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1.
Rev. cuba. med. trop ; 73(1): e590, tab
Article in Spanish | LILACS, CUMED | ID: biblio-1280329

ABSTRACT

Introducción: La tuberculosis persiste como un importante problema de salud mundial. En el 2016 se estimaron 600 000 casos de resistente a rifampicina, y entre estos 490 000 casos multidrogorresistentes. Objetivo: Describir el comportamiento de la resistencia de los aislados de M. tuberculosis de pacientes con tuberculosis pulmonar notificados en Cuba entre los años 2015-2017. Métodos: Se determinó la susceptibilidad a isoniacida y rifampicina mediante el método de la nitratasa. A los aislados resistentes a rifampicina/multidrogorresistentes se les determinó mediante el método proporcional la susceptibilidad a ofloxacina, kanamicina, amikacina y capreomicina. Resultados: El 93,2 por ciento de los aislados fueron sensibles a isoniacida y rifampicina. En 39 se identificó resistencia a isoniacida y 23 fueron resistente a rifampicina. Se identificaron 10 multidrogorresistentes. No se detectó resistencia a fármacos de segunda línea. Conclusiones: Los resultados alertan sobre la necesidad de investigar las causas que han conllevado al incremento de la tuberculosis resistente en Cuba(AU)


Introduction: Tuberculosis continues to be an important health problem worldwide. In the year 2016, as many as 600 000 cases of rifampicin resistance were estimated, among which 490 000 were multi-drug resistant. Objective: Describe the behavior of resistance to M. tuberculosis isolates in patients with pulmonary tuberculosis reported in Cuba in the period 2015-2017. Methods: Susceptibility to isoniazid and rifampicin was determined by the nitratase method. Susceptibility of rifampicin resistant / multi-drug resistant isolates to ofloxacin, kanamycin, amikacin and capreomycin was determined by the proportional method. Results: Of the isolates analyzed, 93.2 percent were sensitive to isoniazid and rifampicin. Isoniazid resistance was identified in 39 and 23 were rifampicin resistant. Ten multi-drug resistant isolates were identified. Resistance to second line drugs was not detected. Conclusions: Results warn about the need to study the factors leading to the increase in resistant tuberculosis in Cuba(AU)


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/prevention & control , Drug Resistance, Multiple, Bacterial/drug effects
2.
Rev. Soc. Bras. Med. Trop ; 54: e02622020, 2021.
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1143877

ABSTRACT

Abstract INTRODUCTION: Carbapenemase-resistant enterobacteria that produce the bla NDM gene are found worldwide. However, this is the first report of blaNDM in Klebsiella aerogenes in Brazil. METHODS: The identification of bacterial species was performed using anautomated system and confirmed by biochemical tests, 16S rRNA gene sequencing, and detection of resistance genes. RESULTS: The clinical isolate showed minimum inhibitory concentration resistance to meropenem and polymyxin B at 8mg/L and 4mg/L, respectively. Only the blaNDM gene was detected. CONCLUSIONS: The current report of the blaNDM gene in isolated MDR enterobacteria indicates that this gene can spread silently in a hospital setting.


Subject(s)
Enterobacter aerogenes/genetics , Bacterial Proteins , beta-Lactamases/genetics , Brazil , RNA, Ribosomal, 16S , Microbial Sensitivity Tests , Drug Resistance, Multiple, Bacterial/genetics , Enterobacteriaceae , Klebsiella pneumoniae/genetics , Anti-Bacterial Agents/pharmacology
3.
Rev. Soc. Bras. Med. Trop ; 54: e20190524, 2021. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136925

ABSTRACT

Abstract INTRODUCTION: The aac(6')-Ib-cr and bla KPC genes are spreading among Enterobacteriaceae species, including Providencia stuartii, in some countries of world. METHODS: These genes were investigated in 28 P. stuartii isolates from a public hospital in Recife, Pernambuco, Brazil, by PCR and sequencing. RESULTS: The aac(6')-Ib-cr gene was detected in 16 resistant isolates, and the bla KPC gene was seen in 14. CONCLUSIONS: The presence of these genes in P. stuartii multi- and extensively drug-resistant isolates indicates that the resistance arsenal of this species is increasing, thus limiting the therapeutic options.


Subject(s)
Humans , Enterobacteriaceae Infections , Plasmids , beta-Lactamases/genetics , Brazil , Microbial Sensitivity Tests , Providencia , Drug Resistance, Multiple, Bacterial , Anti-Bacterial Agents/pharmacology
4.
Malawi med. j. (Online) ; 33(2): 82-84, 2021.
Article in English | AIM | ID: biblio-1290527

ABSTRACT

Background Stenotrophomonas maltophilia is a significant opportunistic pathogen that is associated with high mortality in immunocompromised individuals. In this study, we describe a multidrug-resistant (MDR) S. maltophilia clinical isolate from Kamuzu Central Hospital (KCH), Lilongwe, Malawi. Methods: A ceftriaxone and meropenem nonsusceptible isolate (Sm-MW08), recovered in December 2017 at KCH, was referred to theNational Microbiology Reference Laboratory for identification. In April 2018, we identified the isolate using MALDI Biotyper mass spectrometry and determined its antimicrobial susceptibility profile using microdilution methods. Sm-MW08 was analysed by S1-PFGE, PCR, and Sanger sequencing, in order to ascertain the genotypes that were responsible for the isolate`s multidrug-resistance (MDR) phenotype. Results Sm-MW08 was identified as S. maltophilia and exhibited resistance to a range of antibiotics, including all ß-lactams, aminoglycosides (except arbekacin), chloramphenicol, minocycline, fosfomycin and fluoroquinolones, but remained susceptible to colistin and trimethoprim-sulfamethoxazole. The isolate did not harbour any plasmid but did carry chromosomally-encoded blaL1 metallo-ßlactamase and blaL2 ß-lactamase genes; this was consistent with the isolate's resistance profile. No other resistance determinants were detected, suggesting that the MDR phenotype exhibited by Sm-MW08 was innate. Conclusion : Herein, we have described an MDR S. maltophilia from KCH in Malawi, that was resistant to almost all locally available antibiotics. We therefore recommend the practice of effective infection prevention measures to curtail spread of this organism


