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1.
Rev. Soc. Bras. Med. Trop ; 54: e20200087, 2021. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136920

ABSTRACT

Abstract INTRODUCTION: In this study, we report a clonal dissemination of carbapenem resistant Acinetobacter baumannii isolates due to the acquisition of blaOXA-23 in a regional hospital located in Brazilian Amazon Region. METHODS: The isolates were identified by MALDI-TOF and the carbapenemase-encoding genes were detected by multiplex-PCR. The genetic similarity was investigated by pulsed-field gel electrophoresis (PFGE). RESULTS: Only 10 (55.6%) isolates harbored the gene bla OXA-23. PFGE analysis revealed that these isolates belong to a single clone. CONCLUSIONS: This dissemination strategy indicates the need for surveillance, adoption of control procedures defined in guidelines, and the careful administration of antimicrobials should be reinforced.


Subject(s)
Humans , Acinetobacter Infections/epidemiology , Acinetobacter baumannii/genetics , Bacterial Proteins/genetics , beta-Lactamases/genetics , Brazil/epidemiology , Drug Resistance , Microbial Sensitivity Tests , Electrophoresis, Gel, Pulsed-Field , Molecular Epidemiology , Hospitals , Anti-Bacterial Agents/pharmacology
2.
Braz. j. infect. dis ; 24(4): 310-321, Jul.-Aug. 2020. tab, graf
Article in English | LILACS-Express | LILACS, ColecionaSUS | ID: biblio-1132471

ABSTRACT

Abstract Multi-drug resistant Gram-negative bacilli (GNB) have been reported as cause of serious hospital-acquired infections worldwide. The aim of this study was to investigate the in vitro activity of ceftolozane-tazobactam compared to other agents against GNB isolated from patients admitted to Brazilian medical centers between the years 2016 and 2017. Presence of β-lactamase encoding genes was also evaluated. Methods Antimicrobial susceptibility testing of GNB isolated from intra-abdominal (IAI), respiratory (RTI), and urinary tract infections (UTI) was performed according to ISO 227-1 guidelines and interpreted following CLSI and BrCAST/EUCAST guidelines. Qualifying Enterobacteriaceae isolates were screened for the presence of β-lactamase genes by PCR followed by DNA sequencing. Results 1748 GNB collected from UTI (45.2%), IAI (25.7%) and RTI (29.1%) were evaluated. Ceftolozane-tazobactam remained highly active (94.7%) against E. coli isolates. Among K. pneumoniae, susceptibility rates were 85.9% and 85.4% for amikacin and colistin, whereas ceftolozane-tazobactam (44.1% susceptible) and carbapenems (55.2-62.2% susceptible) showed poor activity due to bla KPC-2. Against E. cloacae amikacin, imipenem, and meropenem retained good activity (>90%). Ceftolozane-tazobactam was the most potent β-lactam agent tested against P. aeruginosa (90.9% susceptible), including ceftazidime and imipenem resistant isolates. β-lactamase encoding genes testing was carried out in 433 isolates. bla CTX-M variants were predominant in E. coli, P. mirabilis and E. cloacae. Among the K. pneumoniae molecularly tested, most carried bla KPC (68.5%), with all harboring bla KPC-2, except two isolates carrying bla KPC-3 or bla KPC-30. ESBL encoding genes, mainly CTX-M family, were frequently detected in K. pneumoniae, plasmid-mediated AmpC were rare. A variety of PDC encoding genes were detected in P. aeruginosa isolates with five isolates harboring MBL and one KPC encoding genes. Conclusion Ceftolozane-tazobactam was very active against E. coli, P. mirabilis and P. aeruginosa isolates and could constitute an excellent therapeutic option including for those isolates resistant to extended-spectrum cephalosporins and carbapenems but not producers of carbapenemases.

