AIG, CFL, SM, JR participaron en la concepción y diseño del estudio; AIG, CFL, MM, TJO y JR en el aporte de pacientes o material de estudio; CFL, TJO y JR en la obtención del financiamiento; TJO, SM, MJP, JR, y LJdV participaron el análisis e interpretación de los datos. Todos los autores participaron de la recolección de resultados, revisión crítica del manuscrito, aprobación de su versión final. / The main aim of this study was to establish the resistance levels to antimicrobial agents, in 222 non-pathogenic E. Coli strains of fecal origin in Peru. The proportion of resistance found to the evaluated antimicrobials was ampicillin (62.6%), cotrimoxazole (48,6%), tetracycline (43,0%) and chloramphenicol (15,8%). We emphasize the high resistance levels found for quinolones: 32% for nalidixic acid (NAL) and 12% for ciprofloxacin (CIP). These high levels of quinoloneresistance in non-pathogenic strains isolated from children in this age group highlight the extensive use and the impact of the intake of this kind of antimicrobials in the community, showing the potential risk of the loss of their utility in the area. / Este trabajo fue parcialmente financiado por Agència Catalana de Cooperació al Desenvolupament proyecto U2006 (LJdV), Centre de Cooperació per al Desenvolupament - Universitat Politècnica de Catalunya (LJdV), Agencia Española de Cooperación Internacional al Desarrollo proyectos numero A/4892/06 (LJdV), D/019499/08 y D/024648/09 (JR), Fogarty International Center, National Institute of Health, USA, proyecto 1K01TW007405 (TJO) Sanofi Pasteur y fondos de investigación del Dr. Lanata, Instituto de Investigación Nutricional, Lima, Perú. La investigación de JR es financiado por el proyecto CP05/0130 del FIS (Fondo de Investigaciones Sanitarias, España). / Revisión por pares.

A resistência bacteriana emergiu como importante problema de saúde pública no mundo. Nesta pesquisa, a distribuição das espécies e a evolução da sensibilidade aos antibióticos entre isolados clínicos obtidos em um hospital terciário foram analisadas no período de 2007 a 2012. As bactérias isoladas foram identificadas por análises bioquímicas convencionais. Segundo as recomendações do Clinical and Laboratory Standards Institute (CLSI) compatíveis ao ano do processamento microbiológico, o perfil de sensibilidade foi determinado pelo método de disco difusão, entretanto para a sensibilidade a vancomicina utilizou-se a concentração inibitória mínima (CIM). Durante o período da pesquisa totalizou-se 4.464 resultados de culturas distribuídos em 2007 (865), 2008 (981), 2009 (485), 2010 (539), 2011 (704) e 2012 (890). Com relação aos cocos Gram-positivos e as enterobactérias, Staphylococcus aureus e Eschericia coli foram as bactérias mais frequentemente isoladas, respectivamente. Dos antibióticos da classe dos beta-lactâmicos, piperacilina + tazobactam e aztreonam mostraram os melhores resultados de atividade antibacteriana. Todas as cepas isoladas de enterobactérias foram sensíveis aos carbapenêmicos. As cepas de Pseudomonas aeruginosa foram mais sensíveis ao imipenem do que ao meropenen, no entanto a redução dos perfis de sensibilidade foi evidenciada para ambos os antibióticos: imipenem (69,6% para 41,7%) e meropenem (63,3% para 25,0%). Todas Burkloderoderia cepacea e Acinetobacter baumanii demonstraram resistência ao meropenem, entretanto as cepas de Acinetobacter iuwoffi foram sensíveis aos carbapenêmicos. Aumentos semelhantes nos perfis de sensibilidade das cepas de Escherichia coli, Klebsiella pneumoniae e Klebsiella oxytoca (70% para 86,7%) foram observados para ciprofloxacina e levofloxacina. Da classe dos aminoglicosídeos, a amicacina mostrou melhor atividade antibacteriana do que a gentamicina. Nas amostras analisadas deste hospital não houve ocorrência de Enterococcus spp. resistente a vancomicina (VRE). Ainda, todas as cepas de cocos Gram-positivos foram sensíveis a vancomicina e teicoplamina. No geral os antibióticos apresentaram resultados preocupantes, uma vez que para as bactérias reconhecidas nos cenários das infecções hospitalares nenhuma foi sensível 100% a todas as classes de antibióticos. A situação da sensibilidade microbiana aos antibióticos é caótica tendo cada vez mais limitada a sua utilização na terapêutica / Bacterial resistance has emerged as an important public health problem in the world. In this study, the distribution of species and the evolution of antibiotic susceptibility among clinical isolates in a tertiary hospital were analyzed in the period from 2007 to 2012. Bacterial isolates were identified by conventional biochemical analyzes. According