Subject(s)
Stenotrophomonas maltophilia , Therapeutics , Ceftriaxone , Carbapenems , Drug Resistance, Multiple, Bacterial
5.
Pesqui. vet. bras ; 40(10): 804-813, Oct. 2020. tab, ilus
Article in English | ID: biblio-1143408

ABSTRACT

Bacterial resistance is shown to be an inevitable side effect due to the excessive use of antibiotics, becoming a significant concern worldwide. Knowledge of regional bacterial resistance profiles enables the development of site-specific infection control practices, making conscious and moderate use of commercially available antibiotics. The aim of this study was the retrospective evaluation of the antimicrobial resistance profile of bacteria isolated from companion animal infections in the region of Umuarama/PR, from 2013 to 2017. This research was performed by analyzing the database belonging to the "Laboratório de Microbiologia Animal" at the "Universidade Estadual de Maringá" (UEM). Staphylococcus spp. represented 45.53% of the bacteria isolated from clinical infections in small animals in the period and place evaluated, followed by enterobacteria (34.04%), non-fermenting Gram-negative bacilli (NFGNB, 11.06%) and Streptococcus/Enterococcus (9.36%). A high number of antimicrobial resistance to antibiotics used in veterinary medicine was found. The lowest resistances associated with the best impact factor values were found for aminoglycosides, especially amikacin, chloramphenicol, and fluoroquinolones (norfloxacin and ciprofloxacin). Intermediate results were found for sulbactam-associated ampicillin, ceftriaxone, amoxicillin-clavulanic acid, and enrofloxacin. According to the number of resistant antimicrobial drugs, 64.26% (151/235) of the isolates were classified as multidrug-resistant, being 15.32% extensively resistant. Considering the resistance to antimicrobial classes, 68.94% (162/235) of the isolates were classified as multiresistant, being 19.15% extensively resistant. No bacterial strains were characterized as pan-resistant, but ten bacteria were resistant to all classes tested, with isolated susceptibility to certain drugs. Through the evaluation of resistance profiles found in the period and place studied and relevant literature, it is clear that there is a growing increase in the number of multiresistant bacteria among domestic animals which characterizes a serious risk to public health. The therapeutic arsenal is becoming increasingly diminished, and there is more difficulty in empirical drug selection, making antimicrobial susceptibility testing essential for more specific selection in antimicrobial therapy. Educational measures on the conscious use of antibiotics, infection control, and prevention of local specific zoonoses need to be instituted for the knowledge of health professionals and general access of the population.(AU)


A resistência bacteriana, mostra-se como um efeito colateral inevitável pelo excessivo uso de antibióticos, tornando-se alvo de grande preocupação mundial. O conhecimento dos perfis de resistência bacteriana regionais possibilita o desenvolvimento de práticas de controle de infecções específicas para cada localidade, fazendo uso consciente e moderado dos antibióticos disponíveis no mercado. O objetivo deste estudo foi a avaliação retrospectiva do perfil de resistência antimicrobiana de bactérias isoladas de infecções de animais de companhia na região de Umuarama/PR, no período de 2013 a 2017. Esta pesquisa foi realizada por meio da análise do banco de dados pertencente ao Laboratório de Microbiologia Animal da Universidade Estadual de Maringá (UEM). Os Staphylococcus spp. representaram 45,53% das bactérias isoladas de infecções clínicas em pequenos animais no período e local avaliado, seguido por enterobactérias (34,04%), bacilos Gram-negativos não fermentados (BGNNF, 11,06%) e Streptococcus/Enterococcus (9,36%). Um número elevado de resistência antimicrobiana frente aos antibióticos utilizados na medicina veterinária foi encontrado. As menores resistências associadas aos melhores valores do fator de impacto foram encontrados para aminoglicosídeos, em especial amicacina, cloranfenicol, fluoroquinolonas (norfloxacina e ciprofloxacina). Já resultados intermediários foram encontrados para ampicilina associada a sulbactam, ceftriaxona, amoxacilina com ácido clavulônico e enrofloxacina. Conforme o número de drogas antimicrobianas resistentes, foram classificados como multirresistentes 64,26% (151/235) dos isolados, sendo 15.32% extensivamente resistentes. Já considerando a resistência a classes de antimicrobianos, 68,94% (162/235) dos isolados foram classificados como multirresistentes, sendo 19.15% extensivamente resistentes. Nenhum isolado bacteriano foi caracterizado como pan-resistente, porém 10 bactérias foram resistentes a todas as classes testadas, com susceptibilidade isolada a determinadas drogas. Por meio da avaliação dos perfis de resistência encontrados no período e local estudados e de literatura pertinente, percebe-se que há um aumento crescente no número de bactérias multirresistentes entre os animais domésticos o que caracteriza um grave risco à saúde pública. O arsenal terapêutico está se tornando cada vez mais diminuto e há mais dificuldade na seleção empírica de drogas, tornando essencial a realização de testes de susceptibilidade antimicrobiana para uma seleção mais específica na terapêutica antimicrobiana. Medidas educativas sobre o uso consciente dos antibióticos, controle de infecções e prevenção de zoonoses específicas para as localidades precisam ser instituídas para conhecimento dos profissionais do setor da saúde e acesso geral da população.(AU)


