measures can be found in the antimicrobial principles of filamentous fungi. Objective.: To evaluate the antimicrobial activity of secondary metabolites of a clinical isolation of Aspergillus fumigatus on clinical strains of Staphylococcus aureus and Streptococcus pneumoniae. Methods. The liquid fermentation of A. fumigatus was carried out in a liquid broth sulfate, potato and dextrose; using ethyl acetate for the extraction of secondary metabolites. The antimicrobial activity considered as a halo greater than 6 mm was evaluated using the diffusion disk methodology. Results. A mean of 24,02 ± 2,51 mm and 23,62 ± 4,68 mm was obtained on sensitive and resistant Staphylococcus aureus, respectively. For Streptococcus pneumoniae sensitive and non-susceptible, the means were 25,82 ± 4,05 mm and 26,5 ± 5,39 mm, respectively. Conclusions. The crude extract of A. fumigatus has secondary metabolites of alkaloid nature and unsaturated sterols with antimicrobial activity.

This in vitro study evaluated the effect of myristyltrimethylammonium bromide (MYTAB) on the physical, chemical, and biological properties of an experimental dental resin. The resin was formulated with dental dimetacrylate monomers and a photoinitiator/co-initiator system. MYTAB was added at 0.5 (G0.5%), 1 (G1%), and 2 (G2%) wt %, and one group remained without MYTAB and was used as the control (GCtrl). The resins were analyzed for the polymerization kinetics, degree of conversion, ultimate tensile strength (UTS), antibacterial activity against Streptococcus mutans, and cytotoxicity against human keratinocytes. Changes in the polymerization kinetics profiling were observed, and the degree of conversion ranged from 57.36% (&plusmn, 2.50%) for G2% to 61.88% (&plusmn, 1.91%) for G0.5%, without a statistically significant difference among groups (p &gt, 0.05). The UTS values ranged from 32.85 (&plusmn, 6.08) MPa for G0.5% to 35.12 (&plusmn, 5.74) MPa for GCtrl (p &gt, 0.05). MYTAB groups showed antibacterial activity against biofilm formation from 0.5 wt % (p &lt, 0.05) and against planktonic bacteria from 1 wt % (p &lt, 0.05). The higher the MYTAB concentration, the higher the cytotoxic effect, without differences between GCtrl e G0.5% (p &gt, 0.05). In conclusion, the addition of 0.5 wt % of MYTAB did not alter the physical and chemical properties of the dental resin and provided antibacterial activity without cytotoxic effect.

Objetivo: Determinar la actividad antibacteriana in vitro del propilenglicol ozonizado (Endozone®) y ultrasonido sobre Enterococcus faecalis (E. faecalis) en conductos radiculares de dientes de bovino. Métodos: El estudio fue de tipo experimental y se realizó en el laboratorio de microbiología de la Facultad de Biología de la Universidad Nacional del Altiplano-Puno. Las muestras fueron sembradas en agar bilis esculina, se contaminó dientes de bovino con E. faecalis a los cuales se les aplicó Endozone® y ultrasonido en distintos tiempos de acción luego de este procedimiento se realizó el recuento de desarrollo de colonias para cada diente mediante la técnica de observación directa estructurada. Resultados: El promedio de la actividad antibacteriana del Endozone® sobre E. faecalis fue de 92%, el promedio de la actividad antibacteriana del Endozone® aplicado con ultrasonido por 10 segundos fue de 94,63%, aplicado por 20 segundos fue 95,01% y aplicado por 30 segundos fue 96,74%, observamos que la actividad antibacteriana es directamente proporcional al tiempo de aplicación, la prueba estadística de Kruskal-Wallis indicó diferencias significativas entre los diferentes tiempos de aplicación. Conclusiones: El Endozone® con aplicación de ultrasonido, tuvo mayor actividad antibacteriana que solo Endozone® sobre E. faecalis. La aplicación de Endozone® y ultrasonido por 30 segundos mostró mayor actividad antibacteriana., Objective: Determine the antibacterial activity in vitro of ozonized Propyleneglycol (Endozone ®) and ultrasound on Enterococcus faecalis (E. faecalis) in root canals of bovine teeth. Methods: The study was experimental, and carried out in the microbiology laboratory of the Faculty of Biology of the Altiplano University. The samples were seeded in bile esculin agar, bovine teeth were contaminated with E. faecalis was carried out, bovine teeth were contaminated with E. faecalis to which was applied Endozone® and ultrasound at different times of action, after this procedure the count of the colony development for each tooth was done using the structured direct observation technique. Results: The average of the antibacterial activity of Endozone® on Enterococcus faecalis was 92%, the average antibacterial activity of Endozone® applied with ultrasound for 10 seconds was 94,63%, applied for 20 seconds was 95,01% and applied for 30 seconds was 96,74%, we observed that the antibacterial activity is directly proportional to the time of application, the statistical test of Kruskall-Wallis indicated that there were significant differences between the different times of application. Conclusions: Endozone® with ultrasound application had a higher antibacterial effect than Endozone® on E. faecalis. The application of Endozone® and ultrasound for 30 seconds showed greater antibacterial activity.

Purpose: The CIGMA study investigated a novel human polyclonal antibody preparation (trimodulin) containing ~ 23% immunoglobulin (Ig) M, ~ 21% IgA, and ~ 56% IgG as add-on therapy for patients with severe community-acquired pneumonia (sCAP). Methods: In this double-blind, phase II study (NCT01420744), 160 patients with sCAP requiring invasive mechanical ventilation were randomized (1:1) to trimodulin (42 mg IgM/kg/day) or placebo for five consecutive days. Primary endpoint was ventilator-free days (VFDs). Secondary endpoints included 28-day all-cause and pneumonia-related mortality. Safety and tolerability were monitored. Exploratory post hoc analyses were performed in subsets stratified by baseline C-reactive protein (CRP; ≥ 70 mg/L) and/or IgM (≤ 0.8 g/L). Results: Overall, there was no statistically significant difference in VFDs between trimodulin (mean 11.0, median 11 [n = 81]) and placebo (mean 9.6; median 8 [n = 79]; p = 0.173). Twenty-eight-day all-cause mortality was 22.2% vs. 27.8%, respectively (p = 0.465). Time to discharge from intensive care unit and mean duration of hospitalization were comparable between groups. Adverse-event incidences were comparable. Post hoc subset analyses, which included the majority of patients (58–78%), showed significant reductions in all-cause mortality (trimodulin vs. placebo) in patients with high CRP, low IgM, and high CRP/low IgM at baseline. Conclusions: No significant differences were found in VFDs and mortality between trimodulin and placebo groups. Post hoc analyses supported improved outcome regarding mortality with trimodulin in subsets of patients with elevated CRP, reduced IgM, or both. These findings warrant further investigation. Trial registration: NCT01420744., 0, SCOPUS: ar.j, info:eu-repo/semantics/published

Resumen Introducción: La infección por Helicobacter pylori es un problema de salud pública, dada su relación con cáncer gástrico. El incremento de la resistencia bacteriana limita la erradicación efectiva, a pesar del empleo de diferentes esquemas de tratamiento. Métodos: Revisión de la literatura en la base de datos Pubmed/Medline entre el 1 de enero de 2015 y el 31 de diciembre de 2016 sobre el manejo del Helicobacter pylori. Resultados: Se incluyeron 26 artículos. La terapia secuencial sobresale como opción de tratamiento de primera línea para escenarios como Colombia. La implementación de coadyuvantes puede influir en las tasas de erradicación. Los estudios de epidemiología local y costo-efectividad son escasos. Conclusiones: El uso y conocimiento adecuado de los esquemas de manejo puede disminuir los costos para el sistema, la resistencia antimicrobiana y favorecer la erradicación de patógenos. Se requieren estudios para generar recomendaciones locales. Abstract Introduction: Helicobacter pylori (H. pylori) infection is a public health problem due to its relationship with gastric cancer. The escalation of antibiotic resistance hampers an effective eradication, despite the availability of treatment options. Methods: A review of the literature was performed in the database PubMed between 01/01/2015 and 31/31/2016. Results: Twenty six articles were included. Sequential therapy stands out as a first line therapy for scenarios such as Colombia. The implementation of adjuvants may have a positive impact on eradication rates. Local epidemiology and cost-effectiveness studies are scarce. The results were analized by erradication therapies, coadyuvant treatment, guidelines and outcomes non mentioned in the guidelines. Conclusions: The correct use and knowledge of the different treatment options could reduce the costs for the health systems, the antibiotics resistance and could favor pathogen eradication. Further studies are required for establishing local recommendations.

It is well known that prolonged antibiotic therapy alters the mucosal microbiota composition, increasing the risk of invasive fungal infection (IFI) in immunocompromised patients. The present study investigated the direct effect of β-lactam antibiotics cefepime (CEF) and amoxicillin (AMOX) on biofilm production by Candida albicans ATCC 10231. Antibacterials at the peak plasmatic concentration of each drug were tested against biofilms grown on polystyrene surfaces. Biofilms were evaluated for biomass production, metabolic activity, carbohydrate and protein contents, proteolytic activity, ultrastructure, and tolerance to antifungals. CEF and AMOX enhanced biofilm production by C. albicans ATCC 10231, stimulating biomass production, metabolic activity, viable cell counts, and proteolytic activity, as well as increased biovolume and thickness of these structures. Nevertheless, AMOX induced more significant changes in C. albicans biofilms than CEF. In addition, it was shown that AMOX increased the amount of chitin in these biofilms, making them more tolerant to caspofungin. Finally, it was seen that, in response to AMOX, C. albicans biofilms produce Hsp70 - a protein with chaperone function related to stressful conditions. These results may have a direct impact on the pathophysiology of opportunistic IFIs in patients at risk.