to the recommendations of the Clinical and Laboratory Standards Institute (CLSI) supported a year of microbiological processing, the sensitivity was determined by the disk diffusion method, however for sensitivity to vancomycin was used the minimum inhibitory concentration (MIC). During the research period, 4,464 culture results were obtained and distributed in 2007 (865), 2008 (981), 2009 (485), 2010 (539), 2011 (704) and 2012 (890). With respect to Gram-positive cocci and Enterobacteriaceae, Staphylococcus aureus and Escherichia coli were the most frequently isolated bacteria, respectively. From beta-lactams class, piperacillin + tazobactam and aztreonam showed the best results of antibacterial activity. All isolated strains of Enterobacteriaceae were susceptible to carbapenems. Pseudomonas aeruginosa strains were more sensitive to imipenem than the meropenen, however reducing the sensitivity profile was observed for both antibiotics imipenem (69.6% to 41.7%) and meropenem (63.3% for 25.0%). All Burkloderoderia cepacia and Acinetobacter baumannii were resistant to meropenem, however Acinetobacter iuwoffi strains were susceptible to carbapenems. Similar increases in the susceptibility of Escherichia coli, Klebsiella pneumoniae and Klebsiella oxytoca strains (70% to 86.7%) were observed for ciprofloxacin and levofloxacin. From aminoglycosides class, amikacin showed better antibacterial activity than gentamicin. In the samples analyzed in this hospital there was no occurrence of Enterococcus spp. resistant to vancomycin (VRE). Furthermore, all strains of Gram-positive cocci were susceptible to vancomycin and teicoplanin. Overall antibiotics showed worrying results, since none was recognized for bacteria in the nosocomial infection scenarios 100% sensitive to all classes of antibiotics. The situation of microbial sensitivity to antibiotics is becoming chaotic having limited their use in therapy

Antimicrobial resistance is a worldwide problem that has deleterious long-term effects as the development of drug resistance outpaces the development of new drugs. Plants have been used for many generations for healing purposes, and screening of extracts of these plants has often yielded positive outcomes. This study was aimed at isolating and characterizing the major active antimicrobial compounds present in the stem bark of C. molle, in a bid to identify potential sources of cheap starting materials for the synthesis of new drugs. Various solvents (hexane, ethyl acetate, dichloromethane, acetone, ethanol and methanol) were used for extraction. The agar well diffusion technique was used to screen for antimicrobial activity of C. molle extracts against Streptococcus pyogenes ATCC 49399, Plesiomonas shigelloides ATCC 51903, Pseudomonas aeruginosa ATCC 15442, Helicobacter pylori ATCC 43526 and Helicobacter pylori 252C (clinical isolate); minimum inhibition concentration (MIC) of the most active extracts was determined by the broth dilution method. Fractionation of acetone extract was done by thin layer chromatography (TLC) and bioautography to determine the compounds present and their antimicrobial activity respectively. The acetone extract was purified by column chromatography and their MIC determined. The most potent fraction (EA4) was subjected to Gas chromatography- Mass spectrometry (GC-MS) and High performance liquid chromatography (HPLC) for identification of the active compounds. Results were analyzed by the Fisher‟s exact test. All the extracts tested demonstrated antimicrobial activity with zone diameters of inhibition ranging from 0–32 mm. Acetone was the most potent extract with its MIC ranging from 0.078–5.0 mg/mL. Seventeen fractions were collected from column chromatography and the most active fraction against all the organisms was EA 4 (eluted with 100 percent ethyl acetate), with its MIC ranging from 0.078 - 2.5mg/mL. There was no statistically significant difference (P>0.05) in the potency of the xii four extracts (acetone, methanol, ethanol and ethyl acetate) and antibiotic (ciprofloxacin) on the different bacterial strains tested, likewise the crude extract and the fractions. No compound was detected by GC-MS whereas numerous peaks were identified by HPLC implying that the active compounds in this plant are non volatile. We could not identify the compounds thereby proposing further studies using Nuclear magnetic resonance to identify the compounds. The study revealed that the acetone extract of C. molle was the most active against all the test organisms and therefore justifies the use of this plant in traditional medicine.