3.
Mem. Inst. Oswaldo Cruz ; 114: e190079, 2019. graf
Article in English | LILACS | ID: biblio-1040613

ABSTRACT

A total of 124 Neisseria gonorrhoeae isolates recovered during a 12-year period (2003-2015) from outpatients assisted at Centro de Referência e Treinamento DST/AIDS-CRT of São Paulo city, Brazil, were analysed. The following resistance rates were observed: penicillin-59.6%, ciprofloxacin-15.3%, and azithromycin-6.7%. Although reduced susceptibility to these drugs was observed since 2003, no ceftriaxone-resistant isolates were detected. Ciprofloxacin- and azithromycin non-susceptible isolates were grouped in 11 clusters. Mutations were detected in GyrA and ParC of isolates 124 and 260, and a C2611T substitution on 23S rRNA alleles was also observed in isolate 260. Both isolates belonged to ST1901/ST6210 (MSLT/NG-MAST schemes).


Subject(s)
Humans , Drug Resistance, Multiple, Bacterial/genetics , Anti-Bacterial Agents/pharmacology , Neisseria gonorrhoeae/drug effects , Neisseria gonorrhoeae/genetics , Time Factors , Urban Population , Microbial Sensitivity Tests , Drug Resistance, Multiple, Bacterial/drug effects , Mutation
4.
Braz. j. microbiol ; 48(3): 493-498, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-889153

ABSTRACT

Abstract Carbapenems are considered last-line agents for the treatment of serious infections caused by Klebsiella pneumoniae, and this microorganism may exhibit resistance to β-lactam antibiotics due to different mechanisms of resistance. We evaluated 27 isolates of K. pneumoniae resistant to carbapenems recovered from inpatients at the University Hospital of Santa Maria-RS from July 2013 to August 2014. We carried out antimicrobial susceptibility, carbapenemase detection, testing for the presence of efflux pump by broth microdilution and loss of porin by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Genetic similarity was evaluated by ERIC-PCR. High levels of resistance were verified by the minimum inhibitory concentration for the antimicrobials tested. The blaKPC gene was present in 89% of the clinical isolates. Blue-Carba and combined disk with AFB tests showed 100% concordance, while the combined disk test with EDTA showed a high number of false-positives (48%) compared with the gold-standard genotypic test. Four isolates showed a phenotypic resistance profile consistent with the overexpression of the efflux pump, and all clinical isolates had lost one or both porins. The ERIC-PCR dendrogram demonstrated the presence of nine clusters. The main mechanism of resistance to carbapenems found in the assessed isolates was the presence of the blaKPC gene.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Drug Resistance, Bacterial , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/metabolism , Microbial Sensitivity Tests
5.
Braz. j. infect. dis ; 21(1): 57-62, Jan.-Feb. 2017. tab, graf
Article in English | LILACS | ID: biblio-839184

ABSTRACT

Abstract The mechanisms involved in the uncommon resistance phenotype, carbapenem resistance and broad-spectrum cephalosporin susceptibility, were investigated in 25 Pseudomonas aeruginosa clinical isolates that exhibited this phenotype, which were recovered from three different hospitals located in São Paulo, Brazil. The antimicrobial susceptibility profile was determined by CLSI broth microdilution. β-lactamase-encoding genes were investigated by PCR followed by DNA sequencing. Carbapenem hydrolysis activity was investigated by spectrophotometer and MALDI-TOF assays. The mRNA transcription level of oprD was assessed by qRT-PCR and the outer membrane proteins profile was evaluated by SDS-PAGE. Genetic relationship among P. aeruginosa isolates was assessed by PFGE. Carbapenems hydrolysis was not detected by carbapenemase assay in the carbapenem-resistant and cephalosporin-susceptible P. aueruginosa clinical isolates. OprD decreased expression was observed in all P. aeruginosa isolates by qRT-PCR. The outer membrane protein profile by SDS-PAGE suggested a change in the expression of the 46 kDa porin that could correspond to OprD porin. The isolates were clustered into 17 genotypes without predominance of a specific PFGE pattern. These results emphasize the involvement of multiple chromosomal mechanisms in carbapenem-resistance among clinical isolates of P. aeruginosa, alert for adaptation of P. aeruginosa clinical isolates under antimicrobial selective pressure and make aware of the emergence of an uncommon phenotype among P. aeruginosa clinical isolates.