Subject(s)
Animals , Cats , Dogs , Staphylococcus/drug effects , Enterococcus/drug effects , Drug Resistance, Multiple, Bacterial , Enterobacteriaceae/drug effects
6.
Rev. chil. infectol ; 37(4): 395-401, ago. 2020. tab, graf
Article in Spanish | LILACS | ID: biblio-1138564

ABSTRACT

Resumen Introducción: La salmonelosis es una zoonosis universal, causante de frecuentes brotes de enfermedades transmitidas por alimentos; Salmonella enterica es la especie con la mayor prevalencia, describiéndose un aumento progresivo de su resistencia a antimicrobianos. Objetivo: Determinar la frecuencia de serotipos y los patrones de resistencia antimicrobiana en aislados de S. enterica remitidos al Instituto Nacional de Salud, Lima, Perú. Materiales y Métodos: Se realizó un estudio descriptivo, transversal. Se incluyeron en el estudio todas las cepas remitidas como parte de la vigilancia nacional basada en laboratorio entre los años 2012 y 2015. Las cepas fueron confirmadas mediante pruebas convencionales y serotipificadas por el esquema de Kauffmann-White; la susceptibilidad antimicrobiana y la confirmación del fenotipo BLEE se realizó según el método de Kirby-Bauer y método de Jarlier. Resultados: Un total de 540 cepas de S. enterica fueron incluidos en el estudio, de las que 96% (520/540) correspondió a cepas de origen humano y 4% (20/540) de origen no humano (aves, alimentos y ambiental). En muestras humanas, el serovar más frecuente fue S. Infantis (57%), seguido de S. Enteritidis (27%) y S. Typhimurium (6%). Se encontró una alta resistencia a nitrofurantoína (74%), ácido nalidíxico (64%), ciprofloxacina (63%), tetraciclina (63%), ampicilina (56%), cotrimoxazol (56%), cefotaxima (53%) y cloranfenicol (50%). En muestras no humanas, el serotipo más frecuente fue S. Infantis (45%), seguido de S. Typhimurium (40%) y S. Enteritidis (10%). encontrándose una alta resistencia a ciprofloxacina (45%), cotrimoxazol (40%), y tetraciclina (40%). El 65% del total de las cepas presentó resistencia a más de dos antimicrobianos, 43,3% fueron productoras de BLEE y 99% de éstas presentaron resistencia a entre seis y ocho antimicrobianos. Conclusiones: Se encontró una alta frecuencia de Salmonella Infantis productoras de BLEE, con multi-resistencia a los antimicrobianos en los aislados de muestras humanas y no humanas recibidas en el Instituto Nacional de Salud.


Abstract Background: Salmonellosis is a universal zoonosis, causing frequent outbreaks of foodborne illness; Salmonella enterica is the species with the highest prevalence, a progressive increase in its resistance to antimicrobials is described. Aim: To determine the frequency of serovars and antimicrobial resistance patterns in S. enterica isolates submitted to the National Institute of Health, Lima, Peru. Methods: This is a cross-sectional study. All strains referred as part of national laboratory-based surveillance between 2012 and 2015 were included in the study. Strains were confirmed by conventional tests and serotyped by the Kauffmann-White scheme; antimicrobial susceptibility and confirmation of the BLEE phenotype was performed according to the method of Kirby-Bauer and Jarlier's method. Results: A total of 540 strains of S. enterica were included in the study, where 96% (520/540) corresponded to human strains and 4% (20/540) to non-human strains (birds, food and environmental). In human samples, the most frequent serovar was S. Infantis (57%), followed by S. Enteritidis (27%) and S. Typhimurium (6%). High resistance to nitrofurantoin (74%), nalidixic acid (64%), ciprofloxacin (63%), tetracycline (63%), ampicillin (56%), sulfamethoxazole-trimethoprim (56%), cefotaxime (53%) and chloramphenicol (50%) was detected. In non-human samples, the most frequent serotype was S. Infantis (45%), followed by S. Typhimurium (40%) and S. Enteritidis (10%); a high resistance to nalidixic acid (55%), ciprofloxacin (45%), sulfamethoxazole-trimethoprim (40%), nitrofurantoin (40%), tetracycline (40%) was found. 65% of all strains had resistance to more than two antibiotics, 43,3% were ESBL producers and 99% of these had resistance between six and eight antibiotics. Conclusions: We found a high frequency of S. Infantis producing ESBL with multi-resistance to the antimicrobials in human and nonhuman samples received by the National Institute of Health.


Subject(s)
Salmonella enterica/drug effects , Peru/epidemiology , Microbial Sensitivity Tests , Cross-Sectional Studies , Drug Resistance, Multiple, Bacterial/drug effects , Serogroup , Anti-Bacterial Agents/pharmacology
7.
Arq. bras. med. vet. zootec. (Online) ; 72(3): 931-935, May-June, 2020. tab, graf
Article in English | ID: biblio-1129612

ABSTRACT

Bacterial resistance is a reality in both human and veterinary health, it limits the therapeutic arsenal and raises the costs of the patient's treatment. A dog with signs of cystitis received treatment with 5mg/kg enrofloxacin at three consecutive times, with low effectiveness. The presence of urethral uroliths was identified and urohydropulsion was done. The animal presented a new obstruction, for which a cystotomy was performed, but continued with signs of infection. Uroculture and antimicrobial susceptibility test were then performed. Escherichia coli was identified, which was resistant to 13 antibiotics, being sensitive only to piperacillin-tazobactam and amikacin. In the screening test for ß-lactamase, the production of ESßL was detected. The qPCR indicated the presence of the bla CTXm, bla DHA, bla OXA, bla IMP, bla TEM, bla GIM, bla SIM, bla SPM and bla SME genes, which may lead to a phenotypic resistance profile for ampicillin, amoxicillin-clavulanate, aztreonam, cefepime cefoxitin, cefuroxime, ceftazidime, ceftriaxone, imipenem, and piperacillin-tazobactam. This case reaffirms the value that laboratory analysis adds to the diagnosis and treatment of cystitis and urolithiasis, which can define the direction of evolution of the prognosis and the speed at which the patient's health will be restored.(AU)