Stenotrophomonas maltophilia is increasingly emerging as an opportunistic pathogen of global concern. Due to its inherent resistance to several classes of antibiotics including carbapenems and its ability to acquire mobile resistance elements, treatment of infections caused by S. maltophilia is a constant challenge for clinicians. Trimethoprim-sulphamethoxazole (TMP-SMX) is the generally accepted antibiotic of choice for the treatment of infections caused by this organism, but resistance to the drug is increasingly being reported; hence, the need for alternative therapeutic options. In this study, the antimicrobial susceptibility profile of 110 commensal S. maltophilia isolates obtained from Nkonkobe municipality, Eastern Cape Province, Republic of South Africa was investigated. Twenty-one antibiotics including TMP-SMX and the newer fluoroquinolones; levofloxacin, gatifloxacin and moxifloxacin were included in the antibiotic panel. About 63.4 percent of the isolates were susceptible to TMP-SMX with a resistance rate of 28.2 percent. The fluoroquinolones were more effective with susceptibilities ranging from 76 percent to 94.7 percent. Resistance to the fluoroquinolones ranged from 1.3 percent to 2.7 percent. Levofloxacin was the most effective fluoroquinolone tested. Phenotypic dectection of extended spectrum β-lactamases (ESBLs) showed double disc synergy test (DDST) positivity in 59.5 percent of the isolates. Cefepime was the most sensitive indicator cephalosporin in the DDST with 77.3 percent of suspected ESBL-producing isolates showing cefepime-clavulanic acid synergy. Isolates exhibited nine different ESBL phenotypes, however, PCR amplification of the bla genes revealed four isolates that possessed genes belonging to the CTX-M group (CTX-M-1 and CTX-M-8 groups). ESBL genes are usually carried on mobile elements such as plasmids and transposons which may also bear genes that mediate resistance to aminoglycosides, tetracyclines, TMP-SMX and fluoroquinolones. ESBL positive isolates appeared more susceptible to the fluoroquinolones compared to TMP-SMX but there was no significant relationship between ESBL production and susceptibility to these drugs (p > 0.05). The newer fluoroquinolones are a possible alternative treatment option for S. maltophilia infections in this environment but further studies and clinical investigations are needed to determine the in vivo efficacy of these drugs.

This study was done in order to assess the incidence of Staphylococcus species from milk of cows with subclinical mastitis and their antimicrobial sensitivity in some selected antibiotics and Usnea barbata lichen extracts. The study was conducted in two different commercial dairy farms. Staphylococcus species isolates were identified using several biochemical tests which included Gram’s staining test, catalase test and oxidase test. A commercial API® staph kit (bioMerieux, France) was used to confirm the bacterial organisms to their species level. The antimicrobial sensitivity of individual species was determined according to the Clinical Laboratory Standard Institute (CLSI) for the selected antibiotics. Agar well diffusion method and the broth micro-dilution technique were used to determine the sensitivity of Staphylococcus species in U. barbata extracts. A total of 467 milk samples were screened for bacterial identification from the two farms. Fifteen different Staphylococcus species isolates were identified from all milk samples that were examined. The most frequently isolated species included Staphylococcus xylosus (54.34%), Staphylococcus hominis (24.78%), Staphylococcus aureus (16.38%), Staphylococcus saprophyticus (16.12%) and Staphylococcus haemolyticus (11.63%). Most Staphylococcus species were resistant to Penicillin (75.35%), Nalidixic acid (72.55%) and Ampicillin (63%). Furthermore, the bacterial sensitivity evaluation of U. barbata lichen extracted with methanol and ethyl-acetate against selected Staphylococcus species isolates showed 92.31% and 53.85% susceptibility, respectively. The minimum inhibitory concentration (MIC) of the methanol and ethyl-acetate extracts ranged between 0.0390 to 10 mg/ml. There was a relatively high incidence of Staphylococcus species identified in milk of cows with subclinical mastitis from both farms. Conversely, Staphylococcus species isolates were resistant to antibiotics (mostly penicillin and ampicillin) commonly used in the farms. Furthermore, the study investigated the antimicrobial sensitivity of U. barbata extract in-vitro which may validate its use in traditional medicine for treatment of cows with mastitis.