Subject(s)
Humans , Pseudomonas aeruginosa/drug effects , Carbapenems/pharmacology , Cephalosporins/pharmacology , beta-Lactam Resistance/genetics , Anti-Bacterial Agents/pharmacology , Phenotype , Pseudomonas aeruginosa/enzymology , Pseudomonas aeruginosa/genetics , Spectrophotometry, Ultraviolet , Bacterial Outer Membrane Proteins , Bacterial Proteins/metabolism , beta-Lactamases/metabolism , Brazil , DNA, Bacterial , Microbial Sensitivity Tests , Electrophoresis, Gel, Pulsed-Field , Sequence Analysis, DNA , Porins/metabolism , Reverse Transcriptase Polymerase Chain Reaction
6.
Rev. Soc. Bras. Med. Trop ; 50(1): 135-137, Jan.-Feb. 2017.
Article in English | LILACS | ID: biblio-842816

ABSTRACT

Abstract: Metallo-beta-lactamase production is an important mechanism for carbapenem resistance of Pseudomonas aeruginosa , which represents an emerging public health challenge. We report the case of a patient admitted to an intensive care unit, with sepsis caused by multidrug-resistant São Paulo Metallo-beta-lactamase-1-producing P. aeruginosa . This is the first case of infection by this pathogenic strain in the State of Mato Grosso do Sul, Brazil. Thus, infection control measures are required for preventing future spread and outbreaks.


Subject(s)
Humans , Male , Pseudomonas aeruginosa/enzymology , Pseudomonas Infections/microbiology , beta-Lactamases/biosynthesis , Cross Infection/microbiology , beta-Lactam Resistance , Pseudomonas aeruginosa/isolation & purification , Brazil , Fatal Outcome , Middle Aged
7.
Braz. j. microbiol ; 47(supl.1): 31-37, Oct.-Dec. 2016. tab
Article in English | LILACS | ID: biblio-839327

ABSTRACT

ABSTRACT During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.


Subject(s)
Humans , Drug Resistance, Bacterial , Enterobacteriaceae/drug effects , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae Infections/epidemiology , Anti-Infective Agents/pharmacology , Plasmids/genetics , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , beta-Lactamases/genetics , beta-Lactamases/metabolism , Brazil/epidemiology , Polymyxins/therapeutic use , Polymyxins/pharmacology , beta-Lactams/therapeutic use , beta-Lactams/pharmacology , Enterobacteriaceae/enzymology , Enterobacteriaceae/genetics , Anti-Infective Agents/therapeutic use , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
8.
Braz. j. microbiol ; 46(2): 501-504, Apr-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-749737

ABSTRACT

The emergence of β-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the blaKPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , beta-Lactamases , Brazil , DNA, Bacterial/genetics , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests , Polymerase Chain Reaction , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Tertiary Care Centers , beta-Lactamases/genetics
10.
Braz. j. infect. dis ; 18(6): 678-680, Nov-Dec/2014.
Article in English | LILACS | ID: lil-730427

ABSTRACT

Nosocomial infections caused by carbapenem-resistant Acinetobacter baumannii isolates have reached epidemic levels in past decades. Currently this microorganism is responsible for outbreaks of difficult eradication and with high mortality rates worldwide. We herein report a rare case of an OXA-72-producing A. baumannii isolate colonizing a 47-year-old male patient with peritonitis due to abdominal stab wound, four years earlier than the first report of this carbapenemase in Acinetobacter pittii in Colombia. Although OXA-72 presents a low prevalence compared with OXA-23, our study demonstrated that A. baumannii isolates carrying the blaOXA-72 gene were present in the hospital environment in Colombia and could act as a reservoir for further spread to other Acinetobacter species, like A. pittii, causing carbapenem-resistance.