Resumen Las betalactamasas, enzimas con capacidad hidrolítica frente a los antibióticos betalactámicos, son responsables del principal mecanismo de resistencia en bacterias Gram negativas; las de mayor impacto clínico y epidemiológico en los hospitales, son las betalactamasas de espectro extendido (BLEE), las de tipo AmpC y las carbapenemasas. El incremento en su frecuencia y su diseminación a nivel mundial ha limitado cada vez más las opciones terapéuticas tanto en infecciones adquiridas en los hospitales como las que se generan en la comunidad. En Colombia, las redes de vigilancia y los grupos de investigación iniciaron su estudio desde finales de los años 90 y, así, se logró la caracterización molecular de las diferentes variantes; además, se reportó una gran prevalencia y diseminación en los hospitales de mediana y alta complejidad, y se describió el impacto clínico de las infecciones que causan. Dichos estudios han evidenciado el alto grado de endemia de algunas de estas betalactamasas y, en consecuencia, la necesidad de una inmediata implementación de programas para inducir el uso prudente de los antibióticos y de medidas de vigilancia, que permitan controlar y prevenir su diseminación, con el fin de disminuir la morbimortalidad en los pacientes y preservar las opciones terapéuticas disponibles en la actualidad. En esta revisión, se recopiló la información sobre las variantes, la distribución geográfica y la caracterización molecular de las betalactamasas en Colombia, así como los estudios llevados a cabo desde finales de la década de 90 hasta el 2016, lo cual permitió tener un panorama de las betalactamasas que circulan en diferentes regiones, su incremento en el tiempo y sus implicaciones clínicas. Abstract Beta-lactamases are enzymes with hydrolytic activity over beta-lactam antibiotics and they are the main resistance mechanism in Gram-negative bacteria. Extended-spectrum beta-lactamases (ESBL), AmpC, and carbapenemases have the greatest clinical and epidemiological impact in hospital settings. The increasing frequency and worldwide spread of these enzymes have limited the therapeutic options in hospital-acquired infections and those originating in the community. In Colombia, surveillance networks and research groups began studying them in the late 90s. Different variants of these enzymes have been molecularly characterized and their high prevalence and dissemination in medium and high complexity hospitals, along with a high clinical impact, have been reported. Furthermore, many studies in Colombia have evidenced high endemicity for some of these beta-lactamases, which requires an urgent implementation of antimicrobial stewardship programs in order to preserve the few therapeutic options and infection control strategies to prevent and limit their dissemination. In this publication, we carried out a review of the different enzyme variants, geographic distribution, and molecular characterization of these beta-lactamases in Colombia. Additionally, we describe the available information in the literature regarding studies conducted between the late 1990s and 2016, which provide an overview of the beta-lactamases circulating in different regions of Colombia, their increase over time, and their clinical implications.

New medicines for the treatment of bacterial biofilm formation are required. For this reason, this study shows the in vitro activity of betulinic acid (BA), ursolic acid (UA) and their twenty derivatives against planktonic and biofilm cells (gram-positive bacterial pathogens: Enterococcus faecalis, Staphylococcus aureus and Staphylococcus epidermidis). We evaluated the antibiofilm activity (through the crystal violet method), as well as the antibacterial activity via absorbance (OD600) at concentrations of 5, 25 and 100 &micro, M. Likewise, the cytotoxicity of all compounds was evaluated on a kidney African green monkey (VERO) cell line at the same concentration, by MTT (3-(4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) methodology. We verified for the first time whether different groups at carbon 3 (C-3) of triterpenes may interfere in the antibiofilm activity with minimal or no antibacterial effect. After the screening of 22 compounds at three distinct concentrations, we found antibiofilm activity for eight distinct derivatives without antibiotic effect. In particular, the derivative 2f, with an isopentanoyl ester at position C-3, was an antibiofilm activity against S. aureus without any effect upon mammalian cells.

A infecção do trato urinário (ITU) é uma doença frequente, que ocorre em todas as faixas etárias afetando principalmente mulheres. Ela se apresenta com picos de maior acometimento no início da atividade sexual ou relacionados a ela, durante a gestação ou na menopausa. Alterações da flora vaginal, estados de hipoestrogenismo, diabetes mellitus, imunodepressão, incontinência urinária, atividade sexual, uso de diafragmas ou espermicidas e gestação são citados como fatores de risco. Predisposição genética nos casos de ITU de repetição também é relatada. Os sinais e sintomas associados à ITU incluem: polaciúria, urgência miccional, disúria, alteração na coloração e no aspecto da urina. É comum a ocorrência de dor abdominal, mais notadamente em topografia do hipogastro e no dorso, podendo surgir febre. Os agentes etiológicos mais frequentemente envolvidos com ITU adquirida na comunidade são em ordem de frequência: a Escherichia coli, o Staphylococcus saprophyticus, espécies de Proteus e de Klebsiella e o Enterococcus faecalis. O diagnóstico da ITU é realizado por meio da associação dos sintomas à urocultura e urina tipo I. A realização de antibiograma é muito útil para a definição da sensibilidade dos microrganismos aos antibióticos e, consequentemente, para o direcionamento da terapia, evitando, dessa maneira, a ocorrência de resistência microbiana.

The infections caused by bacteria and fungi, as well as the subsequent resistance of these microorganisms continue with high incidencesthus studies of medicinal plants and their combination with conventional therapy, are becoming essential. This study examined the antibacterial, antifungal and modifier of resistance to antibiotics and antifungal extracts of ethanol, hexane and methanol from the leaves of Kalanchoe pinnata, used in folk medicine. The phytochemical was performed qualitatively by visual observation of color changes and formation of precipitates after addition of specific reagents, such as ferric chloride (Fecl310%) sodium hydroxide (NaOH10%), hydrochloric acid (HCl 1%), acid acetic acid 5%, ammonium hydroxide (NH4OH 10%), chloroform and reagent Draggendorff 10%. The analysis for antimicrobial activity was through the microdilution test for determination of minimum inhibitory concentration (MIC) and modifying the action of antibiotics (gentamicin and amikacin) and antifungals (ketoconazole and fluconazole) in association with the extracts. The phytochemicals assays indicated the presence of secondary metabolites such as flavonoids, alkaloids and flabobênicos tannins. In assessing the MIC results were obtained

With the evolution of bacterial resistance over conventional antimicrobials and the development of new antimicrobials, the search for new compounds of natural origin has intensified, since plants with therapeutic potential constitute a source of new biologically active compounds, encouraging the development of new therapeutic options. The objective of this study was to evaluate the antibacterial and anti-adherent activity of the ethanolic extract of Praxelis clematidea (Griseb.) R.M. King & Robinson (Asteraceae) on strains of Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa and Enterococcus faecalis. Tests were carried out to determine the MIC and MBC by means of broth microdilution in 96-well plates, and to determine the MICA, a technique with inclined tubes in the presence of 5% sucrose was used. It was observed that the ethanolic extract of P. clematidea has strong bactericidal activity on K. pneumoniae, and moderate bactericidal activity on S. pneumoniae and E. faecalis. Being able to inhibit adherence to K. pneumoniae strains. Thus, the ethanolic extract of P. clematidea proves to be effective as an antimicrobial in the control and prevention of infections by S. pneumoniae, K. pneumoniae and E. faecalis. It also has an effective anti-adherent effect on K. pneumoniae strains. Con la evolución de la resistencia bacteriana sobre los antimicrobianos convencionales y el desarrollo de nuevos antimicrobianos, se ha intensificado la búsqueda de nuevos compuestos de origen natural, ya que las plantas con potencial terapéutico son fuente de nuevos compuestos biológicamente activos, favoreciendo el desarrollo de nuevas opciones terapéuticas. El objetivo de este estudio fue evaluar la actividad antibacteriana y antiadherente del extracto etanólico de Praxelis clematidea (Griseb.) R.M. King & Robinson (Asteraceae) sobre cepas de Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa y Enterococcus faecalis. Se realizaron pruebas para determinar la CMI y CBM mediante microdilución en caldo en placas de 96 pocillos, y para determinar la CIMA se utilizó una técnica con tubos inclinados en presencia de sacarosa al 5%. Se observó que el extracto etanólico de P. clematidea tiene una fuerte actividad bactericida sobre K. pneumoniae y una moderada actividad bactericida sobre S. pneumoniae y E. faecalis. Ser capaz de inhibir la adherencia a cepas de K. pneumoniae. Así, el extracto etanólico de P. clematidea demuestra ser eficaz como antimicrobiano en el control y prevención de infecciones por S. pneumoniae, K. pneumoniae y E. faecalis. También tiene un efecto antiadherente eficaz sobre las cepas de K. pneumoniae. Com a evolução da resistência bacteriana sobre os antimicrobianos convencionais e o desenvolvimento de novos antimicrobianos, a procura por novos compostos de origem natural tem se intensificado, uma vez que plantas que apresentam potencial terapêutico constituem uma fonte de novos compostos biologicamente ativos, incentivando o desenvolvimento de novas opções terapêuticas. O objetivo deste estudo foi avaliar a atividade antibacteriana e antiaderente do extrato etanólico de Praxelis clematidea (Griseb.) R.M. King & Robinson (Asteraceae) sobre cepas de Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae, Pseudomonas aeruginosa e Enterococcus faecalis. Foram realizados os ensaios para determinação da CIM e CBM por meio de técnica de microdiluição em caldo em placas de 96 poços, e para determinação da CIMA foi utilizada técnica com tubos inclinados na presença de 5% de sacarose. Observou-se que o extrato etanólico de P. clematidea apresenta forte atividade bactericida sobre K. pneumoniae, e moderada atividade bactericida sobre S. pneumoniae e E. faecalis. Sendo capaz de inibir a aderência das cepas de K. pneumoniae. Com isso, o extrato etanólico de P. clematidea demonstra ser eficaz como antimicrobiano no controle e prevenção de infecções por S. pneumoniae, K. pneumoniae e E. faecalis. Também apresentando eficaz efeito antiaderente sobre as cepas de K. pneumoniae.