Cocos nucifera belong to the family Aracaceae (palm Family). The English name is coconut and it is used extensively as medicinal remedies against infections such as urinary tract infections, gastro intestinal infections, skin and wound infections. The in vitro antibacterial (including anti-listerial and anti-vibrio) properties as well as the evaluation of the combination potentials of the plant extract with six front-line antibiotics were evaluated in this study using standard procedures. The in vitro anti-listerial properties of the crude aqueous and n-Hexane extract of the husk of Cocos nucifera were carried out against 37 Listeria isolates. Twenty-nine of the test organisms were susceptible to the aqueous extract while thirty were susceptible to the n-Hexane extract both at the screening concentration of 25 mg/ml. Minimum Inhibitory Concentration (MIC) values for all the susceptible bacteria ranged between 0.6 - 5.0 mg/ml. For the aqueous extract, average log reduction in viable cell count ranged between 0.32 Log10 and 4.8 Log10 CFU/ml after 8 hours interaction in 1 × MIC and 2 × MIC. For the n-Hexane extract, the log reduction ranged between 2.4 Log10 and 6.2 Log10 CFU/ml after 8 hours interaction in 1 × MIC and 2 × MIC. The time-kill characteristics of the two extracts suggest that at higher concentration (2 × MIC) and longer duration of interaction (8 hr), more bacteria were killed. In vitro anti-vibrio and antibacterial properties experiment revealed that of all the 45 vibrio and 25 bacteria strains that was tested, 37 were susceptible to the aqueous extract and 38 to the n-Hexane extract, while 17 were susceptible to the aqueous extract and 21 to the n-Hexane extract. Minimum Inhibitory Concentration (MIC) values for all the susceptible bacteria ranged between 0.3 - 5.0 mg/ml. viii The time kill studies revealed that for the aqueous extract, average log reduction in viable cell count in time kill assay ranged between 0.12 Log10 and 4.2 Log10 CFU/ml after 8 hr interaction at 1 × MIC and 2 × MIC. For the n-Hexane extract, the log reduction ranged between 0.56 Log10 and 6.4 Log10 CFU/ml after 8 hr interaction in 1 × MIC and 2 × MIC. In the test for the combination interactions, the checkerboard method revealed synergy of 67% and indifferent of 33%, while the time kill assay detected synergy in 72% and indifferent in 28% of the combinations tested. The synergy detected was not specific to any of the antibiotics or the Gram reaction of the bacteria, and no antagonism was detected. We conclude that the aqueous and n-Hexane extract of the husk of C. nucifera contains potential broad spectrum antibiotics resistance modulating compounds that could be relevant in the treatment of infections caused by these pathogens. In addition, the husk which is being discarded as agro waste will opens up a vista of opportunities for utilization for therapeutic purposes

The stem bark of Peltophorum africanum and Bridelia micrantha are used in South Africa traditional medicine for treatment of intestinal parasites, relieve problems and human immunodeficiency virus/ acquired immune deficiency syndrome (HIV/AIDS). The growing problem of antibiotic resistance by Helicobacter pylori the major etiological agent in gastritis, gastric cancer, peptic and gastric ulcer demands the search for novel compounds from plant based sources. This study was aimed to determine the antimicrobial activity of five solvent (ethylacetate, acetone, ethanol, methanol and water) extracts of the stem bark of P. africanum and B. micrantha on clinical strains of H. pylori in a bid to identify potential sources of cheap starting materials for the synthesis of new drugs. H. pylori strains were isolated from patients presenting with gastric related morbidities at the Livingstone Hospital, Port Elizabeth for endoscopy and confirmed following standard microbiology procedures. The plant extracts including clarithromycin were tested against 31 clinical strains of H. pylori by the agar well diffusion method. The most potent extract was evaluated by the microdilution method to determine the Minimum Inhibitory Concentration (MIC50&90), followed by the rate of kill. Preliminary phytochemical analysis was carried out. The one way ANOVA test was used to statistically analyse the results. All the extracts demonstrated anti-H. pylori activity with zone diameters of inhibition that ranged from 0 to 23 mm for the extracts and 0 to 35 mm for clarithromycin. Marked susceptibility (100%) was recorded for the ethyl acetate extract of P. africanum (P. afr. EA) and the acetone extract of B. micrantha (B. mic. A), which were statistically significant (P < 0.05) compared to all other extracts and clarithromycin. For B. micrantha ethyl acetate extract, 93.5 percent susceptibility was observed while for the control iv antibiotic, clarithromycin it was 58.1 percent. The MIC50 ranged from 0.0048 to 0.313 mg/mL for P. afr. EA, and from 0.0048 to 0.156 mg/mL for B. mic. EA; MIC90 ranged from 0.156 mg/mL to 0.625 mg/mL and 0.0048 to 2.5 mg/mL for P. afr. EA and B. mic. EA respectively. There was a significant statistical difference observed in potency of both P. afr. EA and B. mic. A compared to the two antibiotics (P < 0.05). One hundred percent killing by P. afr EA was observed at 0.05 mg/mL (½ x MIC) and 0.2 mg/mL (2 x MIC) in 66 h for strain PE466C and PE252C respectively. For B. mic. EA, 100 percent killing effect of both strains (PE430C and PE369C) was observed at 0.1 mg/mL (2 x MIC) in 66 h. Qualitative phytochemical analysis confirmed the presence of alkaloids, flavonoids, steroids, tannins and saponins in the ethyl acetate extracts of both plants, which could be a potential template of lead molecule for the design of new anti- Helicobacter pylori therapies.

