Resistência aos compostos de amônio quaternário (QACs) de uso doméstico e hospitalar em patógenos prioritários multirresistentes / Resistance to quaternary ammonium compounds (QACs) for domestic and hospital use in multiresistant priority pathogens

Compostos de amônio quaternário (QACs) têm sido amplamente utilizados como desinfetantes e antissépticos, sendo essenciais na prevenção e controle de infecções bacterianas na medicina humana e veterinária. Embora patógenos prioritários multirresistentes têm sido muito bem caracterizados quanto ao perfil de suscetibilidade e contexto genético da resistência aos antibióticos, dados de resistência aos QACs são limitados. Assim, o objetivo do presente estudo foi avaliar a atividade in vitro dos QACs de uso doméstico e hospitalar [cloreto de benzalcônio (BAC), cloreto de cetilpiridinio (CPC) e brometo de cetiltrimetilamônio (CTAB)], contra patógenos prioritários multirresistentes, identificando os principais genes de resistência associados. Foram estudadas 100 cepas multirresistentes previamente sequenciados usando as plataformas Illumina MiSeq e NextSeq representativas de diferentes hospedeiros (humanos e animais) e fontes (ambientes e alimentos). As cepas foram identificadas como Klebsiella pneumoniae (n= 24), Escherichia coli (n= 30); Pseudomonas aeruginosa (n= 10), Enterobacter spp, (n= 8), Acinetobacter baumannii (n= 11) e Salmonella spp. (n= 17). Genes de resistência aos QACs foram identificados in silico através do alinhamento dos contigs obtidos de cada cepa sequenciada com genes de referência obtidos do GenBank, utilizando o programa Geneious versão 8 (Biomatters Ltd). A identidade de cada gene foi analisada utilizando o programa BLASTx, no qual um critério baseado em ≥90% identidade resultou na identificação dos genes mdfA (77%), qacE (44%), qacEΔ1 (43%), sugE(c) (29%), emrE (21%), qacA (19%), sugE(p) (5%), qacF (7%), qacH (7%) e qacL (7%) em 85 cepas; enquanto que 15 cepas não possuíam nenhum gene de resistência aos QACs. A concentração inibitória mínima (CIM) dos QACs para as 100 cepas foi determinada pelo método de microdiluição em caldo. Os resultados sugeriram que a resistência em patógenos prioritários circulando na interface humano-ambiente-animal não é restrita aos antibióticos, uma vez que a elevada ocorrência de genes qacE, qacEΔ1 e mdfA poderia estar associada com uma redução da suscetibilidade para QACs. Consequentemente, a resistência aos QACs poderia também contribuir para a persistência e adaptação destes patógenos nos seres humanos e outros animais, assim como em ambientes impactados antropogenicamente

Quaternary ammonium compounds (QACs) have been widely used as disinfectants and antiseptics, being applied as essential compounds in the prevention and control of bacterial infections in human-and veterinary hospital medicine. Although multiresistant priority pathogens have been well characterized with respect to their susceptibility profile and their genetic context of resistance for antibiotics, studies of resistance to QACs are limited. Thus, the objective of the present study was to evaluate the in vitro activity of QACs [(benzalkonium chloride (BAC), cetylpyridinium chloride (CPC) and cetyltrimethylammonium bromide (CTAB)] for household and hospital use against multiresistant priority pathogens, identifying the main resistance genes associated. A hundred multiresistant isolates (previously sequenced using the Illumina MiSeq and NextSeq platforms), representative of different hosts (humans and animals) and sources (environment and food) were studied. Isolates were identified as Klebsiella pneumoniae (n=24), Escherichia coli (n=30), Pseudomonas aeruginosa (n=10), Enterobacter spp. (n=8), Acinetobacter baumannii (n=11) and Salmonella spp. (n=17). In silico analysis for identification of genes conferring resistance to QACs were performed by aligning the contigs obtained from the strains with reference genes deposited in GenBank, using the Geneious version program (Biomatters Ltd). Similarities were analyzed using the BLASTx online program, considering the alignment criteria based on ≥ 90% identity. The result of these analysis revealed the presence of the following QAC genes: mdfA (77%), qacE (44%), qacEΔ1 (43%), sugE(c) (29%), emrE (21%), qacA (19%), sugE (p) (5%), qacF (7%), qacH (7%) e qacL (7%); while 15 strains showed no resistance genes for QACs. Determination of QACs minimum inhibitory concentration (MIC) for the 100 isolates, by the broth microdilution method. These results suggest that resistance to QACs in priority pathogens, circulating at the human-environment-animal interface, is not restricted to antibiotics, since the high occurrence of genes qacE, qacEΔ1 and mdfA were associated with a reduced susceptibility to QACs. Consequently, resistance to QACs could also contribute to the persistence and adaptation of these pathogens in humans and othes animals, as well as in anthropogenically impacted environments