A resistência bacteriana aos antibióticos é uma realidade, tanto na saúde humana quanto veterinária, limita o arsenal terapêutico e eleva os custos relacionados ao tratamento do paciente. Um cão, com sinais de cistite, recebeu tratamento com enrofloxacina, na dose de 5mg/kg, em três momentos seguidos, com baixa efetividade. Identificou-se presença de urólitos uretrais e foi feita uro-hidropropulsão. O animal apresentou nova obstrução, para a qual foi realizada uma cistotomia, mas continuou com sinais de infecção. Realizou-se, então, urocultura e teste de antibiograma. Foi identificada Escherichia coli, que se mostrou resistente a 13 antibióticos, sendo sensível somente à piperacilina-tazobactam e amicacina. No teste de triagem para ß-lactamase, detectou-se a produção de ESßL. A qPCR indicou presença dos genes blaCTXm, blaDHA, blaOXA, blaIMP, blaTEM, blaGIM, blaSIM, blaSPM e blaSME, que podem conduzir um perfil fenotípico de resistência para ampicilina, amoxicilina-ácido clavulânico, aztreonam, cefepima, cefoxitina, cefuroxima, ceftazidima, ceftriaxona, imipenem, piperacilina-tazobactam. Este caso reafirma o valor que a análise laboratorial agrega ao diagnóstico e tratamento da cistite e da urolitíase, podendo definir o sentido de evolução do prognóstico e a velocidade em que a saúde do paciente será restabelecia.(AU)


Subject(s)
Animals , Dogs , Cystitis/veterinary , Drug Resistance, Multiple, Bacterial , Escherichia coli/isolation & purification , Urolithiasis , Cystotomy/veterinary , Enrofloxacin
8.
Braz. j. infect. dis ; 24(1): 34-43, Feb. 2020. tab, graf
Article in English | LILACS | ID: biblio-1089324

ABSTRACT

ABSTRACT Introduction: Multidrug-resistant gram-negative rods (MDR GNR) represent a growing threat for patients with cancer. Our objective was to determine the characteristics of and risk factors for MDR GNR bacteremia in patients with cancer and to develop a clinical score to predict MDR GNR bacteremia. Material and Methods: Multicenter prospective study analyzing initial episodes of MDR GNR bacteremia. Risk factors were evaluated using a multiple logistic regression (forward-stepwise selection) analysis including variables with a p < 0.10 in univariate analysis. Results: 394 episodes of GNR bacteremia were included, with 168 (42.6 %) being MDR GNR. Five variables were identified as independent risk factors: recent antibiotic use (OR = 2.8, 95 % CI 1.7-4.6, p = 0.001), recent intensive care unit admission (OR = 2.9, 95 % CI 1.1-7.8, p = 0.027), hospitalization ≥ 7 days prior to the episode of bacteremia (OR = 3.5, 95 % CI 2-6.2, p = 0.005), severe mucositis (OR = 5.3, 95 % CI 1.8-15.6, p = 0.002), and recent or previous colonization/infection with MDR GNR (OR = 2.3, 95 % CI 1.2-4.3, p = 0.028). Using a cut-off value of two points, the score had a sensitivity of 66.07 % (95 % CI 58.4-73.2 %), a specificity of 77.8 % (95 % CI 71.4-82.7 %), a positive predictive value of 68 % (95 % CI 61.9-73.4 %), and a negative predictive value of 75.9 % (95 % CI 71.6-79.7 %). The overall performance of the score was satisfactory (AUROC 0.78; 95 % CI 0.73-0.82). In the cases with one or none of the risk factors identified, the negative likelihood ratio was 0.18 and the post-test probability of having MDR GNR was 11.68 %. Conclusions: With the growing incidence of MDR GNR as etiologic agents of bacteremia in cancer patients, the development of this score could be a potential tool for clinicians.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Young Adult , Gram-Negative Bacterial Infections/etiology , Bacteremia/etiology , Risk Assessment/methods , Drug Resistance, Multiple, Bacterial , Gram-Negative Bacteria/drug effects , Neoplasms/microbiology , Argentina , Time Factors , Logistic Models , Multivariate Analysis , Predictive Value of Tests , Prospective Studies , Risk Factors , Gram-Negative Bacterial Infections/drug therapy , Statistics, Nonparametric , Anti-Bacterial Agents/therapeutic use , Neoplasms/complications
9.
Rev. chil. infectol ; 37(1): 87-88, feb. 2020.
Article in Spanish | LILACS | ID: biblio-1092727

ABSTRACT

Resumen Utilizando cepas clínicas de bacilos gramnegativos multi-resistentes (MDR), comparamos las CIM obtenidas de la microdilución en caldo, el método de referencia y el método de elución de sensidiscos. Encontramos que, con la excepción de A. baumannii, los resultados fueron muy similares. El método de elución de sensidiscos podría ser una buena alternativa y confiable para la determinación de la resistencia a colistín.


Abstract Using clinical strains of multidrug resistant (MDR) Gram negative bacilli, we compared MICs obtained from both broth microdilution, the reference method, and sensi-disk elution method. We found that, with A. baumannii exception, results were very similar. Sensi-disk elution method could be a good and reliable alternative for colistin resistance determination.