Thesis (M.Sc. (Microbiology)) -- University of Limpopo, 2020 / The aim of the study was to isolate and characterise the antibacterial and antioxidant compounds from the leaf extracts of the two mistletoes (Viscum rotundifolium and Tapinanthus oleifolius) and to determine the synergistic effects of the plants with their hosts (Mystroxylon aethiopicum and Dichrostachys cinerea). The leaves of the selected plants were collected, dried and ground into fine powder. The powdered plant leaves were extracted using n-hexane, ethyl acetate, acetone, methanol and water. The qualitative phytochemical analysis was done using standard chemical tests and thin layer chromatography. The total phenolic, tannin and flavonoid content were estimated using spectrophotometric methods. The qualitative antioxidant activity was determined using 2, 2-Diphenyl-1-pycrylhydryzyl (DPPH) free radical scavenging assay on thin layer chromatography and quantitative antioxidant activity was determined using colorimetric DPPH assay and ferric reducing power assay. The antibacterial activity of extracts was tested against S. aureus, E. faecalis, E. coli and P. aeruginosa using bioautography and serial broth micro-dilution assay. The cytotoxic effects of the plant extracts were determined using cell viability assay. The active compounds were extracted using serial exhaustive extraction and isolated using the bioassay-guided fractionation and then purified using thin layer chromatography and open column chromatography. The pure compound was identified using the NMR and mass spectroscopy. Methanol was the best extractant with the highest percentage yield. The distinct fluorescing compounds were observed on the CEF and EMW mobile phase. The non-fluorescing compounds detected with vanallin-sulphuric acid spray reagent showed that V. rotundifolium, T. oleifolius and D. cinerea have more polar compounds while M. aethiopicum have more non-polar compounds. All the plants revealed the presence of terpenoids, flavonoids, phlobatannin, tannins steroids and cardiac-glycosides and the absence of alkaloids and saponins. The n-hexane extract of T. oleifolius was significantly high in flavonoid content (34.801±0.798 mgQE/g of extract) and tannin content (15.367±0.320 mgGAE/g of extract) whereas the ethyl acetate extract of M. aethiopicum was high in phenolic content (893.210±3.016 mgGAE/g of extract). The results indicate that the compounds that exhibit antioxidant activity are non-polar to polar, which was confirmed by quantitative tests. M. aethiopicum showed activity against all tested bacteria while V. rotundifolium only had activity against E. faecalis whereas T. oleifolius and D. cinerea did not have any activity. The quantitative antibacterial test confirmed the activity of the plant extracts where the MIC values ranged from 0.04-2.5 mg/mL. The combination of V. rotundifolium and M. aethiopicum (n-hexane, ethyl acetate and acetone extracts) and T. oleifolius and D. cinerea (n-hexane, acetone and methanol extracts) showed synergistic effects in inhibiting the growth of S. aureus whereas the methanol extract of T. oleifolius and D. cinerea showed antagonistic effects in inhibiting the growth of all tested bacteria. The cell viability assay indicated that acetone extracts of all plants were non-toxic on the human liver (C3A) cells. M. aethiopicum was selected for isolation and purification of bioactive compounds. The bioassay-guided fractionation led to the isolation of oleanolic acid acetate. This study demonstrated that the selected plants have antibacterial potential that is ascribed to the phytochemicals present. Further studies including in vivo assays are needed in order to support their use in traditional medicine / National Research Foundation (NRF)

