Isolation of blaNDM-producing Enterobacteriaceae in a public hospital in Salvador, Bahia, Brazil

ABSTRACT Carbapenemases have great importance in the global epidemiological scenario since infections with carbapenemase-producing bacteria are associated with high mortality, especially in hospitalized patients in intensive care units. This study describes two microorganisms producers of the New Delhi Metallo-b-lactamase, Klebsiella pneumoniae and Citrobacter freundii, from two patients admitted to a public hospital in Salvador, Bahia. These are the first clinical cases of New Delhi Metallo-b-lactamase described in microorganisms in the north and northeast Brazil. The isolates were characterized by antimicrobial susceptibility test, with resistance to all β-lactams including carbapenems, negative Modified Hodge Test and the synergy test with Ethylenediaminetetraacetic acid, Phenylboronic Acid and Cloxacillin was positive only with Ethylenediaminetetraacetic acid (difference of >5 mm in the inhibition zone between the disk without and with the inhibitor). Analysis by multiplex PCR for blaIMP, blaVIM, blaNDM, blaKPC and blaOXA-48 enzymes confirmed the presence of blaNDM gene. This report of two different New Delhi Metallo-b-lactamase-producing microorganisms in a different region of Brazil confirms the risk of spreading resistance genes between different species and emphasizes the need for prevention and control of infections caused by these pathogens, which have limited treatment options and have been linked to high mortality rates.

Direct identification from positive blood broth culture by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS)

ABSTRACT Bloodstream infections (BSIs) are among the most concerning bacterial infections. They are one of the leading causes of morbidity and mortality, and occur in 30-70% of critical care patients. The prompt identification of the causative microorganism can help choosing the appropriate antimicrobial therapy that will lead to better clinical outcomes. Blood culture is one of the most relevant tests for microbiological diagnosis of bacterial infections. The introduction of the MALDI-TOF microbiological diagnosis significantly decreased the time of identifying microorganisms. However, it depends on the growth on solid culture medium. In this study, 538 bottles of positive blood cultures were evaluated to test the accuracy of an in house modified protocol. The study sample consisted of 198 Gram-negative and 350 Gram-positive bacteria. In all, 460 (83.94%) species were identified based on the direct plate findings. The protocol allowed the identification of 185/198 (93.43%) of the Gram-negative bacteria, including aerobes, anaerobes, and non-fermenters, and 275/350 (78.85%) of the Gram-positive bacteria. The proposed method has the potential to provide accurate results in comparison to the traditional method with the potential to reduce the turnaround time for the results and optimize antimicrobial therapy in BSI.

Avaliação da prevalência de resistência transmitida aos antirretrovirais em indivíduos infectados pelo HIV-1 em Salvador- Bahia / Prevalence of transmitted resistance to antiretroviraldrugs in patients infected with HIV-1 in Salvador, Bahia. Luiz Carl

Avaliar a prevalência de resistência transmitida aos antirretrovirais em indivíduos infectados pelo HIV-1 em acompanhamento clínico e laboratorial na cidade de Salvador-Bahia. Estudo descritivo de corte transversal com amostragem de conveniência composto por 121 pacientes infectados pelo HIV-1, com 18 anos de idade ou mais, virgens de tratamento antirretrovial e que fazem coletas de exame para quantificação das Subpopulações Linfocitárias e da carga viral sérica do HIV-1 no Laboratório de Retrovírus do Hospital Universitário Professor Edgard Santos ou no Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP). Os pacientes foram entrevistados para preenchimento de um questionário epidémiologico e consentiram na utilização do excedente de sangue para realização do sequenciamento do gene pol do HIV-1 contendo parte da Transcriptase e da Protease para análise das mutações de resistência aos antirretrovirais e a caracterização genotípica, análise de recombinações e estudo da história evolutiva viral. Entre os 103 pacientes 66% são do sexo masculino, a mediana de idade e do tempo estimado do diagnóstico do HIV-1 são respectivamente de 35 anos e 29 meses. A principal categoria de exposição relatada foi a sexual com 88,3%, seguida por 3% com acidentes com perfurocortantes e 1% uso de drogas intravenosas. A mediana da contagem dos Linfócitos TCD4+ foi de 438 cel/mm3 e de 4,4 log10. Na análise de Mutação de Resistência à Fármacos (DRM) atráves da ferramenta de Calibração da População com Resistência (CPR) observamos uma prevalência global de 6,8%, 3 (2,9%)...

To evaluate the prevalence of transmitted resistance to antiretroviral drugs in patients infected with HIV- 1 assisted in the city of Salvador, Bahia. A descriptive crosssectional study with 121 patients with 18 years of age or older, chronic or recent diagnosis of HIV -1, antirretrovial naïve and make collections for examination and quantification of lymphocyte subpopulations serum viral load of HIV -1 in the Retrovirus Laboratory, Hospital Universitário Professor Edgard Santos or in Centro Especializado em Diagnóstico, Assistência e Pesquisa (CEDAP). Patients were interviewed to fill an epidemiological questionnaire and consented to the use of drawed blood to be sequenced of the transcriptase and protease region of the pol gene of HIV - 1 for analysis of antiretroviral resistance mutations and subtype viral. Of the 121 patients, 104 sequences for phylogenetic analysis and transmitted resistance were obtained, 18 individuals were excluded due quality or amplification problems. Among 103 patients 66% were male, the median age and the estimated time of diagnosis of HIV -1 were respectively 35 and 29 months. The main category of reported exposure was sexual with 88.3%, followed by 3% with Occupational Exposure and 1% use of Intravenous Drugs. The median CD4 + lymphocyte count was 438 cells/mm3 and 4.4 log10. The analysis of Drug Resistance Mutation (DRM) by Calibrating Population Resistance tool (CPR) has a global prevalence of 6.8%, distributed: 2.9%...

Acute HIV infection with rapid progression to AIDS

Acute HIV infection is rarely recognized as the signs and symptoms are normally unspecific and can persist for days or weeks. The normal HIV course is characterized by a progressive loss of CD4+ cells, which normally leads to severe immunodeficiency after a variable time interval. The mean time from initial infection to development of clinical AIDS is approximately 8-10 years, but it is variable among individuals and depends on a complex interaction between virus and host. Here we describe an extraordinary case of a man who developed Pneumocisits jiroveci pneumonia within one month after sexual exposure to HIV-1, and then presented with 3 consecutive CD4 counts bellow 200 cells/mm³ within 3 months, with no other opportunistic disease. Although antiretroviral therapy (AZT+3TC+ATZ/r) was started, with full adherence of the patient, and genotyping indicating no primary antiretroviral resistance mutations, he required more than six months to have a CD4 restoration to levels above 200 cells/mm³ and 10 months to HIV-RNA to become undetectable.