Enterococcus faecalis infective endocarditis (EFIE) is a severe disease of increasing incidence. The objective was to analyze whether the outcome of patients with native valve EFIE (NVEFIE) treated with a short course of ampicillin plus ceftriaxone (4wAC) was similar to patients treated according to international guidelines (6wAC). Between January 2008 and June 2018, 1,978 consecutive patients with definite native valve IE were prospectively included in a national registry. Outcomes of patients with NVEFIE treated with 4wAC were compared to those of patients who received 6wAC. Three hundred and twenty-two patients (16.3%) had NVEFIE. One hundred and eighty-three (56.8%) received AC. Thirty-nine patients (21.3%) were treated with 4wAC for four weeks and 70 patients (38.3%) with 6wAC. There were no differences in age or comorbidity. Patients treated 6wAC presented a longer duration of symptoms before diagnosis (21 days, IQR 7-60 days vs. 7 days, IQR 1-22 days; p = 0.002). Six patients presented perivalvular abscess and all of these received 6wAC. Surgery was performed on 14 patients (35.9%) 4wAC and 34 patients (48.6%) 6wAC (p = 0.201). In-hospital mortality, one-year mortality and relapses among 4wAC and 6wAC patients were 10.3% vs. 11.4% (p = 0.851); 17.9% vs. 21.4% (p = 0.682) and 5.1% vs. 4.3% (p = 0.833), respectively. In conclusion, a four-week course of AC may be considered as an alternative regimen in NVEFIE, notably in patients with shorter duration of symptoms and those without perivalvular abscess. These results support the performance of a randomized clinical trial to evaluate the efficacy of this short regimen., This work was supported in part by the “Fondo de Investigaciones Sanitarias” (FIS) grant 17/01251 from the “Instituto de Salud Carlos III”, Madrid, Spain awarded to JMM. JMM received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–19. JMP was member of the Endocarditis Team of the Hospital Clinic of Barcelona, Spain when this project was approved by the GAMES Steering Committee.’

Critically ill patients are physiologically unstable and recent studies indicate that the intestinal microbiota could be involved in the health decline of such patients during ICU stays. This study aims to assess the intestinal microbiota in critically ill patients with and without sepsis and to determine its impact on outcome variables, such as medical complications, ICU stay time, and mortality. A multi-center study was conducted with a total of 250 peri-rectal swabs obtained from 155 patients upon admission and during ICU stays. Intestinal microbiota was assessed by sequencing the V3-V4 hypervariable regions of the 16S rRNA gene. Linear mixed models were used to integrate microbiota data with more than 40 clinical and demographic variables to detect covariates and minimize the effect of confounding factors. We found that the microbiota of ICU patients with sepsis has an increased abundance of microbes tightly associated with inflammation, such as Parabacteroides, Fusobacterium and Bilophila species. Female sex and aging would represent an increased risk for sepsis possibly because of some of their microbiota features. We also evidenced a remarkable loss of microbial diversity, during the ICU stay. Concomitantly, we detected that the abundance of pathogenic species, such as Enterococcus spp., was differentially increased in sepsis patients who died, indicating these species as potential biomarkers for monitoring during ICU stay. We concluded that particular intestinal microbiota signatures could predict sepsis development in ICU patients. We propose potential biomarkers for evaluation in the clinical management of ICU patients., This work was supported with funds from the Universidad de Antioquia (Fondo de Apoyo a la Internacionalización Científica, Estrategía de Sostenibilidad de los Grupos de Investigación 2018-2019 y Escuela de Nutrición y Dietética), Instituto de Nutrición y Salud Kellogg´s, and Institución Universitaria Colegio Mayor de Antioquia.

Objetivo: El propósito del presente estudio fue determinar la actividad antibacteriana de Croton lechleri (C. lechleri) sobre cepas de S. mutans ATCC 35668. Métodos: Se utilizó concentraciones al 50, 75 y 100% de C. lechleri, como control positivo a la clorhexidina 0,12% y al agua destilada como control negativo. Se midieron los halos de inhibición producidos alrededor de discos embebidos con cada una de las concentraciones de C. lechleri sobre colonias de S. mutans sembradas en Agar Muller Hinton. Resultados: Las concentraciones al 75% y 100% de C. lechleri mostraron actividad antibacteriana in vitro sobre S. mutans, la concentración al 50% no manifestó ninguna actividad. La clorhexidina al 0,12% mostró mayor actividad antibacteriana in vitro que las concentraciones de C. lechleri en los grupos de estudio evaluados. Conclusiones: Croton lechleri puede ser una alternativa natural, accesible y de bajo costo para métodos de prevención en caries dental al utilizarse al 75 y 100%., Objective: The purpose of this study was to determine the antibacterial activity of Croton lechleri (C. lechleri) on strains of S. mutans ATCC 35668. Methods: It was used 50%, 75% and 100% concentrations of C. lechleri, and chlorhexidine (0.12%) as a positive control and distilled water as a negative control. It was measured the inhibition halos produced around imbibed discs with each of the concentrations of C. lechleri on colonies of S. mutans which were seeded in Muller Hinton Agar. Results: 75% and 100% of C. lechleri concentration showed antibacterial activity in vitro over S. mutans, 50% concentration showed no activity. 0.12% chlorhexidine concentration showed a higher antibacterial activity in vitro than all the concentrations of C. lechleri groups evaluated. Conclusions: Croton lechleri can be a natural, accessible and low-cost alternative for prevention methods in dental caries when used at 75% and 100%.

Clostridium difficile infection is a common complication following intestinal dysbiosis caused by abusive antibiotic use. It presents medical importance due to the high rates of recurrence and morbidity. Fecal microbiota transplantation is an effective alternative for the treatment of recurrent and refractory C. difficile infection and consists of introducing the intestinal microbiota from a healthy donor into a patient with this infection. The exact physiological mechanism by which fecal microbiota transplantation alters the intestinal microbiota is not well established, but it is clear that it restores the diversity and structure of the microbiota by promoting increased resistance to colonization by C. difficile. Several routes of transplant administration are being studied and used according to the advantages presented. All forms of application had a high cure rate, and the colonoscopic route was the most used. No relevant complications and adverse events have been documented, and the cost-effectiveness over conventional treatment has proven advantageous. Despite its efficacy, it is not commonly used as initial therapy, and more studies are needed to establish this therapy as the first option in case of refractory and recurrent Clostridium difficileinfection. RESUMO A infecção por Clostridium difficile é uma complicação comum após a disbiose intestinal ocasionada pelo uso abusivo de antibióticos. Apresenta elevada importância médica devido às altas taxas de recorrência e morbidade. O transplante de microbiota fecal é uma alternativa eficaz para o tratamento da infecção recorrente e refratária pelo C. difficile e consiste na introdução da microbiota intestinal de um doador saudável em um paciente portador desta infecção. O mecanismo fisiológico exato pelo qual o transplante de microbiota fecal altera a microbiota intestinal não está tão bem estabelecido, mas é evidente que restaura a diversidade e a estrutura da microbiota promovendo aumento da resistência à colonização pelo C.difficile. Diversas vias de administração do transplante estão sendo estudadas e utilizadas de acordo com as vantagens apresentadas. Todas as formas de aplicação apresentaram elevada taxa de cura, sendo a via colonoscópica a mais utilizada. Não foram documentados complicações e efeitos adversos relevantes, e seu custo benefício em relação ao tratamento convencional se mostrou vantajoso. Apesar da sua eficácia é pouco utilizado como terapia inicial, sendo necessários mais estudos para firmar essa terapêutica como primeira opção no caso de infecção por Clostridium difficile refratária e recorrente.

Objetivo: Determinar si existe actividad antibacteriana del extracto de hoja de coca (Erythroxylum coca), sobre bacilos negro pigmentados (BNP). Materiales y método: Se emplearon dos pruebas: Test de Difusión en Agar y Dilución en medio líquido. Las cepas de BNP fueron aisladas de muestras tomadas de bolsas periodontales de pacientes con enfermedad periodontal atendidos en la Facultad de Odontología de la Universidad Nacional Mayor de San Marcos. El extracto hidroalcohólico de hoja de coca fue obtenido de la Empresa Nacional de la Coca (ENACO). Resultados: La primera prueba difusión en agar indicó sensibilidad nula (-) para la mayor parte de las concentraciones evaluadas, y sensibilidad límite (sensibilidad: +) para las concentración de 12,5% y 100%. Los resultados de la sensibilidad por dilución determinaron una concentración mínima del extracto capaz de inhibir el crecimiento de dicha bacteria, 100% (concentración mínima inhibitoria), y a las concentraciones de 12,5% y 6,25% se observa una repotenciación del efecto antibacteriano del extracto. Conclusiones: El extracto hidroalcohólico de hoja de coca, sí presenta una actividad antibacteriana frente a BNP, a las concentraciones de 100% y 12,5%., Objective: To determine whether there is antibacterial activity of coca leaf extract (Erythroxylum coca), on black pigmented bacilli (BPB). Materials and method: Two tests were used: Diffusion Test in Agar and Dilution in liquid medium. The BPB strains were isolated from samples taken from periodontal pockets of patients with periodontal disease treated at the Faculty of Dentistry of the Mayor National University of San Marcos. The hydroalcoholic extract of coca leaf was obtained from the National Company of Coca (ENACO). Results: The first agar diffusion test indicated null sensitivity (-) for most of the concentrations evaluated, and limit sensitivity (sensitivity: +) for the concentrations of 12.5% and 100%. The results of the dilution sensitivity determined a minimum concentration of the extract capable of inhibiting the growth of this bacterium, 100% (minimum inhibitory concentration), and at the concentrations of 12.5% and 6.25% a repotentiation of the antibacterial effect of the extract. Conclusions: The hydroalcoholic extract of coca leaf, does present an antibacterial activity against BPB, at concentrations of 100% and 12.5%.