O presente estudo avaliou a ação in vitro de diferentes nanopartículas de prata (nanoAg) sintetizadas pelo Instituto de Pesquisas Tecnológicas (IPT) e Universidade Federal de São Carlos (IFSC) e controles de sulfadiazina de prata, nitrato de prata e nanoAg comercial Sigma, frente a bactérias e leveduras. Os objetivos do estudo foram avaliar a ação in vitro de NanoAg sintetizadas no Brasil frente a bactérias sensíveis aos antimicrobianos e multirresistentes (MR), incluindo Gram positivos e negativos, além de candidas isoladas de amostras clínicas. Definir as condições de síntese que resultem em nanoAg com melhor efeito antimicrobiano in vitro frente a isolados sensíveis e MR. Foram utilizadas diferentes metodologias tais como agar well diffusion, determinação de concentração inibitória mínima CIM, concentração bactericida mínima (CBM), curva do tempo de morte e inibição da formação de biofilme. Ao todo, foram avaliados 110 isolados, sendo 37 sensíveis aos antimicrobianos, 54 MR, e 19 candidas frente a 29 nanoAg com diferentes características de síntese. Os testes de difusão em meio sólido apresentaram heterogeneidade de resultados frente aos micro-organismos avaliados. Enquanto as informações de CIM50 e CIM90 evidenciaram não existir variações no efeito inibitório frente isolados sensíveis ou resistentes aos antimicrobianos. As curvas do tempo de morte ilustraram a dinâmica de inibição dos compostos de prata e a interferência do sangue nos testes in vitro. A partir dos testes com biofilme foi possível observar efeito inibitório e de descolamento de biofilme previamente formado. Os resultados permitiram concluir a maior eficácia para nanoAg com Citrato e Quitosana, seguido por nitrato de prata, sulfadiazina de prata e PVA. A NanoAg comercial (Sigma, 60 nm) apresentou resultados inferiores ao de nanoAg Citrato, nanoAg Quitosana e nitrato de prata. Estes resultados abrem caminho para novas análises de nanoAg sintetizadas no Brasil em busca de produtos com maior eficácia com ação contra bactérias MR e candidas / The present study evaluated the in vitro action of different silver nanoparticles (nanoAg) synthesized by \"Instituto de Pesquisas Tecnológicas\" (IPT) and \"Universidade Federal de São Carlos\" (IFSC) and silver sulfadiazine, silver nitrate and commercial nanoAg Sigma against bacteria and yeasts. The objectives of the study were to evaluate the in vitro action of NanoAg synthesized in Brazil against antimicrobial susceptible bacteria and multidrug-resistant (MDR), including Gram positive and negative, as well as some candida isolates from clinical source. Define the conditions that result in nanoAg synthesis with best in vitro antimicrobial effect against sensitive isolates and MDR. Different methodologies were used such as agar well diffusion, determination of minimum inhibitory concentration (MIC), minimum bactericidal concentration (CBM), the time-kill curve and inhibition of biofilm formation. Altogether 110 isolates were evaluated, being 37 antimicrobial sensitive, 54 MDR, and 19 candidas, against 29 nanoAg with different synthesis. The solid medium diffusion tests showed heterogeneity of results against the evaluated microorganisms. While the information of MIC50 and MIC90 showed no changes in inhibitory effect against sensitive isolates or MDR. The time-kill curve illustrated the dynamics of inhibition of silver compounds and the interference of blood on the in vitro tests. From the tests with biofilm was possible to observe biofilm inhibitory effect and detachment of biofilm previously formed. The conclusion defined to greater effectiveness for nanoAg with Chitosan and Citrate, followed by silver nitrate, silver sulfadiazine and PVA. The commercial NanoAg (Sigma, 60 nm) presented lower performance than nanoAg citrate, nanoAg Chitosan and silver nitrate. These results open the way for new analyses of Brazil synthetized nanoAg with better efficiency against MDR bacterial and candida

