RESUMEN
OBJECTIVE: We describe an IncX4 pHC891/16mcr plasmid carrying mcr-1 in a colistin-resistant and carbapenem-susceptible E. coli isolate (HC891/16), ST156, which caused a blood infection in a Brazilian patient with gallbladder adenocarcinoma. METHODS: Strain HC891/16 was subjected to whole genome sequencing using the MiSeq Platform (Illumina, Inc., USA). Assembly was performed using Mira and ABACAS. RESULTS: The isolates showed resistance only to ciprofloxacin, ampicillin and cefoxitin, and whole-genome sequencing revealed the presence of aac(6')Ib-cr and blaTEM1. CONCLUSION: Our findings warn of the possible silent dissemination of colistin resistance by carbapenem-susceptible mcr-1 producers, as colistin susceptibility is commonly tested only among carbapenem-resistant isolates.
Asunto(s)
Humanos , Femenino , Anciano , Carbapenémicos/farmacología , Bacteriemia/tratamiento farmacológico , Colistina/farmacología , Proteínas de Escherichia coli/efectos de los fármacos , Escherichia coli/efectos de los fármacos , Antibacterianos/farmacología , Plásmidos/efectos de los fármacos , Brasil , Pruebas de Sensibilidad Microbiana , Proteínas de Escherichia coli/aislamiento & purificación , Proteínas de Escherichia coli/genética , Farmacorresistencia Bacteriana Múltiple , Escherichia coli/aislamiento & purificación , Escherichia coli/genética , Infecciones por Escherichia coli/tratamiento farmacológicoRESUMEN
Abstract Colistin resistance involving Gram-negative bacilli infections is a challenge for health institutions around of the world. Carbapenem-resistance among these isolates makes colistin the last therapeutic option for this treatment. Colistin resistance among Enterobacteriaceae, Acinetobacter spp., and Pseudomonas spp. was evaluated between 2010 and 2014 years, at Hospital das Clínicas, São Paulo, Brazil. Over five years 1346 (4.0%) colistin resistant Gram-negative bacilli were evaluated. Enterobacteriaceae was the most frequent (86.1%) pathogen isolated, followed by Acinetobacter spp. (7.6%), and Pseudomonas spp. (6.3%). By temporal analysis there was a trend for an increase of colistin resistance among Enterobacteriaceae, but not among non-fermentative isolates. Among 1346 colistin resistant isolates, carbapenem susceptibility was observed in 21.5%. Colistin resistance in our hospital has been alarmingly increased among Klebsiella pneumoniae isolates in both KPC positive and negative, thus becoming a therapeutic problem.
Asunto(s)
Humanos , Pseudomonas/efectos de los fármacos , Acinetobacter/efectos de los fármacos , Colistina/farmacología , Farmacorresistencia Bacteriana/efectos de los fármacos , Enterobacteriaceae/efectos de los fármacos , Antibacterianos/farmacología , Pseudomonas/aislamiento & purificación , Factores de Tiempo , Acinetobacter/aislamiento & purificación , Brasil , Pruebas de Sensibilidad Microbiana , Estudios Retrospectivos , Enterobacteriaceae/aislamiento & purificación , Hospitales UniversitariosRESUMEN
OBJECTIVE: Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase. METHOD: From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk. RESULTS: Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively. CONCLUSION: Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase 2. The test may therefore be regarded as a good epidemiological tool.
Asunto(s)
Humanos , Proteínas Bacterianas/genética , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/aislamiento & purificación , beta-Lactamasas/genética , Antibacterianos/farmacología , ADN Bacteriano/análisis , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/enzimología , Pruebas de Sensibilidad Microbiana/métodos , Valor Predictivo de las Pruebas , Resistencia betalactámica/efectos de los fármacos , Resistencia betalactámica/genética , beta-Lactamas/farmacologíaRESUMEN
Dentro do Projeto Medicina Popular, lançado pela Fundaçäo Projeto Rondon em 1985, desenvolveu-se juntamente com a Universidade do Sagrado Coraçäo um trabalho visando extrair o máximo de informaçöes sobre as propriedades farmacológicas e nutricionais das espécies nativas existentes nos cerrados do município de Bauru - SP. Esta primeira comunicaçäo, além da apresentaçäo do programa, inclui também os primeiros resultados do programa, inclui também os primeiros resultados da pesquisa bibliográfica feita com o pequi (Caryocar brasiliense Camb.)