Some novel (phenyl-diazenyl) phenols (4a-m) were designed and synthesized to be evaluated for their antibacterial activity. Starting from an active previously-synthesized azobenzene chosen as lead compound, we introduced some modifications and optimization of the structure, in order to improve solubility and drug conveyance. Structures of all newly-synthesized compounds were confirmed by H-1 nuclear magnetic resonance (NMR), mass spectrometry, and UV-Vis spectroscopy. Antibacterial activity of the new compounds was tested with the dilution method against the bacteria strains Listeria monocytogenes, Staphylococcus aureus, Escherichia coli, and Pseudomonas aeruginosa PAO1. All the compounds were selectively active against Gram-positive bacteria. In particular, compounds 4d, 4h, and 4i showed the highest activity against S. aureus and Listeria monocytogenes, reaching remarkable MIC100 values of 4 mu g/mL and 8 mu g/mL. The relationship between antimicrobial activity and compound structure has suggested that the presence of hydroxyl groups seems to be essential for antimicrobial activity of phenolic compounds., This research work was financially supported by the Italian Minister of Instruction, University and Research (MIUR)-300395FRB16. The authors are grateful to Fabrizio dal Piaz for the mass spectral measurements.

Background: Antibiotic resistance (ABR) is a quickly worsening problem worldwide, also in low-and middle-income countries (LMICs). Appropriate antibiotic use in humans and animals, i.e. antibiotic stewardship (ABS), is one of the cornerstones of the World Health Organization's global action plan for ABR. Many LMICs are in the process of developing stewardship programs. Aims: We highlight challenges for ABS initiatives in LMICs, give an outline of (inter) national recommendations and demonstrate examples of effective, contextualized stewardship interventions. Sources: We searched PubMed for articles on ABS interventions in humans in LMICs. Relevant websites and experts were consulted for additional sources. Content: Evidence on effective and feasible stewardship interventions in LMICs is limited, and challenges for implementation of interventions are numerous. Nevertheless, several initiatives at the international and local levels in Latin America, Africa and Asia have shown that ABS effective interventions are feasible in LMICs, although contextualization is essential. Implications: Specific guidance for setting up antimicrobial stewardship programs in LMICs should be developed. Strategic points might need to be progressively addressed in LMICs, such as (a) ensuring availability of diagnostic testing, (b) providing dedicated education in ABR both for healthcare workers and the general public, (c) creating or strengthening (inter) national agencies towards better regulations and audit on production, distribution and dispensing of drugs, (d) strengthening healthcare facilities, (e) exploring a broader synergism between policy makers, academia, professional bodies and civil society and (f) designing and studying easy and scalable ABS interventions for both hospital and community settings. (C) 2017 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.

To describe the frequency and factors associated with antibiotic use in early childhood, and estimate the proportion of diarrhoea and respiratory illnesses episodes treated with antibiotics.Between 2009 and 2014, we followed 2134 children from eight sites in Bangladesh, Brazil, India, Nepal, Pakistan, Peru, South Africa and the United Republic of Tanzania, enrolled in the MAL-ED birth cohort study. We documented all antibiotic use from mothers' reports at twice-weekly visits over the children's first two years of life. We estimated the incidence of antibiotic use and the associations of antibiotic use with child and household characteristics. We described treatment patterns for diarrhoea and respiratory illnesses, and identified factors associated with treatment and antibiotic class.Over 1 346 388 total days of observation, 16 913 courses of antibiotics were recorded (an incidence of 4.9 courses per child per year), with the highest use in South Asia. Antibiotic treatment was given for 375/499 (75.2%) episodes of bloody diarrhoea and for 4274/9661 (44.2%) episodes of diarrhoea without bloody stools. Antibiotics were used in 2384/3943 (60.5%) episodes of fieldworker-confirmed acute lower respiratory tract illness as well as in 6608/16742 (39.5%) episodes of upper respiratory illness. Penicillins were used most frequently for respiratory illness, while antibiotic classes for diarrhoea treatment varied within and between sites.Repeated antibiotic exposure was common early in life, and treatment of non-bloody diarrhoea and non-specific respiratory illnesses was not consistent with international recommendations. Rational antibiotic use programmes may have the most impact in South Asia, where antibiotic use was highest.Décrire la fréquence et les facteurs associés à l'utilisation d'antibiotiques chez les jeunes enfants et estimer la proportion d'épisodes de diarrhée et de maladies respiratoires traités avec des antibiotiques.De 2009 à 2014, nous avons suivi 2134 enfants qui participaient à l'étude de cohorte de naissance MAL-ED sur huit sites en Afrique du Sud, au Bangladesh, au Brésil, en Inde, au Népal, au Pakistan, au Pérou et en République-Unie de Tanzanie. Nous avons noté l'utilisation de tous les antibiotiques déclarés par les mères lors de consultations bi-hebdomadaires pendant les deux premières années de vie des enfants. Nous avons estimé l'incidence du recours aux antibiotiques ainsi que les associations entre utilisation d'antibiotiques et caractéristiques des enfants et des foyers. Nous avons décrit les habitudes de traitement de la diarrhée et des maladies respiratoires et avons identifié les facteurs associés aux traitements et aux classes d'antibiotiques.Sur 1 346 388 jours d'observation au total, 16 913 traitements aux antibiotiques ont été enregistrés (incidence de 4,9 traitements par enfant et par an), la plus forte utilisation ayant été observée en Asie du Sud. Un traitement antibiotique a été administré pour 375/499 (75,2%) épisodes de diarrhée sanglante et pour 4274/9661 (44,2%) épisodes de diarrhée sans présence de sang dans les selles. Des antibiotiques ont été utilisés pour 2384/3943 (60,5%) épisodes de maladie aiguë des voies respiratoires inférieures confirmée par un professionnel sur le terrain ainsi que pour 6608/16 742 (39,5%) épisodes de maladie des voies respiratoires supérieures. Les pénicillines étaient les plus fréquemment utilisées pour combattre les maladies respiratoires, tandis que les classes d'antibiotiques utilisées pour traiter la diarrhée variaient selon les sites et au sein d'un même site.L'exposition répétée aux antibiotiques à un jeune âge était courante et le traitement de la diarrhée sans présence de sang dans les selles et de maladies respiratoires non spécifiques ne respectait pas les recommandations internationales. C'est en Asie du Sud, où l'usage des antibiotiques était le plus important, que les programmes d'utilisation rationnelle des antibiotiques pourraient avoir le plus fort impact.Describir la frecuencia y los factores relacionados con el uso de antibióticos en la primera infancia y estimar la proporción de los episodios de diarrea y enfermedades respiratorias tratados con antibióticos.Entre 2009 y 2014, se realizó el seguimiento de 2 134 niños de ocho lugares en Bangladesh, Brasil, India, Nepal, Pakistán, Perú, la República Unida de Tanzania y Sudáfrica inscritos en el estudio de cohortes en el nacimiento MAL-ED. Se documentó el uso de todos los antibióticos de los informes de las madres en las visitas dos veces por semana a lo largo de los dos primeros años de vida de los niños. Se estimó la incidencia del uso de antibióticos y las asociaciones del uso de antibióticos con características familiares y con niños. Se describieron los patrones de tratamiento para la diarrea y las enfermedades respiratorias, y se identificaron los factores relacionados con las clases de tratamientos y de antibióticos.De un total de 1 346 388 días de observación, se registraron 16 913 tratamientos con antibióticos (una incidencia de 4,9 tratamientos por niño al año), siendo el mayor uso en el sur de Asia. Se empleó tratamiento con antibióticos en 375/499 (75,2%) episodios de diarrea hemorrágica y en 4 274/9 661 (44,2%) episodios de diarrea sin deposiciones hemorrágicas. Se usaron antibióticos en 2 384/3 943 (60,5%) episodios de enfermedad respiratoria aguda de las vías bajas confirmadas por los investigadores, así como en 6 608/16 742 (39,5%) episodios de enfermedad respiratoria de las vías altas. Las penicilinas se usaron más frecuentemente para las enfermedades respiratorias, mientras que los antibióticos para el tratamiento de la diarrea variaron entre los distintos lugares.La exposición repetida a antibióticos fue común en los primeros años de vida, y el tratamiento de diarrea no hemorrágica y de enfermedades respiratorias no específicas no fue coherente con las recomendaciones internacionales. Los programas de uso racional de antibióticos pueden tener el mayor efecto en el sur de Asia, donde el uso de antibióticos fue el más alto.وصف وتيرة إعطاء المضادات الحيوية للأطفال في مراحلهم العمرية المبكرة والعوامل المرتبطة بذلك، وتقدير نسبة حالات الإصابة بالإسهال وأمراض الجهاز التنفسي التي عولجت بالمضادات الحيوية.قمنا في الفترة ما بين عامي 2009 و 2014 بمتابعة 2134 طفلاً من ثماني مواقع في بنغلاديش والبرازيل والهند ونيبال وباكستان وبيرو وجنوب أفريقيا وجمهورية تنزانيا المتحدة، الذين تم تسجيلهم في دراسة الأترابية الخاصة بالمواليد MAL-ED. وقمنا بتوثيق جميع حالات تناول المضادات الحيوية من بلاغات الأمهات في الزيارات الأسبوعية التي تحدث مرتين طوال العامين الأولين للطفل. كما قمنا بتقدير عدد حالات تناول المضادات الحيوية والروابط بين تناول المضادات الحيوية مع خصائص الطفل والأسرة. وبذلك قدمنا وصفًا لأنماط العلاج للحالات المصابة بالإسهال وأمراض الجهاز التنفسي، وحددنا العوامل المرتبطة بفئة العلاج والمضاد الحيوي.على مدار 1346388 من إجمالي أيام الرصد والملاحظة، تم تسجيل إعداد 16913 خطة علاجية بالمضادات الحيوية (بمعدل إعداد 4.9 خطة علاجية لكل طفل في العام الواحد)، مع ملاحظة أن معدل تناول المضادات الحيوية هو الأعلى في جنوب آسيا. تم إعطاء العلاج بالمضادات الحيوية بمعدل 375/499 (75.2‏%) للحالات المصابة بالإسهال الدموي وبمعدل 4274/9661 (44.2‏%) للحالات المصابة بالإسهال من دون نزول براز دموي. وتم تناول المضادات الحيوية في 2348/3943 (60.5‏%) من حالات الإصابة المؤكدة بعدوى القناة التنفسية السفلية الحاد وكذلك في 6608/16742 (39.5‏%) من حالات الإصابة المؤكدة بعدوى القناة التنفسية العلوية لدى العاملين الميدانيين. تم إعطاء أدوية البنسلين في معظم الأحيان لعلاج أمراض الجهاز التنفسي، بينما تباينت فئات المضادات الحيوية لعلاج الإسهال داخل وبين المواقع المختلفة.لقد كان التعرض المتكرر للمضادات الحيوية شائعًا في مرحلة عمرية مبكرة، ولم يكن علاج الإسهال غير الدموي وأمراض الجهاز التنفسي غير المحددة متناسقًا مع التوصيات الدولية. ولعل برامج تناول المضادات الحيوية المنطقية هي ما حقق أكبر الأكبر في جنوب آسيا، حيث كان معدل تناول المضادات الحيوية هو الأعلى.旨在描述幼儿期抗生素使用频率及相关因素，并评估使用抗生素进行治疗的腹泻和呼吸道疾病病例的比例。.在 2009 年至 2014 年期间，我们对巴基斯坦、巴西、秘鲁、孟加拉国、南非、尼泊尔、坦桑尼亚联合共和国以及印度八个地区报名参加营养不良和肠道疾病联盟 (MAL-ED) 出生群组研究的 2134 名儿童进行了跟踪调查。 我们在儿童出生后两年内对其进行每周两次的访问，通过其母亲的叙述记录了全部抗生素使用情况。 我们对抗生素使用率以及抗生素使用与儿童和家庭特征之间的关联进行了评估。 我们描述了腹泻和呼吸道疾病的治疗模式，并确定了与治疗和抗生素种类有关的因素。.经过共 1 346 388 天的观察，我们记录了 16 913 个抗生素使用案例（每名儿童每年平均使用 4.9 次），其中抗生素在南亚的使用率最高。 出血性腹泻的抗生素治疗比例为 375/499 (75.2%)，无血便性腹泻的抗生素治疗比例为 4274/9661 (44.2%)。 在经实地调查员确认的急性下呼吸道疾病案例中，抗生素使用比例为 2384/3943 (60.5%)，上呼吸道疾病案例中，抗生素使用比例为 6608/16742 (39.5%)。盘尼西林最常用于呼吸道疾病治疗，腹泻治疗用抗生素的种类在同一地区内以及不同地区间均有所不同。.反复接触抗生素在童年时期很常见，并且非出血性腹泻和非特异性呼吸道疾病的疗法与国际建议不一致。 合理使用抗生素项目或许在南非会产生最大影响，在该地区，抗生素的使用率最高。.Описать частоту употребления антибиотиков в раннем детстве и факторы, связанные с этим, и определить долю случаев диареи и заболеваний дыхательных путей, для лечения которых использовались антибиотики.В период между 2009 и 2014 годами авторы осуществляли наблюдение за 2134 детьми из восьми локаций в Бангладеш, Бразилии, Индии, Непале, Объединенной Республике Танзания, Пакистане, Перу и Южной Африке, участвующих в исследовании возрастной группы MAL-ED. Все случаи приема антибиотиков были задокументированы со слов матерей работниками местного центра, совершавшими визит два раза в неделю в течение первых двух лет жизни ребенка. Авторы определили частотность приема антибиотиков и связи между приемом антибиотиков детьми и особенностями домашнего хозяйства. Были описаны модели лечения диареи и заболеваний дыхательных путей, а также определены факторы, связанные с лечением и классом антибиотиков.За 1 346 388 суммарных дней наблюдения было зарегистрировано 16 913 курсов лечения антибиотиками (частотность составила 4,9 курса на ребенка в год), большая доля которых пришлась на Южную Азию. Лечение антибиотиками было прописано в 375 из 499 случаев диареи с кровью (75,2%) и в 4274 из 9661 случая диареи без кровавых примесей (44,2%). Антибиотики применялись в 2384 из 3943 случаев острого заболевания нижних дыхательных путей (60,5%), подтвержденного работниками местного центра, а также в 6608 из 16 742 случаев заболевания верхних дыхательных путей (39,5%). Чаще других для лечения заболеваний дыхательных путей использовались пенициллины, в то время как класс антибиотиков для лечения диареи различался как в пределах одной локации, так и между локациями.В раннем возрасте было распространено неоднократное воздействие антибиотиков, а лечение диареи без следов крови и неспецифических заболеваний дыхательных путей проводилось не в соответствии с международными рекомендациями. Программы рационального использования антибиотиков, возможно, оказывают наибольшее влияние в Южной Азии, где процент применения антибиотиков был наиболее высок.