Subject(s)
Microbial Sensitivity Tests/methods , Microbial Sensitivity Tests/standards , Colistin/pharmacology , Gram-Negative Bacteria/drug effects , Anti-Bacterial Agents/pharmacology , Drug Resistance, Multiple, Bacterial , Acinetobacter baumannii/drug effects
10.
Rev. Soc. Bras. Med. Trop ; 53: e20200064, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136871

ABSTRACT

Abstract INTRODUCTION: Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon. METHODS: In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, bla GES, bla NDM, bla SPM, bla IMP, bla VIM, and bla OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. RESULTS: Seventy-four (50.3%) isolates were positive for bla NDM, eight (5.4%) for bla KPC, and one (1.2%) for both bla NDM and bla KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response. CONCLUSIONS: Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.


Subject(s)
Humans , Bacterial Proteins/genetics , beta-Lactamases/genetics , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Brazil , DNA, Bacterial , Microbial Sensitivity Tests , Polymerase Chain Reaction , Prevalence , Drug Resistance, Multiple, Bacterial/genetics , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/genetics
11.
Rev. Soc. Bras. Med. Trop ; 53: e20200248, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136841

ABSTRACT

Abstract INTRODUCTION: The increase in the prevalence of multidrug-resistant Acinetobacter baumannii infections in hospital settings has rapidly emerged worldwide as a serious health problem. METHODS: This review synthetizes the epidemiology of multidrug-resistant A. baumannii, highlighting resistance mechanisms. CONCLUSIONS: Understanding the genetic mechanisms of resistance as well as the associated risk factors is critical to develop and implement adequate measures to control and prevent acquisition of nosocomial infections, especially in an intensive care unit setting.


Subject(s)
Humans , Acinetobacter Infections/drug therapy , Acinetobacter Infections/epidemiology , Cross Infection/drug therapy , Cross Infection/epidemiology , Acinetobacter baumannii , Disease Outbreaks , Drug Resistance, Multiple, Bacterial , Delivery of Health Care , Anti-Bacterial Agents/therapeutic use , Anti-Bacterial Agents/pharmacology
12.
Rev. Soc. Bras. Med. Trop ; 53: e20190526, 2020. tab, graf
Article in English | LILACS, ColecionaSUS, SES-SP | ID: biblio-1136834

ABSTRACT

Abstract INTRODUCTION: This study investigated the genetic environment of bla KPC-2 in Klebsiella pnemoniae multi-drug resistant clinical isolates. METHODS: Four carbapenemase gene isolates resistant to carbapenems, collected from infected patients from two hospitals in Brazil, were investigated using polymerase chain reaction and plasmid DNA sequencing. RESULTS: The bla KPC-2 gene was located between ISKpn6 and a resolvase tnpR in the non-Tn4401 element (NTEKPC-IId). It was detected on a plasmid belonging to the IncQ1 group. CONCLUSIONS To our knowledge, this is the first report of the presence of the bla KPC-2 gene in the NTEKPC-IId element carried by plasmid IncQ1 from infections in Brazil.


Subject(s)
Humans , beta-Lactamases/genetics , Klebsiella Infections/microbiology , Klebsiella pneumoniae/genetics , Anti-Bacterial Agents/pharmacology , Plasmids/genetics , DNA, Bacterial/genetics , Microbial Sensitivity Tests , Polymerase Chain Reaction , Drug Resistance, Multiple, Bacterial , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/enzymology
13.
Mem. Inst. Oswaldo Cruz ; 115: e200055, 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1135234

ABSTRACT

BACKGROUND Tuberculosis (TB) is an infectious disease caused by the bacterium Mycobacterium tuberculosis, and the number of new cases of multidrug resistant TB (MDR-TB), pre extensively drug-resistant TB (pre-XDR-TB) and extensively drug-resistant TB (XDR-TB) has increased considerably worldwide. OBJECTIVES Herein, using 156 M. tuberculosis isolates from 106 patients previously classified as MDR or pre-XDR or XDR isolates, we investigated the genetic mutation profiles associated with phenotypic resistances in patients with MDR-TB, pre-XDR-TB and XDR-TB, treatment outcomes and resistance evolution. METHODS Molecular analyses were performed by partial sequencing of the rpoB, katG, gyrA, gyrB, rrs genes and analysis of the fabG-inhA promoter region. Clinical, epidemiologic and demographic data were obtained from the TB Notification database system of São Paulo (TB-WEB) and the Information System for Special Tuberculosis Treatments (SITE-TB). FINDINGS Drug resistance was attributed to previously known mutations and a novel Asp449Val mutation in gyrB was observed in four isolates from the same patient. Ten patients had more than one isolate evaluated and eight of these patients displayed resistance progression. MAIN CONCLUSIONS The present study is the first to report the frequency of mutations related to second-line drug resistance in MDR-TB, pre-XDR-TB and XDR-TB isolates. The results could lead to the improvement of available technologies for the rapid detection of drug resistant TB.


Subject(s)
Humans , Male , Female , Adolescent , Adult , Young Adult , Tuberculosis, Multidrug-Resistant/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Mutation/genetics , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Socioeconomic Factors , Brazil , Microbial Sensitivity Tests , Extensively Drug-Resistant Tuberculosis/microbiology , Middle Aged , Mycobacterium tuberculosis/isolation & purification
14.
Mem. Inst. Oswaldo Cruz ; 115: e200215, 2020. tab, graf
Article in English | LILACS, SES-SP | ID: biblio-1135232

ABSTRACT

The human-adapted strains of the Mycobacterium tuberculosis complex (MTBC) comprise seven phylogenetic lineages originally associated with their geographical distribution. Here, we report the genomes of three drug-resistant clinical isolates of the Latin American-Mediterranean (LAM) family collected in Kazakhstan. We utilised whole-genome sequencing to study the distribution and drug resistance of these isolates. Phylogenetic analysis grouped the genomes described in this study with the sequences from Russia, Uzbekistan, and Kazakhstan belonging to the LAM family. One isolate has acquired extensive drug resistance to seven antituberculosis drugs. Our results suggest at least two multi-drug resistant (MDR)/extensively drug-resistant (XDR)-associated genotypes of the LAM family circulate in Kazakhstan.