Subject(s)
Humans , Male , Middle Aged , Acinetobacter Infections/microbiology , Acinetobacter baumannii/isolation & purification , Bacterial Proteins/biosynthesis , beta-Lactamases/biosynthesis , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/enzymology , Colombia , Microbial Sensitivity Tests , Molecular Typing
11.
Braz. j. microbiol ; 45(4): 1439-1448, Oct.-Dec. 2014. graf, tab
Article in English | LILACS | ID: lil-741298

ABSTRACT

Antimicrobial susceptibility testing for Helicobacter pylori is increasingly important due to resistance to the most used antimicrobials agents. Only agar dilution method is approved by CLSI, but it is difficult to perform routinely. We evaluated the reliability of E-test and disk diffusion comparing to agar dilution method on Helicobacter pylori antimicrobial susceptibility testing. Susceptibility testing was performed for amoxicillin, clarithromycin, furazolidone, metronidazole and tetracycline using E-test, disk-diffusion and agar dilution method in 77 consecutive Helicobacter pylori strains from dyspeptic children and adolescents. Resistance rates were: amoxicillin - 10.4%, 9% and 68.8%; clarithromycin - 19.5%, 20.8%, 36.3%; metronidazole - 40.2%33.7%, 38.9%, respectively by agar dilution, E-test and disk diffusion method. Furazolidone and tetracycline showed no resistance rates. Metronidazole presented strong correlation to E-test (r = 0.7992, p < 0.0001) and disk diffusion method (r=-0.6962, p < 0.0001). Clarithromycin presented moderate correlation to E-test (r = 0.6369, p < 0.0001) and disk diffusion method (r=-0.5656, p < 0.0001). Amoxicillin presented weak correlation to E-test (r = 0.3565, p = 0.0015) and disk diffusion (r=-0.3565, p = 0.0015). Tetracycline presented weak correlation with E-test (r = 0.2346, p = 0.04) and furazolidone to disk diffusion (r=-0.0288, p = 0.8038). E-test presented better agreement with gold standard. It is an easy and reliable method for Helicobacter pylori susceptibility testing. Disk diffusion method presented high disagreement and high rates of major errors.


Subject(s)
Adolescent , Child , Humans , Anti-Bacterial Agents/pharmacology , Helicobacter pylori/drug effects , Microbial Sensitivity Tests/methods , Brazil , Drug Resistance, Bacterial , Helicobacter Infections/microbiology , Helicobacter pylori/isolation & purification
12.
J. bras. patol. med. lab ; 49(3): 191-197, June 2013. ilus
Article in English | LILACS | ID: lil-684555

ABSTRACT

Rapid identification of microorganisms by the clinical microbiology laboratory is of crucial importance for optimal patients’ management and treatment. In general, bacterial identification by conventional methods requires 18-24 hours for colony isolation and at least 24 additional hours for species identification. New technologies in microbiology have focused on the rapid diagnosis of bloodstream infections, since they are associated with high morbidity and mortality rates.


A rápida identificação de microrganismos no laboratório de microbiologia clínica é de extrema importância para direcionar o manejo e o tratamento de pacientes. Geralmente, a identificação bacteriana por métodos bioquímicos convencionais necessita de 18 a 24 horas para o crescimento e o isolamento da colônia bacteriana e, pelo menos, 24 horas adicionais para a identificação da espécie. Novas tecnologias em microbiologia têm focado no desenvolvimento de métodos relacionados com o diagnóstico rápido das infecções da corrente sanguínea, uma vez que essas infecções são associadas à alta morbimortalidade.


Subject(s)
Clinical Diagnosis , Diagnostic Techniques and Procedures , Bacterial Infections/diagnosis , Bacterial Infections/microbiology , Mass Spectrometry , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
13.
Mem. Inst. Oswaldo Cruz ; 107(6): 747-751, set. 2012. ilus, tab
Article in English | LILACS | ID: lil-649489