Empleando un prototipo de reactor, se sintetizaron nanopartículas (NPs) de CuO a través del método de precipitación a partir de CuSO2·5H2O y de Cu(CH3COO)2·H2O. Las NPs obtenidas fueron caracterizadas mediante XRD, FT-IR, TEM y SEM. La actividad antimicrobiana de las NPs se determinó mediante el método de difusión en placa, colocando 20 mg de NPs de CuO sobre cuatro cepas intrahospitalarias o nosocomiales aisladas de la Unidad de Cuidados Intensivos de un hospital nacional de Lima norte (Staphylococcus epidermidis, Aerococcus viridans, Ochrobactrum anthropi y Micrococcus lylae). La caracterización de las NPs de CuO demostró que las sintetizadas a partir de acetato (CuO–Acet) presentaron una fase pura de CuO, mientras que las sintetizadas a partir de sulfato (CuO–Sulf) presentaron dos fases, donde la de CuO representó más del 84%. Los dominios cristalinos del CuO–Acet y CuO–Sulf fueron 15 y 19 nm, respectivamente. Los halos de inhibición de las cepas estudiadas fueron mayores para las NPs de CuO–Sulf que para las NPs de CuO–Acet; solo para la cepa Ochrobactrum anthropi se presentaron halos similares para ambos tipos de NPs, Using a prototype reactor, CuO nanoparticles (NPs) were synthetized through the precipitation method, starting from CuSO2 .5H2O and Cu(CH3COO)2 .H2O. The obtained NPs were characterized by XDR, FT-IR, SEM, and TEM. The antimicrobial activity of the NPs was determined by the plate diffusion method, placmg 20 mg of NPs onto four nosocomial strains obtained from north Lima national hospital Intensive-Care Unit (Staphylococcus epideiwidis, Aerococcus viridans, Ochrobactrwn anthropic, and Micrococcus lylae). NPs characterization revealed that those synthetized from acetate (CuO-Acet) shown pure CuO phase, while those synthetized from sulphate CuO-Sulf shown two phases where CuO was the predominant one, having more than 84%. The crystal domains for CuO-Acet and CuO-Sulf were 15 and 19 nm, respectively. The inhibition halos for the studied strains were larger for CuO-Sulf NPs than CuO-Acet NPs, only Ochrobactrum anthropi displayed similar inhibition halos for both types of NPs., Facultad de Ciencias Exactas, Facultad de Ingeniería

As part of our ongoing research on the antibacterial activity of Achyrocline satureioides, this study seeks to better understand the interactions between the metabolites isolated from this plant. For this purpose, the combined effect of 23-methyl-6-O-desmethylauricepyrone (1), quercetin (2) and 3-O-methylquercetin (3), obtained through bioguided fractionation from A. satureioides ethanol extract, was evaluated against Staphylococcus aureus and Escherichia coli. In first place, the antibacterial effect of the combination of flavonols 2 and 3 was assessed, as these showed individual effectiveness lower than or equal to that of the fraction from which they were obtained. When the flavonols were applied together at concentrations below their minimum inhibitory concentration (MIC) values, a synergistic effect (FICI < 0.30) against S. aureus was observed. In addition, compounds 2 and 3 in combination reduced 1000 times the MIC of compound 1, showing a clear synergistic interaction (FICI < 0.15) in treatments against the Gram (+) bacterium. The most active combination against E. coli showed an additive interaction (FICI < 0.62) between the three assayed compounds 1–3. These results indicated the existence of concerted action between these metabolites, evidence of the importance of the synergistic interactions between the components of plant-derived extracts for the control of pathogenic bacteria. Fil: Joray, Mariana Belén. Universidad Católica de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Palacios, Sara Maria. Universidad Católica de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina Fil: Carpinella, Maria Cecilia. Universidad Católica de Córdoba; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentina

La diarrea del viajero es una de las condiciones que con mayor frecuencia afecta a los viajeros de países industrializados que visitan las zonas tropicales y subtropicales del planeta. El 20 a 50% de viajeros se van afectar por esta condición, siendo en ocasiones tan severa como para afectar los planes del viajero en la quinta parte de pacientes. El cuadro se manifiesta por la aparición de diarrea asociada a síntomas entéricos como dolor abdominal, nauseas, vómitos y en caso de diarrea inflamatoria fiebre y deposiciones con sangre. Entre los agentes etiológicos bacterianos más frecuentes están Escherichia coli enterotoxigénica, Salmonella, Shigella, entre otros agentes, aunque en cerca de la mitad de los casos no se aísla un agente etiológico. En caso de diarrea persistente debe descartarse parásitos y en zonas endémicas debe realizarse las pruebas especiales para descartar infección por Cyclospora cayetanensis. En pacientes con diarrea del viajero está indicado el manejo empírico con antibióticos, lo cual disminuye la duración de la enfermedad. En ausencia de fiebre o diarrea con sangre puede usarse loperamida. La prevención es importante en especialmente en pacientes de alto riesgo o en quienes sea importante que no se afecte el viaje. Travelers’ diarrhea is one of the most common conditions that affect travelers from industrialized countries who visit tropical and subtropical areas of the world. Twenty to fifty percent of travelers will suffer from this condition, and one fifth of these subjects will have diarrhea severe enough to affect their travel plans. Illness is characterized by the occurrence of diarrhea, associated with other gastrointestinal symptoms such as abdominal pain, nausea, vomiting and sometimes, in association of inflammatory diarrhea, fever and bloody stools. Among the most common etiologic agents Enterotoxigenic Escherichia coli, Salmonella, and Shigella are among the most common bacterial pathogens, although in close to one half of cases culture results are negative. In cases of persistent diarrhea parasites must be ruled out, and in endemic areas special stains must be ordered to rule agents like Cyclospora cayetanensis. In patients with Travelers’ diarrhea empiric treatment with antibiotics is indicated, reducing the duration of illness. In the absence of fever or bloody diarrhea loperamide can be used. Prevention is important, especially in high risk patients or those in whom the trip must not be affected by the illness.

[Objectives] This study aims to analyze the mortality and the length of ICU stay (LOS) of A. baumannii VAP compared to respiratory colonization in patients with mechanical ventilation (MV)., [Methods] A prospective cohort study was performed in an ICU of adult patients (February 2010–June 2011). One hundred patients on MV with A. baumannii in lower respiratory airways were recruited, and classified as VAP or airways colonization according to CPIS criteria, with a punctuation ≥6. LOS, 30-days mortality, A. baumannii bacteremia, and clinical features including antibiotic therapy were recorded. Multivariate analysis (linear and Cox regression) and survival analysis (Kaplan-Meier curves) were performed., [Results] Fifty-seven VAP and 43 colonized A. baumannii patients were analyzed. Among the A. baumannii strains, 99% were non-susceptible to carbapenems and the MIC90 of colistin was 0.12 mg/l. Therapy was appropriate in 94.6% of VAP patients, most of them with colistin 6 MIU/day, although in 13 (23.6%) cases colistin was started 48 hours after the onset of VAP. Mortality was similar in both groups (VAP 24.6% vs. colonized 27.9%, p = 0.7). Bacteremia and acute kidney insufficiency were associated with decreased survival (p = 0.02 and p = 0.04, respectively) in VAP patients. LOS was 21.5 (11.5–42.75) vs. 9 (6–22) days for VAP and colonized patients (p = 0.004). VAP (p = 0.003) and age (p = 0.01) were independently related to a longer LOS., [Conclusions] Multidrug-resistant A. baumannii VAP treated with colistin does not have a different mortality compared to lower airways colonization, among patients on mechanical-ventilation, in a setting of high susceptibility to colistin of A. baumannii., The present study has been granted by the Instituto de SaludCarlos III (PS09/01427) and supported by Plan Nacional de I+D+i and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía y Competitividad, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015/0001) - co-financed by European Development Regional Fund "A way to achieve Europe" ERDF. RAM has a Rio Hortega grant from the Instituto de Salud Carlos III (CM14/00179).

Journal Article; English Abstract; Given the relevance of proper clinical validation of Streptococcus bovis, we here consider revising its presence in urine samples in order to determine its relative frequency and the pattern of antibiotic susceptibility. The susceptibility to antibiotics of 91 isolates of S. bovis from urine samples was retrospectively reviewed over a period of 4 years (2012-2015). The mean age of patients was 55 years, 81% of whom were women and 37.4% were hospitalized patients suffering from urological diseases (61%). Susceptibility to penicillin, vancomycin and teicoplanin was 97.8%. Due to the fact that S. bovis can be infrequent in urine isolates and given its presence in patients suffering from urological diseases, further pathogenic studies, showing the true ability of this group of bacteria to produce disease, are required. Yes Dada la importancia de la correcta validación clínica de los aislamientos de Streptococcus bovis, nos planteamos la revisión de su presencia en muestras de orina con el objetivo de conocer su frecuencia relativa y su patrón de sensibilidad antibiótica. Se revisó retrospectivamente la sensibilidad a los antibióticos de 91 aislados de S. bovis recuperados de muestras de orina durante un período de 4 anos ˜ (2012-2015). La media de la edad de los pacientes fue de 55 anos ˜ y en su mayoría fueron mujeres (81%). El 37,4% eran pacientes hospitalizados con enfermedades urológicas (61%). La sensibilidad a penicilina, vancomicina y teicoplanina fue del 97,8%. Aunque S. bovis puede ser poco común en los aislamientos de orina, su presencia en sujetos con enfermedades de base justifica la realización de estudios de patogenicidad que demuestren la verdadera capacidad de producir enfermedad de este grupo de bacterias.

Pasteurella multocida is an important veterinary pathogen causing infections in animals and birds. Nowadays, different reports have described the severity of infections, increasing resistance of micro-organisms to antibiotics, and the contribution of ethnoveterinary practices towards the treatment of various ailments of animals. The aim of the present study was to investigate the antibacterial efficacy of the ethanolic extracts of endophytic fungi against P. multocida Capsular Type A strains. A total of six endophytic fungi were isolated from two tropical ethnoveterinary plants: Garcinia xanthochymus H. and Polygonum chinense L. The ethanolic extracts of the endophytic fungi were subjected to in vitro antimicrobial activity by the well diffusion method. Besides, we evaluated the treatment of mice with the potent fungal extract and observed the effects in different organs under electron microscopy. Our results showed that four fungi had antimicrobial activity against the selected pathogen. The best antibacterial activity was showed by the extract of the endophytic fungi, Glomerella magna isolated from G. xanthochymus, with a minimum inhibitory concentration of 46.9 µg/mL and minimum bactericidal concentration of 750 µg/mL. Treatment of mice with the potent fungal extract caused a considerable inhibitory effect on the pathogen growth in vital organs, results that was also confirmed by histopathological studies made by scanning electron microscopy. The present findings indicated that the endophytic fungi G. magna has the potential to provide an effective treatment against infections caused by Pasteurella multocida. However, the isolation of bioactive components needs further investigation. Rev. Biol. Trop. 64 (2): 733-745. Epub 2016 June 01. ResumenPasteurella multocida es un importante patógeno veterinario que causa infecciones en animales y aves. Hoy en día, diferentes informes han descrito la gravedad de las infecciones, aumentando la resistencia de los microorganismos a los antibióticos, y la contribución de las prácticas etnoveterinarias hacia el tratamiento de diversas enfermedades de los animales. El objetivo del presente estudio fue investigar la eficacia antibacteriana de los extractos etanólicos de hongos endófitos contra cepas de P. multocida tipo capsular A. Un total de seis hongos endófitos fueron aisladas de dos plantas etnoveterinarias tropicales: Garcinia xanthochymus H. y Polygonum chinense L. Los extractos etanólicos de los hongos endófitos fueron sometidos a la actividad antimicrobiana in vitro por el método de difusión. Además, se evaluó el tratamiento de ratones con el extracto de hongos potente y observamos los efectos en diferentes órganos bajo el microscopio electrónico. Nuestros resultados mostraron que cuatro hongos tenían actividad antimicrobiana contra el patógeno seleccionado. La mejor actividad antibacteriana la mostró el extracto de los hongos endófitos, Glomerella magna aislado de G. xanthochymus, con una concentración inhibitoria mínima de 46.9 mg/ml y la concentración bactericida mínima de 750 mg/ml. El tratamiento de ratones con el extracto de hongos potente causó un considerable efecto inhibidor sobre el crecimiento de patógenos en órganos vitales, resultados que también fueron confirmados por estudios histopatológicos realizados por microscopía electrónica de barrido. Los presentes hallazgos indican que el hongos endófitos G. magna tienen el potencial de proporcionar un tratamiento eficaz contra las infecciones causadas por Pasteurella multocida. Sin embargo, el aislamiento de componentes bioactivos necesita más investigación.