INTRODUÇÃO: As infecções do trato urinário (ITU) feminino são muito prevalentes em mulheres. Em geral, elas dividem-se em cistites e pielonefrites de acordo com seu nível anatômico. Seu tratamento, apesar de simples, depende do conhecimento da flora bacteriana e do padrão de sensibilidade local, principalmente em tempos de aumento de resistência bacteriana. Este estudo avaliou e comparou a flora e o padrão de sensibilidade das bactérias causadoras de infecção não complicada do trato urinário feminino no período de 2007 a 2012. MÉTODOS: Analisamos retrospectivamente os resultados de 493 culturas de urina de pacientes com idade a partir de 14 anos e sintomas clínicos de cistite ou pielonefrite tratadas no Pronto-Socorro ou Ambulatório de Urologia do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo. As pacientes foram separadas em três grupos: 1- pacientes com cistite simples atendidas no Pronto-Socorro; 2- pacientes com cistite simples atendidas no Ambulatório; 3- pacientes com pielonefrite atendidas no Pronto-Socorro. As características demográficas como idade, presença de ITU de repetição, diabetes mellitus (DM) e outras comorbidades, e os resultados de flora bacteriana e padrão de sensibilidade foram analisados e comparados entre os grupos. RESULTADOS: A média de idade das pacientes nos três grupos foi 43,2, 55,0 e 36,0 anos, respectivamente. ITU de repetição esteve presente em 36,0%, 76,1% e 26,5% das pacientes dos grupos 1, 2 e 3, respectivamente, enquanto que 8,5%, 22,7% e 2,2% das pacientes nos grupos 1, 2 e 3, respectivamente, eram diabéticas. Escherichia coli (E. coli) foi a bactéria responsável por 75,1% das infecções no geral e 87,3% das pielonefrites. Staphylococcus saprophyticus foi o segundo agente etiológico mais frequente (6,7%), principalmente no grupo 1 (10,0%), enquanto que nas diabéticas, Enterococcus faecalis foi o segundo agente etiológico (15,6%). Ao avaliarmos todas as pacientes, o antibiograma demonstrou sensibilidade à amoxacilina/ácido clavulânico (AAC), ampicilina, ciprofloxacina, levofloxacina, nitrofurantoína, norfloxacina e sulfametoxazol/trimetoprima (SMT) de 85,8%, 46,5%, 82,0%, 83,3%, 88,3%, 83,3% e 65,7%, respectivamente. Nas pielonefrites, a sensibilidade geral à cefalotina, cefepime, ceftriaxone, ciprofloxacina e gentamicina foi de 67,0%, 95,5%, 94,3%, 81,8% e 98,0%, respectivamente. Ao analisarmos apenas as infecções por E. coli, os antibióticos orais com sensibilidade > 90% foram AAC (96,5%) e nitrofurantoína (98,8%). No geral, ao compararmos pacientes sem e com ITU de repetição, os antibióticos amicacina, gentamicina e nitrofurantoína foram os únicos que não apresentaram diminuição significativa de sensibilidade. Nas infecções de repetição por E. coli, os únicos antibióticos orais que mantiveram sensibilidade > 90% foram AAC e nitrofurantoína. Ao compararmos ITU por E. coli nas pacientes = 50 anos, os antimicrobianos orais que mantiveram sensibilidade > 90% em ambas faixas etárias foram AAC e nitrofurantoína. Nas pacientes diabéticas, houve diminuição estatística da sensibilidade ao ácido nalidíxico (80,5% x 61,5%), ciprofloxacina (84,8% x 65,1%), gentamicina (97,4% x 81,0%), levofloxacina (85,4% x 66,7%) e SMT (66,0% x 50%), respectivamente. As infecções por E. coli nas pacientes diabéticas também apresentaram diminuição estatística aos mesmos antibióticos; AAC e nitrofurantoína mantiveram sensibilidade > 95% nesta situação. Análise de regressão logística identificou aumento de chance de resistência ao ácido nalidíxico, ciprofloxacina e levofloxacina de 3,62, 4,72 e 5,27, respectivamente, quando há ITU de repetição, e à gentamicina de 5,38 quando há DM. CONCLUSÕES: Pielonefrites foram mais comuns em mulheres jovens em relação às cistites. E. coli foi o principal agente causador das infecções urinárias não complicadas, principalmente em pielonefrites. A nitrofurantoína manteve sensibilidade in vitro acima de 90% em diversas situações como no tratamento geral das cistites por E. coli, em casos de cistite de repetição, em mulheres > 50 anos e em diabéticas. AAC mostrou sensibilidade in vitro acima de 90% em algumas situações: ITU de repetição por E. coli, mulheres com idade >= 50 anos e diabéticas. A ceftriaxone apresentou sensibilidade in vitro suficiente para o tratamento empírico de pielonefrite. O histórico de infecção urinária de repetição aumentou a chance de resistência ao ácido nalidíxico, ciprofloxacina e levofloxacina e DM aumentou a chance de resistência à gentamicina. / INTRODUCTION: Uncomplicated urinary tract infections (UTIs) in women are common. Urinary tract infections