ABSTRACT

The aim of this study was to characterize two metallo-β-lactamases (MBLs)-producing Pseudomonas aeruginosa clinical isolates showing meropenem susceptibility. Antimicrobial susceptibility was assessed by automated testing and Clinical and Laboratory Standards Institute agar dilution method. MBL production was investigated by phenotypic tests. Molecular typing was determined by pulsed field gel electrophoresis (PFGE). MBL-encoding genes, as well as their genetic context, were identified by polymerase chain reaction (PCR) and sequencing. The location of blaIMP-16 was determined by plasmid electrophoresis, Southern blot and hybridization. Transcriptional levels of blaIMP-16, mexB, mexD, mexF, mexY, ampC and oprD were determined by semi-quantitative real time PCR. The P. aeruginosa isolates studied, Pa30 and Pa43, showed imipenem and meropenem susceptibility by automated testing. Agar dilution assays confirmed meropenem susceptibility whereas both isolates showed low level of imipenem resistance. Pa30 and Pa43 were phenotypically detected as MBL producers. PFGE revealed their clonal relatedness. blaIMP-16 was identified in both isolates, carried as a single cassette in a class 1 integron that was embedded in a plasmid of about 60-Kb. Pa30 and Pa43 overexpressed MexAB-OprM, MexCD-OprJ and MexXY-OprM efflux systems and showed basal transcriptional levels of ampC and oprD. MBL-producing P. aeruginosa that are not resistant to meropenem may represent a risk for therapeutic failure and act as silent reservoirs of MBL-encoding genes.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Imipenem/pharmacology , Pseudomonas aeruginosa/drug effects , Thienamycins/pharmacology , beta-Lactam Resistance/genetics , beta-Lactamases/biosynthesis , Bacterial Outer Membrane Proteins/metabolism , Electrophoresis, Gel, Pulsed-Field , Microbial Sensitivity Tests/methods , Polymerase Chain Reaction , Pseudomonas aeruginosa/enzymology
14.
Braz. j. infect. dis ; 15(6): 513-520, Nov.-Dec. 2011. tab
Article in English | LILACS | ID: lil-610520

ABSTRACT

In vitro activity of doripenem and comparator antimicrobial agents was evaluated against Gram-negative bacilli recently isolated from Brazilian private hospitals that were enrolled in the INVITA-A-DORI Brazilian Study. A total of 805 unique Gram-negative bacilli were collected from patients hospitalized at 18 medical centers between May/08 and March/09. Each hospital was asked to submit 50 single Gram-negative bacilli isolated from blood, lower respiratory tract or intraabdominal secretions. Bacterial identification was confirmed and antimicrobial susceptibility testing was performed using Clinical Laboratory Standards Institute (CLSI) microdilution method at a central laboratory. CLSI M100-S21 (2011) or US-FDA package insert criteria (tigecycline) was used for interpretation of the antimicrobial susceptibility results. Doripenem was as active as meropenem and more active than imipenem against E. coli and K. pneumoniae isolates. A total of 50.0 percent of Enterobacter spp. isolates were resistant to ceftazidime but 85.7 percent of them were inhibited at doripenem MICs < 1 µg/mL. Polymyxin B was the only agent to show potent activity against Acinetobacter spp. (MIC50/90, < 0.5/1 µg/mL) and P. aeruginosa (MIC50/90, 1/2 µg/mL). Although high rates of imipenem (53.1 percent) and meropenem (44.5 percent) resistance were detected among P. aeruginosa, doripenem showed MIC50 of 16 µg/mL against imipenem-resistant P. aeruginosa and inhibited a greater number of imipenem-resistant P. aeruginosa (10.5 percent) at MIC values of < 4 µg/mL than did meropenem (0.0 percent). In this study, doripenem showed similar in vitro activity to that of meropenem and retained some activity against imipenem-resistant P. aeruginosa isolated from Brazilian medical centers.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Gram-Negative Bacteria/drug effects , Brazil , Gram-Negative Bacteria/isolation & purification , Hospitals, Private , Imipenem/pharmacology , Microbial Sensitivity Tests/methods , Thienamycins/pharmacology
15.
Rev. Soc. Bras. Med. Trop ; 44(5): 604-606, Sept.-Oct. 2011. tab
Article in English | LILACS | ID: lil-602904

ABSTRACT

INTRODUCTION: Pseudomonas aeruginosa is a leading cause of ventilator-associated pneumonia (VAP) and exhibits high rates of resistance to several antimicrobial drugs. The carbapenens are usually the drugs of choice against this microorganism. However, the carbapenem resistance has increased among these strains worldwide. The presence of metallo-β-lactamases (MBL) has been pointed out as a major mechanism of resistance among these strains. No previous study addressed outcomes of respiratory infections caused by these strains. METHODS: Our group sought to analyze the epidemiology and clinical outcomes of patients with VAP caused by imipenem-resistant P. aeruginosa. A total of 29 clinical isolates of carbapenem-resistant Pseudomonas aeruginosa were screened for metallo-β-lactamase (MBL) genes. RESULTS: Demographic and clinical variables were similar between the SPM-1-producing and non-SPM-1-producing group. Five (17.2 percent) isolates were positive for blaSPM-1. No other MBL gene was found. All patients were treated with polymyxin B. The infection-related mortality was 40 percent and 54.2 percent for SPM-1-producing and -non-producing isolates, respectively. CONCLUSIONS: There were no differences in epidemiological and clinical outcomes between the two groups.