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/drug therapy , Drug Resistance, Multiple, Bacterial/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Phylogeny , Kazakhstan , Tuberculosis, Multidrug-Resistant/genetics , Genomics , Genotype , Latin America
15.
Braz. J. Vet. Res. Anim. Sci. (Online) ; 57(1): e160956, 2020. ilus, mapas, tab
Article in English | ID: biblio-1122160

ABSTRACT

Antimicrobial resistance is a current and important issue to public health, and it is usually associated with the indiscriminate use of antimicrobials in animal production. This study aimed to evaluate the antimicrobial susceptibility profile in bacterial isolates from pigs with clinical respiratory signs in Brazil. One hundred sixty bacterial strains isolated from pigs from 51 pig farms in Brazil were studied. In vitro disk-diffusion method was employed using 14 antimicrobial agents: amoxicillin, penicillin, ceftiofur, ciprofloxacin, enrofloxacin, chlortetracycline, doxycycline, oxytetracycline, tetracycline, erythromycin, tilmicosin, florfenicol, lincomycin, and sulfadiazine/trimethoprim. The majority of isolates were resistant to at least one antimicrobial agent (98.75%; 158/160), while 31.25% (50/160) of the strains were multidrug resistant. Streptococcus suis and Bordetella bronchiseptica were the pathogens that showed higher resistance levels. Haemophilus parasuis showed high resistance levels to sulfadiazine/trimethoprim (9/18=50%). We observed that isolates from the midwestern and southern regions exhibited four times greater chance of being multidrug resistant than the isolates from the southeastern region studied. Overall, the results of the present study showed a great level of resistance to lincomycin, erythromycin, sulfadiazine/trimethoprim, and tetracycline among bacterial respiratory pathogens isolated from pigs in Brazil. The high levels of antimicrobial resistance in swine respiratory bacterial pathogens highlight the need for the proper use of antimicrobials in Brazilian pig farms.(AU)


A resistência antimicrobiana é uma questão atual e muito importante para a saúde pública, geralmente associada ao uso indiscriminado de antimicrobianos na produção animal. Diante disso, foi investigado o perfil de sensibilidade-antimicrobiana em isolados bacterianos de suínos com sinais clínicos respiratórios no Brasil. Foram estudadas 96 isolados provenientes de 51 granjas de suínos do Brasil. O método de disco-difusão foi empregado usando 14 antimicrobianos: amoxicilina, penicilina, ceftiofur, ciprofloxacina, enrofloxacina, clortetraciclina, doxiciclina, oxitetraciclina, tetraciclina, eritromicina, tilmicosina, florfenicol, lincomicina e sulfadiazina/trimetoprim. Streptococcus suis e Bordetella bronchiseptica foram os patógenos que apresentaram maiores níveis de resistência. Haemophilus parasuis apresentou altos níveis de resistência à sulfadiazina/trimetoprim (9/18=50%). Observou-se que isolados das regiões Centro-Oeste e Sul apresentaram quatro vezes mais chance de serem multirresistentes do que os isolados da região Sudeste. A maioria foi resistente a pelo menos um agente antimicrobiano (98,75%; 158/160) e 31,25% (50/160) das estirpes isoladas eram multirresistentes. No geral, os resultados do presente estudo mostraram grande nível de resistência à lincomicina, eritromicina, sulfadiazina/trimetoprim e tetraciclina entre patógenos respiratórios bacterianos isolados de suínos no Brasil. Os altos níveis de resistência antimicrobiana em patógenos bacterianos respiratórios em suínos reforçam a necessidade do uso criterioso de antimicrobianos na suinocultura brasileira.(AU)


Subject(s)
Animals , Swine , Bordetella bronchiseptica , Drug Resistance, Multiple, Bacterial , Streptococcus , Brazil/epidemiology , Pasteurella multocida , Actinobacillus pleuropneumoniae , Haemophilus parasuis , Disk Diffusion Antimicrobial Tests/veterinary
16.
Mem. Inst. Oswaldo Cruz ; 115: e200520, 2020. tab, graf
Article in English | LILACS | ID: biblio-1154871

ABSTRACT

BACKGROUND The evaluation of procedures for drug susceptibility prediction of Mycobacterium tuberculosis based on genomic data against the conventional reference method test based on culture is realistic considering the scenario of growing number of tools proposals based on whole-genome sequences (WGS). OBJECTIVES This study aimed to evaluate drug susceptibility testing (DST) outcome based on WGS tools and the phenotypic methods performed on isolates of M. tuberculosis Lineage 1 from the state of Pará, Brazil, generally associated with low levels of drug resistance. METHODOLOGY Culture based DST was performed using the Proportion Method in Löwenstein-Jensen medium on 71 isolates that had been submitted to WGS. We analysed the seven main genome sequence-based tools for resistance and lineage prediction applied to M. tuberculosis and for comparison evaluation we have used the Kappa concordance test. FINDINGS When comparing the WGS-based tools against the DST, we observed the highest level of agreement using TB-profiler. Among the tools, TB-profiler, KvarQ and Mykrobe were those which identified the largest number of TB-MDR cases. Comparing the four most sensitive tools regarding resistance prediction, agreement was observed for 43 genomes. MAIN CONCLUSIONS Drug resistance profiling using next-generation sequencing offers rapid assessment of resistance-associated mutations, therefore facilitating rapid access to effective treatment.