Many dental implants fail due to the infection and inflammation that walk hand in hand with poor healing and soft tissue integration. Titanium surfaces were nanocoated with quercitrin, a natural flavonoid, with the aim to improve soft tissue integration and increase dental implants success. Streptococcus mutans attachment and biofilm formation was analysed. Then, the anti-inflammatory properties and the potential of quercitrin-nanocoated surfaces to boost soft tissue regeneration were tested using human gingival fibroblasts. An inflammatory situation was mimicked using interleulin-1-beta. We found that quercitrin-nanocoated surfaces decreased initial bacterial adhesion while increasing human gingival fibroblasts attachment. Furthermore, quercitrin-nanocoated Ti increased collagen mRNA levels and decreased matrix metalloproteinase-1/tissue inhibitor of metalloproteinanse-1 mRNA ratio, which is related to a reduced metalloproteinase-mediated collagen degradation, while also decreasing the pro-inflammatory prostaglandin E-2 release under basal and inflammatory conditions. These results suggest that quercitrin-nanocoated surfaces could enhance the soft tissue integration and increase dental implants success., This work was supported by the Conselleria d'Educacio, Cultura i Universitats of the Balearic Islands Government and the European Social Fund (contract to JMR - PD/018/2014), by the Osteology Foundation (Grant Number: 13-069) and by the Instituto de Salud Carlos III (CIBER-BBN Mobility grant to MGF). The authors thank Dr. Ferran Hierro (University of the Balearic Islands) for his technical contribution with SEM.

A total of 183 patients were colonized or infected with multidrug-resistant Pseudomonas aeruginosa isolates at a hospital in Spain during 2007-2010; prevalence increased over this period from 2.8% to 15.3%. To characterize these isolates, we performed molecular epidemiologic and drug resistance analysis. Genotyping showed that 104 (56.8%) isolates belonged to a single major clone (clone B), which was identified by multilocus sequence typing as sequence type (ST) 175. This clone was initially isolated from 5 patients in 2008, and then isolated from 23 patients in 2009 and 76 patients in 2010. PCR analysis of clone B isolates identified the b/a(VIM-2) gene in all but 1 isolate, which harbored b/a(IMP-22). ST175 isolates were susceptible to only amikacin (75%) and colistin (100%). Emergence of the ST175 clone represents a major health problem because it compromises therapy for treatment of P aeruginosa nosocomial infections., This study was supported by Spanish Network for the Research in Infectious Diseases (RD06/0008) from the Instituto de Salud Carlos III, Spain.

Objetivo: Evaluar el efecto antibacteriano in vitro de los extractos de Psidium guajava L (P. guajava) y Psidium acutangulum Mart. ex DC (P. acutangulum) sobre cepas aisladas de Streptococcus mutans (S. mutans) y la cepa control ATCC 25175. Métodos: Los extractos se obtuvieron de frutos sanos y frescos de guayaba en su estado verde y maduro de las especies mencionadas. La identificación de S. mutans a partir de muestras de pacientes con caries cavitadas (código 5 según ICDAS) y de la cepa control se realizó mediante la siembra en agar Mitis Salivarius, en condiciones de anaerobiosis, a 37 ºC, durante 48 horas, observándose colonias azules, rugosas, y las pruebas de susceptibilidad se realizaron mediante el método de difusión en disco con los extractos obtenidos. Resultados: S. mutans fue sensible al extracto de las cáscaras de P. guajava en estadio verde, tanto para la cepa control, como para la cepa del paciente, observándose el mayor halo para S. mutans ATCC 25175, reportándose un porcentaje de inhibición de 43,8%. Conclusiones: Los extractos de las cáscaras de P. acutangulum y P. guajava tienen efecto antibacteriano sobre S. mutans, representando una opción alternativa frente a este microorganismo, siendo un posible producto complementario a la prevención del desarrollo de la caries dental., Objective: To evaluate the in vitro antibacterial effect of Psidium guajava L. (P. guajava) and Psidium acutangulum Mart. ex DC (P. acutangulum) extracts on isolated strains of Streptococcus mutans and control strain ATCC 25175. Methods: The extracts were obtained from healthy and fresh guava fruits in their green and mature state of the mentioned species. The identification of S. mutans from samples of patients with cavitated caries lesions (code 5, ICDAS) and from the control strain was carried out on Mitis Salivarius agar, under conditions of anaerobiosis, at 37 °C, for 48 hours, observing blue, rough colonies, and susceptibility tests were carried out using the disc diffusion method with the extracts obtained. Results: S. mutans was sensitive to the P. guajava extract, both for the control strain and for the patient strain, observing the highest inhibition halo for S. mutans ATCC 25175, reporting 43.8% of inhibition. Conclusions: The extracts of the P. perteneacutangulum and P. guajava husks have antibacterial effect on S. mutans, representing an alternative option against this microorganism, being a possible complementary product to the prevention of the development of dental caries.

Journal Article; BACKGROUND Despite widespread use, optimum choice of antimicrobial agents, concentrations, combinations and exposure times have not been determined for antibiotic lock technique (ALT). Our objective was to evaluate the efficacy of different antibiotic combinations using an in vitro model of catheter-related infection. Daptomycin (DAP) 5 mg/mL, teicoplanin (TEC) 5 mg/mL, both alone and combined with gentamicin (GM) 2.5 mg/mL, clarythromycin (CLA) 5 mg/mL or ethanol 35 % were evaluated against four clinical strains of methicillin resistant coagulase negative staphylococci. Lock solutions were renewed every 24 h. RESULTS After 72 h catheters were reincubated with culture media to investigate bacterial regrowth. All antibiotic combinations resulted in significant reductions (p

Menadione, vitamin K3, belongs to the class of lipid-soluble vitamins and lipophilic substances as menadione cause disturbances in the bacterial membrane, resulting in damage to the fundamental elements for the integrity of the membrane, thus allowing increased permeability. Accordingly, the aim of this study was to evaluate in vitro the antibiotic-modifying activity of menadione in multiresistant strains of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, with a gradual increase in its subinhibitory concentration. In addition, menadione was compared with cholesterol and ergosterol for similarity in mechanism of drug modulatory action. Antibiotic-modifying activity and antibacterial effect were determined by the broth microdilution assay. Menadione, cholesterol and ergosterol showed modulatory activity at clinically relevant concentrations, characterizing them as modifiers of bacterial drug resistance, since they lowered the MIC of the antibiotics tested. This is the first report of the antibacterial activity of menadione and its potentiation of aminoglycosides against multiresistant bacteria.

Background Daptomycin has become a front-line antibiotic for multidrug-resistant Enterococcus faecium bloodstream infections (BSIs). We previously showed that E. faecium strains with daptomycin minimum inhibitory concentrations (MICs) in the higher end of susceptibility frequently harbor mutations associated with daptomycin resistance. We postulate that patients with E. faecium BSIs exhibiting daptomycin MICs of 3-4 µg/mL treated with daptomycin are more likely to have worse clinical outcomes than those exhibiting daptomycin MICs ≤2 µg/mL. Methods We conducted a multicenter retrospective cohort study that included adult patients with E. faecium BSI for whom initial isolates, follow-up blood culture data, and daptomycin administration data were available. A central laboratory performed standardized daptomycin MIC testing for all isolates. The primary outcome was microbiologic failure, defined as clearance of bacteremia ≥4 days after the index blood culture. The secondary outcome was all-cause in-hospital mortality. Results A total of 62 patients were included. Thirty-one patients were infected with isolates that exhibited daptomycin MICs of 3-4 µg/mL. Overall, 34 patients had microbiologic failure and 25 died during hospitalization. In a multivariate logistic regression model, daptomycin MICs of 3-4 µg/mL (odds ratio [OR], 4.7 [1.37-16.12]; P = .014) and immunosuppression (OR, 5.32 [1.20-23.54]; P = .028) were significantly associated with microbiologic failure. Initial daptomycin dose of ≥8 mg/kg was not significantly associated with evaluated outcomes. Conclusions Daptomycin MICs of 3-4 µg/mL in the initial E. faecium blood isolate predicted microbiological failure of daptomycin therapy, suggesting that modification in the daptomycin breakpoint for enterococci should be considered.

The isolation and cultivation of antibiotic-producing bacteria can yield a rich supply of bacteria that produce new antibiotics to which pathogens are sensitive. However, predicting the evolution of pathogen resistance to these antibiotics is tricky.

Background: Pseudomonas aeruginosa is an environmentally ubiquitous Gram-negative bacterium and important opportunistic human pathogen, causing severe chronic respiratory infections in patients with underlying conditions such as cystic fibrosis (CF) or bronchiectasis. In order to identify mechanisms responsible for adaptation during bronchiectasis infections, a bronchiectasis isolate, PAHM4, was phenotypically and genotypically characterized. Results: This strain displays phenotypes that have been associated with chronic respiratory infections in CF including alginate over-production, rough lipopolysaccharide, quorum-sensing deficiency, loss of motility, decreased protease secretion, and hypermutation. Hypermutation is a key adaptation of this bacterium during the course of chronic respiratory infections and analysis indicates that PAHM4 encodes a mutated mutS gene responsible for a similar to 1,000-fold increase in mutation rate compared to wild-type laboratory strain P. aeruginosa PAO1. Antibiotic resistance profiles and sequence data indicate that this strain acquired numerous mutations associated with increased resistance levels to b-lactams, aminoglycosides, and fluoroquinolones when compared to PAO1. Sequencing of PAHM4 revealed a 6.38 Mbp genome, 5.9 % of which were unrecognized in previously reported P. aeruginosa genome sequences. Transcriptome analysis suggests a general down-regulation of virulence factors, while metabolism of amino acids and lipids is up-regulated when compared to PAO1 and metabolic modeling identified further potential differences between PAO1 and PAHM4. Conclusions: This work provides insights into the potential differential adaptation of this bacterium to the lung of patients with bronchiectasis compared to other clinical settings such as cystic fibrosis, findings that should aid the development of disease-appropriate treatment strategies for P. aeruginosa infections., This work was supported by the National Institutes of Health [J.J.V. was supported in part by T32AI055432 awarded to the University of Virginia, J.P.O. was partially supported by T32AI007046 awarded to the University of Virginia, J.A.P., J.A.B., and J.B.G. were supported in part by grant R01GM088244 awarded to J.A.P.], the Cystic Fibrosis Foundation [J.B.G., M.B., J.P.O, and M.R.D. were supported in part by GOLDBE10G0 awarded to J.B.G., F.H.D. was supported by a postdoctoral fellowship (DAMRON10F0)], the Ministerio de Economia y Competitividad and Instituto de Salud Carlos III and by the Direccio General d'Universitats, Reserca I Transferencia del Coneixement del Govern de les Illes Balears [X.M., I.M.R., S.A. and A.O were supported by SAF2008-0467, REIPI RD06/0008, RD12/0015, PRE-R-22584-2011, and PI 12/00103]. P.B. and V.A.P.M.D.S. were supported by the Helmholtz Centre for Infection Research, Germany (project: Systems Biology of Pseudomonas, number 1100187) and the FP7 projects SystemTB (# 241587) and Microme (# 222886). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