INTRODUÇÃO: Pseudomonas aeruginosa é uma importante causa de pneumonia associada à ventilação mecânica (PAV) e exibe altas taxas de resistência a vários antimicrobianos. Os carbapenens são usualmente as drogas de escolha para esse microorganismo. Contudo, a resistência a carbapenens tem crescido entre essas amostras em todo o mundo. A presença de metalo- β-lactamase (MBL) tem sido apontado como um importante mecanismo de resistência nessas cepas. Nenhum estudo prévio avaliou desfechos clínicos de infecções respiratórias causadas por essas amostras MÉTODOS: Nosso grupo analisou a epidemiologia e evolução clínica de episódios de PAV causada por P. aeruginosa resistente a imipenem. Um total de vinte e nove isolados clínicos de Pseudomonas aeruginosa resistente a carbapenem foram avaliados quanto à presença de genes para metalo-β-lactamase (MBL). RESULTADOS: Variáveis clínicas e demográficas foram similares entre o grupo produtor de SPM-1 e o não-produtor. Cinco (17,2 por cento) isolados foram positivos para blaSPM-1. Nenhum outro gene para MBL foi encontrado. Todos os pacientes foram tratados com polimixina B. A mortalidade relacionada à infecção foi de 40 por cento e 50 por cento respectivamente para os isolados produtores de SPM-1 e não-produtores de SPM-1. CONCLUSÕES: Nao houve diferença entre os dados epidemiológicos e a evolução clínica entre os dois grupos.


Subject(s)
Female , Humans , Male , Middle Aged , Pneumonia, Ventilator-Associated/microbiology , Pseudomonas Infections/microbiology , Pseudomonas aeruginosa/drug effects , beta-Lactam Resistance/genetics , beta-Lactamases/genetics , Anti-Bacterial Agents/pharmacology , Brazil/epidemiology , Imipenem/pharmacology , Prevalence , Pneumonia, Ventilator-Associated/epidemiology , Pseudomonas Infections/epidemiology , Pseudomonas aeruginosa/genetics , Pseudomonas aeruginosa/metabolism , beta-Lactamases/biosynthesis
16.
Braz. j. infect. dis ; 15(2): 167-169, Mar.-Apr. 2011. ilus, tab
Article in English | LILACS | ID: lil-582428

ABSTRACT

The objective of this study was to evaluate the susceptibility to cefepime of a large group of ESBL- producing enterobacteria recently isolated in a Brazilian teaching hospital . The study included 280 strains of ESBL-producing enterobacteria, isolated between 2005 and 2008. The presence of the genes blaCTX-M, blaTEM and blaSHV was determined by PCR and confirmed by nucleotide sequencing. Susceptibility testing for cefepime was performed by disc-diffusion, agar dilution method and E-test®. Among the isolates, 34 (12.1 percent) presented a cefepime inhibition zone > 21 and MIC < 8 mg/L by agar dilution and E-strip methods. The use of cefepime for the treatment of infections caused by ESBL-producing bacteria has been controversial. Some studies of PD/PK show the probability of achieving the required PD parameters for cefepime, when the MICs were < 8 mg/L, whereas others have reported therapeutic failure with the same MIC. Additional data is essential to come to terms about the report and treatment with cefepime in ESBL-producing organisms especially when these microorganisms are isolated from sterile sites and from critically ill patients.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Cephalosporins/pharmacology , Enterobacteriaceae/drug effects , beta-Lactamases/biosynthesis , Enterobacteriaceae/classification , Enterobacteriaceae/enzymology , Microbial Sensitivity Tests/methods
17.
J. bras. patol. med. lab ; 47(2): 157-164, abr. 2011. ilus, tab
Article in Portuguese | LILACS-Express | LILACS | ID: lil-588146