Subject(s)
Humans , Tuberculosis, Multidrug-Resistant/genetics , Drug Resistance, Multiple, Bacterial/genetics , Mycobacterium tuberculosis/drug effects , Mycobacterium tuberculosis/genetics , Antitubercular Agents/pharmacology , Brazil , Pharmaceutical Preparations , Microbial Sensitivity Tests , Tuberculosis, Multidrug-Resistant/drug therapy , Drug Resistance, Multiple, Bacterial/drug effects , Whole Genome Sequencing , Mycobacterium tuberculosis/isolation & purification , Antitubercular Agents/therapeutic use
17.
Rev. Soc. Bras. Med. Trop ; 53: e20190044, 2020. tab
Article in English | LILACS | ID: biblio-1057279

ABSTRACT

Abstract INTRODUCTION: Acinetobacter baumannii are opportunistic bacteria, highly capable of acquiring antimicrobial resistance through the production of carbapenemases and aminoglycoside modifying enzymes (AMEs). METHODS: Carbapenemase and AME genes were investigated in A. baumannii recovered from inpatients of a Brazilian hospital. RESULTS: The key genes found were bla OXA-51-like, the association ISAba1- bla OXA-23-like, and the AME genes aph(3´)-VI, aac(6´)-Ib, aac(3)-Ia, and aph(3´)-Ia. Different clusters spread through the institution wards. CONCLUSIONS: The dissemination of bla OXA-23-like and AME-carrying A. baumannii through the hospital highlights the need for improved preventive measures to reduce the spread of infection.


Subject(s)
Humans , Bacterial Proteins/genetics , beta-Lactamases/genetics , Acinetobacter Infections/microbiology , Acinetobacter baumannii/enzymology , Aminoglycosides/genetics , Brazil , Microbial Sensitivity Tests , Drug Resistance, Multiple, Bacterial , Acinetobacter baumannii/isolation & purification , Acinetobacter baumannii/drug effects , Tertiary Care Centers , Intensive Care Units , Anti-Bacterial Agents/pharmacology
18.
Rev. Soc. Bras. Med. Trop ; 53: e20180498, 2020. tab
Article in English | LILACS | ID: biblio-1057281

ABSTRACT

Abstract INTRODUCTION: Pseudomonas aeruginosa is one of the main pathogens causing infection in intensive care units (ICUs) and usually presents antimicrobial resistance. METHODS: Data were obtained from ICUs between 2010 and 2013. RESULTS: P. aeruginosa had a prevalence of 14.5% of which 48.7% were multidrug resistant. We observed increasing resistance to carbapenems and polymyxin B and growing consumption of aminoglycosides, meropenem, ceftazidime, and polymyxin B. The regression impact between resistance and consumption was significant with respect to amikacin, imipenem, meropenem, and polymyxin B. CONCLUSIONS: Monitoring antimicrobial consumption and resistant microorganisms should be reinforced to combat antimicrobial- and multi-drug resistance.


Subject(s)
Humans , Pseudomonas aeruginosa/drug effects , Pseudomonas Infections/microbiology , Cross Infection/microbiology , Pseudomonas aeruginosa/isolation & purification , Microbial Sensitivity Tests , Prevalence , Drug Resistance, Multiple, Bacterial , Intensive Care Units , Anti-Bacterial Agents/pharmacology
19.
Braz. j. infect. dis ; 23(6): 371-380, Nov.-Dec. 2019. tab, graf
Article in English | LILACS | ID: biblio-1089307

ABSTRACT

ABSTRACT Introduction: The presence of Acinetobacter baumannii outside hospitals remains unclear. This study aimed to determine the prevalence of multidrug-resistance (MDR) A. baumannii in the extra-hospital environment in Mthatha, South Africa and to investigate the frequency of carbapenemase-encoding genes. Material and Methods: From August 2016 to July 2017 a total of 598 abattoir samples and 689 aquatic samples were collected and analyzed presumptively by cultural methods for the presence of A. baumannii using CHROMagar™ Acinetobacter medium. Species identification was performed by autoSCAN-4 (Dade Behring Inc., IL) and confirmed by the detection of their intrinsic blaOXA-51 gene. Confirmed MDR A. baumannii isolates were screened for the presence of carbapenemase-encoding genes, ISAba1 insertion sequence and integrase intI1. Results: In total, 248 (19.3%) Acinetobacter species were isolated. Acinetobacter. baumannii was detected in 183 (73.8%) of which 85 (46.4%) and 98 (53.6%) were recovered from abattoir and aquatic respectively. MDR A. baumannii was detected in 56.5% (48/85) abattoir isolates and 53.1% (52/98) aquatic isolates. Isolates showed high resistance to antimicrobials most frequently used to treat Acinetobacter infections such as piperacillin/tazobactam; abattoir (98% of isolates resistant), aquatic (94% of isolates resistant), ceftazidime (84%, 83%), ciprofloxacin (71%, 70%), amikacin (41%, 42%), imipenem (75%, 73%), and meropenem (74%, 71%). All the isolates were susceptible to tigecycline and colistin. All the isolates carried blaOXA-51-like. The blaOXA-23 was detected in 32 (66.7%) abattoir isolates and 11 (21.2%) aquatic isolates. The blaOXA-58-like was positive in 7 (14.6%) and 4 (7.7%) abattoir and aquatic isolates, respectively. Both groups of isolates lacked blaOXA-24-like, blaIMP-type, blaVIM-type, blaNDM-1, blaSIM, blaAmpC, ISAba1 and inI1. Isolates showed high level of Multiple Antibiotic Resistance Index (MARI) ranging from 0.20-0.52. Conclusion: Extra-hospital sources such as abattoir and aquatic environments may be a vehicle of spread of MDR A. baumannii strains in the community and hospital settings.