Enfermedades transmisibles, salud mental y exposición a contaminantes ambientales en población aledaña al proyecto minero Las Bambas antes de la fase de explotación, Perú 2006 / Comunicable diseases, mental health and exposure to environmental pollutants in population living near Las Bambas mining project before exploitation phase, peru 2006

Objetivo. Determinar la prevalencia de enfermedades transmisibles, salud mental y exposición a contaminantes ambientales en la población aledaña al proyecto minero Las Bambas antes de la fase de explotación. Materiales y métodos. Estudio descriptivo transversal realizado en 453 personas (niños y adultos) residentes en tres distritos de la región Apurímac: Haquira, Chalhuahuacho y Progreso. Se evaluó el desarrollo psicomotor, coeficiente intelectual y niveles de ansiedad y depresión, así como la presencia de enfermedades transmisibles (sífilis, VIH, hepatitis viral B, C y Delta,) metales pesados (nivel de plomo en sangre, nivel de cadmio, arsénico y mercurio, en orina) y colinesterasa sérica. Resultados. La edad promedio fue de 29,0 ± 17,3 años, 59,2 por ciento fueron mujeres y el tiempo de residencia fue de 6 a 15 años. No se encontraron casos de VIH, hepatitis C y Delta, 1,4 por ciento fueron positivos a sífilis y en relación con hepatitis B se encontró 1,7 por ciento positivos a anti HBc total y 0,5 por ciento positivos a HBs Ag. Se encontraron valores por encima de lo permitido de mercurio en 1,8 por ciento de la población, arsénico en 4,6 por ciento, plomo en 24,3 por ciento y cadmio en 43,9 por ciento. Además, el 29,1 por ciento de la población tuvo valores de colinesterasa inferiores al rango referencial. En la población infantil, 12,5 por ciento presentaba riesgo en su desarrollo psicomotor; 2,1 por ciento y 3,1 por ciento presentaba retardo mental leve y fronterizo, respectivamente; 34,3 por ciento de los mayores de 12 años sufrían de ansiedad y 17,5 por ciento de depresión. Conclusiones. Existen evidencias de contaminación ambiental por metales pesados y presencia de enfermedades transmisibles en esta población. Una futura explotación minera irresponsable podría agravar dicha situación epidemiológica.

Objective. To determine the prevalence of communicable diseases, mental health and environmental pollutants exposure in population living near Las Bambas mining project before exploitation phase. Material and methods. Cross sectional study performed in 453 subjects (children and adults) living in three Apurimac region districts: Haquira, Chalhuahuacho and Progreso. Psychomotor development, intelligence quotient, anxiety and depression levels and the presence of communicable diseases (viral hepatitis B, C and delta, syphilis and HIV) were evaluated, as well as heavy metals (lead in blood, and cadmium, arsenic and mercury in urine samples) and serum cholinesterase levels. Results. Mean age was 29 ± 17.25 years, 59.2 percent were female and a range of 6 to 15 years of living in the area was found. No cases of HIV, hepatitis C and delta were found, 1.4 percent were positive for syphilis and in relation to hepatitis B, we found 1,7 percent of subjects positive to total anti HBc and 0.5 percent positive for HBsAg. Heavy metal testing identified people with exceeding limits of mercury in 1.8 percent arsenic in 4.6 percent, lead in 24.3 percent and cadmium in 43.9 percent. Besides, 29.1 percent of the population had cholinesterase levels below normal range. Among children, 12.5 percent were at psychomotor development levels of risk; 2.1 percent and 3.1 percent suffered from mild and borderline intellectual disability (mental retardation), respectively. 34.3 percent of subjects older than 12 had anxiety and 17.5 percent depression. Conclusions. Evidence of heavy metal environmental pollution and presence of communicable diseases in this population were already found. Future careless mining activity could worsen the current health situation.