ABSTRACT

INTRODUÇÃO: As fitas Oxoid® M.I.C.Evaluator® (M.I.C.E., Thermo Fisher Scientific, Basingstoke, UK), recém-lançadas no mercado brasileiro, representam uma alternativa rápida para a realização de testes de sensibilidade a antimicrobianos (TSA). OBJETIVO: Avaliar o desempenho da metodologia M.I.C.E. em relação à microdiluição em caldo (teste de referência) e ao Etest® (BioMérieux, Marcy l'Étoile, France). Material e métodos: Foram selecionados 160 isolados bacterianos, sendo P. aeruginosa (20), Acinetobacter spp. (20), K. pneumoniae (20), E. coli (20), S. aureus (20), Staphylococcus coagulase-negativa (20), E. faecalis (20) e E. faecium (20). Os TSAs foram realizados por microdiluição em caldo, Etest e M.I.C.E., seguindo-se as recomendações do Clinical Laboratory Standards Institute (CLSI, 2009) e dos respectivos fabricantes. Os resultados foram interpretados segundo os critérios estabelecidos pelo CLSI e comparados por análise de regressão. RESULTADOS: Avaliando-se todas as combinações de antimicrobianos vs. a espécie bacteriana, o desempenho da metodologia M.I.C.E. foi muito bom, apresentando uma concordância geral (variação na concentração inibitória mínima [CIM] ± 1-log2) > 90 por cento, exceto para cefotaxima (85 por cento) e vancomicina (76,3 por cento), quando em comparação com os resultados da metodologia de referência. Quando comparado com o Etest, a metodologia M.I.C.E. apresentou concordância geral > 96 por cento, com exceção para a combinação amoxicilina/ácido clavulânico (67,5 por cento). CONCLUSÃO: Os resultados do TSA obtidos pela metodologia M.I.C.E. apresentaram boa correlação com aqueles obtidos pela microdiluição em caldo e pelo Etest, indicando que essa metodologia é uma alternativa rápida para a determinação da CIM pelos laboratórios de microbiologia clínica. Atenção especial deve ser dada á determinação da CIM para a combinação amoxicilina/ácido clavulânico.


INTRODUCTION: The Oxoid® M.I.C.EvaluatorTM methodology (M.I.C.E., Thermo Fisher Scientific, Basingstoke, UK), recently released into the market, represents a rapid alternative to antimicrobial susceptibility testing. OBJECTIVE: The objective of this study was to evaluate the performance of M.I.C.E. methodology in relation to broth microdilution (reference test) and Etest® (BioMérieux, Marcy l'Étoile, France). Material and method: A total of 160 bacterial isolates were collected comprising the following species: P. aeruginosa (20), Acinetobacter spp. (20), K. pneumoniae (20), E. coli (20), S. aureus (20), coagulase-negative Staphylococcus (20), E. faecalis (20) and E. faecium (20). Following Clinical Laboratory Standands Institute (CLSI) standards (2009) and the manufacturers' recommendations, antimicrobial susceptibility testing was performed using broth microdilution method, Etest and M.I.C.E. The results were interpreted according to the criteria established by CLSI and compared through regression analysis. RESULTS: All antimicrobial combinations vs. bacterial species were evaluated and M.I.C.E. methodology yielded good results with general correlation (MIC variation ± 1-log2) > 90 percent, except for cefotaxime (85 percent) and vancomycin (76.3 percent) when compared with the reference method. The M.I.C.E. results compared to Etest showed general correlation (> 96 percent), except for amoxicillin/clavulanic acid (67.5 percent) combination. CONCLUSION: AST results obtained from M.I.C.E. methodology showed a good correlation with those from broth microdilution and Etest, which corroborates its time effectiveness in the determination of MIC. However, the combination of amoxicillin/clavulanic acid requires further attention.