are usually divided into cystitis or pyelonephritis, according to anatomical level. Although treatment of UTI is simple, it depends on knowledge of the local uropathogens and antimicrobial susceptibility patterns due to increasing antimicrobial resistance. This study analyzed the causative pathogens of UTIs in women and their susceptibility patterns between 2007 and 2012. METHODS: We conducted a retrospective analysis of 493 urine culture results of female patients aged 14 years and older with clinical diagnosis of cystitis or pyelonephritis who were treated at the urological emergency unit or urological outpatient clinic. Patients were divided into three groups: 1- simple cystitis attended to in the emergency unit; 2- simple cystitis attended to in the urological outpatient clinic; 3- pyelonephritis attended to in the emergency unit. Results of demographic data, such as age, history of recurrent UTI, diabetes mellitus (DM) and comorbidities, and those of the causative pathogens and their susceptibility patterns were analyzed and compared. RESULTS: The mean age for groups 1, 2 and 3 was 43.2, 55.0 and 36.0 years, respectively. Recurrent UTI was present in 36.0%, 76.1% and 26.5% of patients in groups 1, 2 and 3, respectively. DM was present in 8.5%, 22.7% and 2.2% of patients in group 1, 2 and 3, respectively. Escherichia coli (E. coli) was responsible for 75.1% of all UTIs and 87.3% of pyelonephritis. Staphylococcus saprophyticus was the second most common agent (6.7%), mainly in group 1 (10.0%), while Enterococcus faecalis was the second most common agent in diabetic patients (15.6%). General susceptibility rates to amoxicillin/clavulanate (A/C), ampicillin, ciprofloxacin, levofloxacin, nitrofurantoin, norfloxacin and sulfamethoxazole/trimethoprim (SMT) were 85.8%, 46.5%, 82.0%, 83.3%, 88.3%, 83.3% and 65.7%, respectively. For pyelonephritis, the general susceptibility rates to cephalothin, cefepime, ceftriaxone, ciprofloxacin and gentamicin were 67.0%, 95.5%, 94.3%, 81.8% and 98.0%, respectively. Analysis of the E.coli isolates showed that more than 90% of the strains were susceptible to A/C (96.5%) and nitrofurantoin (98.8%). There was a decrease in the susceptibility rates to all antimicrobials in patients with recurrent UTI, except for amikacin, gentamicin and nitrofurantoin. In cases of recurrent UTI by E. coli, susceptibility rates for oral nitrofurantoin and A/C were above 90%. In a comparison of patients below 50 years and those aged 50 and older diagnosed with E. coli UTI, only A/C and nitrofurantoin maintained susceptibility rates above 95% for all ages. Comparison between diabetic and non-diabetic patients showed a significant decrease in susceptibility rates for ciprofloxacin (84.8% x 65.1%), gentamicin (97.4% x 81.0%), levofloxacin (85.4% x 66.7%), nalidixic acid (80.5% x 61.5%) and SMT (66.0% x 50%), respectively. A similar susceptibility rate of E. coli was found in diabetic patients; however, A/C and nitrofurantoin maintained susceptibility rates above 95% in this situation. A multivariate analysis identified an increased odds of resistance to ciprofloxacin, levofloxacin and nalidixic acid (OR=4.72, 5.27 and 3.62, respectively) in the presence of recurrent UTI, while there was an increased probability for resistance to gentamicin (OR=5.38) in the presence of DM. CONCLUSIONS: Pyelonephritis was more common in young women than cystitis. E. coli was the main agent for uncomplicated UTI, particularly for pyelonephritis. Nitrofurantoin maintained in vitro susceptibility rates above 90% in many situations, such as E. coli infections, recurrent infections, women older than 50 years and diabetic patients. A/C maintained susceptibility rates above 90 % in some situations, such as recurring UTI caused by E. coli, women aged 50 years or older and diabetic patients. Ceftriaxone had a sufficient in vitro susceptibility profile to be indicated for empirical treatment of pyelonephritis. Recurrent UTI increased the odds of resistance to ciprofloxacin, levofloxacin and nalidixic acid, while DM increased the chance of resistance to gentamicin