Subject(s)
Humans , Acinetobacter Infections/microbiology , Acinetobacter Infections/drug therapy , Drug Resistance, Multiple, Bacterial/genetics , Acinetobacter baumannii/isolation & purification , Anti-Bacterial Agents/therapeutic use , South Africa/epidemiology , Acinetobacter Infections/transmission , Acinetobacter Infections/epidemiology , Microbial Sensitivity Tests , Polymerase Chain Reaction , Prevalence , Cross-Sectional Studies , Prospective Studies , Acinetobacter baumannii/genetics
20.
Rev. epidemiol. controle infecç ; 9(4): 281-286, out.-dez. 2019. ilus
Article in Portuguese | LILACS | ID: biblio-1152242

ABSTRACT

Justificativa e objetivos: Infecções Relacionadas à Assistência à Saúde (IRAS) causadas por bacilos Gram negativos multirresistentes (BGN-MDR) são consideradas um problema de saúde pública e um impacto nas taxas de mortalidade nas Unidades de Terapia Intensiva (UTI). O objetivo deste estudo foi verificar o perfil fenotípico de resistência à colistina e à tigeciclina, consideradas como último recurso terapêutico aos BGN-MDR. Métodos: Os dados foram coletados nas fichas de busca ativa do serviço de controle de infecções e prontuários médicos de pacientes internados em duas UTIs de um hospital público de Joinville, entre janeiro de 2016 e junho de 2017. Resultados: Ocorreram 256 IRAS por BGN, acometendo principalmente o gênero masculino (62%), com mediana de idade de 65 anos. Entre os BGN, 37% expressaram MDR; sendo as espécies mais frequentes: Klebsiella pneumoniae e (47%), Acinetobacter baumannii (23%) e Stenotrophomonas maltophilia (11%). A resistência de BGN-MDR à colistina e tigeciclina foi de 5% e de 12%, respectivamente; 5% dos isolados foram resistentes aos dois antibióticos. A taxa de óbito entre os pacientes com IRAS por BGN-MDR resistentes à colistina foi mais alta (60%) que aquelas à tigeciclina (45%). Conclusão: K. pneumoniae e A. baumannii produtores de carbapenemases, resistentes a colistina e tigeciclina prevaleceram entre os BGN-MDR, e estiveram associadas a maioria dos óbitos. Essas observações, junto com o alto uso de carbapenêmicos na terapia empírica, mostra a necessidade do uso racional de antimicrobianos.(AU)


Background and objectives: Healthcare-associated Infections (HAIs) caused by multidrug-resistant Gram-negative bacilli (GNB-MDR) are considered a public health problem and have an impact on mortality rates in Intensive Care Units (ICU). The aim of this study was to verify the phenotypic profile of resistance to colistin and tigecycline, considered as the last antimicrobial choice to treat BGNMDR infections. Methods: Data were collected on the active search records of the infection control service and medical records of patients admitted to two ICUs at a public hospital in Joinville between January 2016 and June 2017. Results: There were 256 HAIs caused by GNB, mainly affecting males (62%), with a median age of 65 years. Among GNBs, 37% expressed MDR; the most frequent species were: Klebsiella pneumoniae (47%), Acinetobacter baumannii (23%) and Stenotrophomonas maltophilia (11%). The resistance of GNB-MDR to colistin and tigecycline was 5% and 12%, respectively; 5% of the isolates were resistant to both antibiotics. The death rate among patients with HAIs caused by colistin-resistant GNB-MDR was higher (60%) than those to tigecycline (45%). Conclusion: Carbapenemase-producing K. pneumoniae and A. baumannii, resistant to colistin and tigecycline, prevailed among GNB-MDRs, and were associated with most deaths. These observations, coupled with the high use of carbapenems in empirical therapy, show the need for rational use of antimicrobials.(AU)


Justificación y objetivos: Las Infección nosocomial (IHs) causadas por bacilos Gram negativos multirresistentes (BGN-MDR) se consideran un problema de salud pública y un impacto en las tasas de mortalidad en las Unidades de Terapia Intensiva (UTI). El objetivo de este estudio fue verificar el perfil fenotípico de resistencia a la colistina ya la tigeciclina, consideradas como último recurso terapéutico a los BGN-MDR. Métodos: Los datos fueron recolectados en las fichas de búsqueda activa del servicio de control de infecciones y prontuarios médicos de pacientes internados en dos UTIs de un hospital público de Joinville, entre enero de 2016 y junio de 2017. Resultados: Ocurrieron 256 IHs por BGN, que afectan principalmente al género masculino (62%), con mediana de edad de 65 años. Entre los BGN, el 37% expresó MDR; siendo las especies más frecuentes: Klebsiella pneumoniae (47%), Acinetobacter baumannii (23%) y Stenotrophomonas maltophilia (11%). La resistencia de BGN-MDR a la colistina y tigeciclina fue del 5% y del 12%, respectivamente; 5% de los aislados fueron resistentes a los dos antibióticos. La tasa de muerte entre los pacientes con IH causadas por los BGN-MDR resistentes la colistina fue más alta (60%) que aquellas a tigeciclina (45%). Conclusión: K. pneumoniae y A. baumannii productoras de carbapenemases, resistentes la colistina y la tigeciclina, fueron más frecuentes entre los BGN-MDR y su asociación estuvo presente en la mayoría de las muertes. Estas observaciones, junto con el alto uso de carbapenems en la terapia empírica, muestran la necesidad de un uso racional de los antimicrobianos.(AU)


Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Young Adult , Colistin/pharmacology , Drug Resistance, Multiple, Bacterial , Tigecycline/pharmacology , Gram-Negative Bacteria/drug effects , Anti-Bacterial Agents/pharmacology , Phenotype , Cross Infection/drug therapy , Gram-Negative Bacterial Infections/drug therapy , Colistin/therapeutic use , Stenotrophomonas maltophilia/drug effects , Stenotrophomonas maltophilia/genetics , Acinetobacter baumannii/drug effects , Acinetobacter baumannii/genetics , Tigecycline/therapeutic use , Gram-Negative Bacteria/genetics , Hospitalization , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/genetics , Anti-Bacterial Agents/therapeutic use
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