18.
Braz. j. infect. dis ; 15(1): 69-73, Jan.-Feb. 2011. tab
Article in English | LILACS | ID: lil-576789

ABSTRACT

In 2008 isolates of KPC-producing Klebsiella pneumoniae (KPC-KPN) were detected for the first time at Hospital Heliópolis, São Paulo, Brazil. The aim of this study was to characterize the clinical and microbiological outcomes of infections caused by KPC-KPN. A historical cohort of patients from whom KPC-KPN strains were isolated was performed. Isolates were identified as resistant to ertapenem by automated broth microdilution system and screened as carbapenemase producers by the modified Hodge test. The beta-lactamase resistance gene blaKPC was detected by PCR. The genetic relatedness of isolates was determined by PFGE. The study provides early clinical experience in treating KPC-KPN infections in a Brazilian tertiary center.


Subject(s)
Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/biosynthesis , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , beta-Lactamases/biosynthesis , Brazil , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/genetics , Microbial Sensitivity Tests
19.
Rev. odonto ciênc ; 26(4): 336-340, 2011. ilus, tab
Article in English | LILACS, BBO | ID: lil-625018

ABSTRACT

PURPOSE: The aim of this study was to verify the antimicrobial effect of calcium hydroxide and iodoform on Enterococcus faecalis with different exposure times evaluating the bacterial morphologic alterations. METHODS: The antibacterial action was investigated in culture broth after zero, seven, fourteen and twenty-one days. Five mL samples were analyzed morphologically on the seventh day by transmission electron microscopy. The data of the antibacterial test were analyzed by Fisher's exact test. RESULTS: The results revealed that between the seventh and fourteenth day, there was a decrease in bacterial growth with both medicaments (P=0.098), where they were eliminated between the fourteenth and twenty-first day. Transmission electronic microscopy showed alterations in the morphologic structures. CONCLUSION: It concluded that both medicaments kill Enterococcus faecalis, with an exposure time of 7 to 14 days, where no cell viability is seen after this period due to irreversible alterations in bacterial cell morphology.


OBJETIVO: O presente estudo verificou o efeito antibacteriano do hidróxido de cálcio e do iodofórmio em Enterococcus faecalis com diferentes tempos de exposição, avaliando as alterações morfológicas bacteriana. MÉTODOS: A ação antibacteriana foi investigada através de caldo de cultura após zero, sete, 14 e 21 dias, e assim, 5 mL das amostras do sétimo dia foram analisadas morfologicamente por microscopia eletrônica de transmissão. Os dados da ação antibacteriana em caldo foram analisados pelo teste Exato de Fisher. RESULTADOS: Os resultados revelaram que entre o 7º e o 14º dia houve diminuição do crescimento bacteriano com ambos os medicamentos (P=0,098), onde a eliminação bacteriana ocorreu entre o 14º e 21º dia. A microscopia eletrônica de transmissão apresentou alterações na estutura morfolófica bacteriana. CONCLUSÃO: Pode-se concluir que ambos os medicamentos destroem o Enterococcus faecalis com tempo de exposição de 7 a 14 dias, onde a viabilidade celular não é observada após este período devido alterações irreversíveis na morfologia celular bacteriana.


Subject(s)
Calcium Hydroxide , Enterococcus faecalis/virology , Iodoformium/therapeutic use
20.
Braz. j. infect. dis ; 14(5): 508-509, Sept.-Oct. 2010. ilus
Article in English | LILACS | ID: lil-570567

ABSTRACT

This study evaluated the clonal spread of carbapenem-resistant P. aeruginosa producing SPM-1 type metallo-β-lactamase (MBL), at the university hospital of Florianópolis, Santa Catarina, Brazil, compared to an epidemic clone previously reported, as well as strains collected in other three Brazilian states. Among the isolates, 17 (62 percent) were clonal and highly related to strains from other regions of Brazil. Six clonal strains harbored the blaSPM-1 gene. The finding of a unique SPM-1 producer clone suggests that its dissemination has contributed to the high resistance to carbapenems in Brazilian hospitals.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Pseudomonas aeruginosa/drug effects , beta-Lactam Resistance/genetics , beta-Lactamases/genetics , Brazil , Electrophoresis, Gel, Pulsed-Field , Microbial Sensitivity Tests , Pseudomonas aeruginosa/enzymology , Pseudomonas aeruginosa/genetics
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