We report a case of posttraumatic skin and soft-tissue infection in a patient with a left thigh wound after a traffic accident.Pseudomonas fulvawas isolated from a wound aspirate and was identified to the species level by Maldi-tof. The patient responded to drainage, debridement of wound, and two weeks of intravenous antibiotic therapy. Follow-up after 3 weeks was satisfactory with healthy cover of the injured area.

In order to evaluate the usefulness of a peripheral blood PCR assay in the posttreatment follow-up of brucellosis, a cohort of 30 patients was studied by means of blood cultures, rose Bengal, seroagglutination, Coombs' antibrucella tests, and PCR assay at the time of diagnosis, at the end of treatment, and 2, 4, and 6 months later. Of the 29 patients whose PCR assays were initially positive, 28 (96.5%) were negative at the conclusion of the treatment. PCR was positive for the two patients who had relapses and negative for another four who had suspected but unconfirmed relapses. PCR was negative for 98.3% of the follow-up samples from those patients who had a favorable evolution. In conclusion, PCR appears to be a very useful technique, not only for the initial diagnosis of the disease, but also for posttreatment follow-up and the early detection of relapses.

Chronic respiratory infection by Pseudomonas aeruginosa is a major cause of mortality in cystic fibrosis (CF). We investigated the interplay between three key microbiological aspects of these infections: the occurrence of transmissible and persistent strains, the emergence of variants with enhanced mutation rates (mutators) and the evolution of antibiotic resistance. For this purpose, 10 sequential isolates, covering up to an 8-year period, from each of 10 CF patients were studied. As anticipated, resistance significantly accumulated overtime, and occurred more frequently among mutator variants detected in 6 of the patients. Nevertheless, highest resistance was documented for the nonmutator CF epidemic strain LES-1 (ST-146) detected for the first time in Spain. A correlation between resistance profiles and resistance mechanisms evaluated [ efflux pump (mexB, mexD, mexF, and mexY) and ampC overexpression and OprD production] was not always obvious and hypersusceptibility to certain antibiotics (such as aztreonam or meropenem) was frequently observed. The analysis of whole genome macrorestriction fragments through Pulsed-Field Gel Electrophoresis (PFGE) revealed that a single genotype (clone FQSE-A) produced persistent infections in 4 of the patients. Multilocus Sequence typing (MLST) identified clone FQSE-A as the CF epidemic clone ST-274, but striking discrepancies between PFGE and MLST profiles were evidenced. While PFGE macrorestriction patterns remained stable, a new sequence type (ST-1089) was detected in two of the patients, differing from ST-274 by only two point mutations in two of the genes, each leading to a nonpreviously described allele. Moreover, detailed genetic analyses revealed that the new ST-1089 is a mutS deficient mutator lineage that evolved from the epidemic strain ST-274, acquired specific resistance mechanisms, and underwent further interpatient spread. Thus, presented results provide the first evidence of interpatient dissemination of mutator lineages and denote their potential for unexpected short-term sequence type evolution, illustrating the complexity of P. aeruginosa population biology in CF., This study was supported by the Ministerio de Economia y Competitividad of Spain, Instituto de Salud Carlos III, through the Spanish Network for the Research in Infectious Diseases (REIPI RD06/0008 and RD12/0015) and grant PI12/00103 and by the Direccio General dUniversitats, Reserca I Transferencia del Coneixement del Govern de les llles Balears. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Six multiresistant, NDM-1-producing Klebsiella pneumoniae strains were recovered from an outbreak that affected six neonatal patients in a Colombian hospital. Molecular analysis showed that all of the isolates harbored the bla NDM-1 , qnrA , and intI1 genes and were clonally related. Multilocus sequence typing showed that the isolates belonged to a new sequence type (ST1043) that was different from the sequence types that had previously been reported. This is the first report of NDM-1-producing isolates in South America.

[Background and Aim] The genotype-phenotype interaction in drug-induced liver injury (DILI) is a subject of growing interest. Previous studies have linked amoxicillin-clavulanate (AC) hepatotoxicity susceptibility to specific HLA alleles. In this study we aimed to examine potential associations between HLA class I and II alleles and AC DILI with regards to phenotypic characteristics, severity and time to onset in Spanish AC hepatotoxicity cases. [Methods] High resolution genotyping of HLA loci A, B, C, DRB1 and DQB1 was performed in 75 AC DILI cases and 885 controls. [Results] The distributions of class I alleles A*3002 (P/Pc = 2.6E-6/5E-5, OR 6.7) and B*1801 (P/Pc = 0.008/0.22, OR 2.9) were more frequently found in hepatocellular injury cases compared to controls. In addition, the presence of the class II allele combination DRB1*1501-DQB1*0602 (P/Pc = 5.1E-4/0.014, OR 3.0) was significantly increased in cholestatic/mixed cases. The A*3002 and/or B*1801 carriers were found to be younger (54 vs 65 years, P = 0.019) and were more frequently hospitalized than the DRB1*1501-DQB1*0602 carriers. No additional alleles outside those associated with liver injury patterns were found to affect potential severity as measured by Hy’s Law criteria. The phenotype frequencies of B*1801 (P/Pc = 0.015/0.42, OR 5.2) and DRB1*0301-DQB1*0201 (P/Pc = 0.0026/0.07, OR 15) were increased in AC DILI cases with delayed onset compared to those corresponding to patients without delayed onset, while the opposite applied to DRB1*1302-DQB1*0604 (P/Pc = 0.005/0.13, OR 0.07). [Conclusions] HLA class I and II alleles influence the AC DILI signature with regards to phenotypic expression, latency presentation and severity in Spanish patients., This study was supported by the research grant Proyecto Excelencia P10-CTS-6470 and by the Agencia Española del Medicamento. CIBERehd and Red Genómica del Cancer are funded by Instituto de Salud Carlos III.

In vitro tests conducted with extracts rich in tannins have identified several biological activities of this class of substance. Thus, this paper intends to evaluate the antibacterial activity of tannin-rich fraction obtained from leaf extracts of Anacardium humile A.St.-Hil. Extracts of A. humile leaves in 70% acetone were semi-purified with ethyl acetate and butanol. We quantified the total tannins of the semi-purified fractions, of the crude extract and of aqueous residues and then performed tests of the antibacterial activity of the tannins against Staphylococcus aureus ATCC 6538, Pseudomonas aeruginosa ATCC 27853 and Enterococcus faecalis ATCC 29212. All positive extracts underwent tannin isolation using a Sephadex LH-20 column. The tannins isolated from the samples were quantified and tested for the minimal inhibitory concentrations (MIC) and minimum bactericidal concentrations (MBC). The tannins from crude extracts, semi-purifications and residues showed inhibition of S. aureus growth with MIC=500 g mL-1. All tannin fractions showed MIC against all strains and MBC, except against E. faecalis. The tannin fractions from Anacardium humile have antibacterial activity against Staphylococcus aureus, Pseudomononas aeruginosa and Enterococcus faecalis and, therefore, may be promising for future synthesis of new antibacterial agents. Testes in vitro realizados com extratos ricos em taninos têm identificado muitas atividades biológicas dessa classe de substâncias. Nesse contexto, esse artigo propõe a avaliação da atividade antibacteriana de frações tânicas, obtidas de extratos de folhas de Anacardium humile A.St.-Hil. Extratos de A. humile em acetona 70% foram particionados com acetato de etila e butanol. Foram quantificados taninos totais das frações particionadas, do extrato bruto e dos resíduos aquosos, e foi realizado teste de atividade antibacteriana dos taninos contra Staphylococcus aureus ATCC 6538, Pseudomonas aeruginosa ATCC 27853 e Enterococcus faecalis ATCC 29212. Todos os extratos positivos foram submetidos ao isolamento de taninos, utilizando-se coluna de Sephadex LH-20. Os taninos isolados das amostras foram quantificados e testados sua concentração inibitória mínima (CIM) e concentração bactericida mínima (CBM). Os taninos do extrato bruto, partições e resíduos apresentaram inibição do crescimento de S.aureus com CIM =500 g mL-1. As frações tânicas apresentaram CIM contra todas as cepas e CBM, exceto contra E. faecalis. As frações tânicas de Anacardium humile possuem atividade antibacteriana contra Staphylococcus aureus, Pseudomononas aeruginosa e Enterococcus faecalis e, portanto, podem ser promissoras em sínteses futuras de novos agentes antimicrobianos.