Overlapped sequence types (STs) and serogroups of avian pathogenic (APEC) and human extra-intestinal pathogenic (ExPEC) Escherichia coli isolated in Brazil.

Avian pathogenic Escherichia coli (APEC) strains belong to a category that is associated with colibacillosis, a serious illness in the poultry industry worldwide. Additionally, some APEC groups have recently been described as potential zoonotic agents. In this work, we compared APEC strains with extraintestinal pathogenic E. coli (ExPEC) strains isolated from clinical cases of humans with extra-intestinal diseases such as urinary tract infections (UTI) and bacteremia. PCR results showed that genes usually found in the ColV plasmid (tsh, iucA, iss, and hlyF) were associated with APEC strains while fyuA, irp-2, fepC sitDchrom, fimH, crl, csgA, afa, iha, sat, hlyA, hra, cnf1, kpsMTII, clpVSakai and malX were associated with human ExPEC. Both categories shared nine serogroups (O2, O6, O7, O8, O11, O19, O25, O73 and O153) and seven sequence types (ST10, ST88, ST93, ST117, ST131, ST155, ST359, ST648 and ST1011). Interestingly, ST95, which is associated with the zoonotic potential of APEC and is spread in avian E. coli of North America and Europe, was not detected among 76 APEC strains. When the strains were clustered based on the presence of virulence genes, most ExPEC strains (71.7%) were contained in one cluster while most APEC strains (63.2%) segregated to another. In general, the strains showed distinct genetic and fingerprint patterns, but avian and human strains of ST359, or ST23 clonal complex (CC), presented more than 70% of similarity by PFGE. The results demonstrate that some "zoonotic-related" STs (ST117, ST131, ST10CC, ST23CC) are present in Brazil. Also, the presence of moderate fingerprint similarities between ST359 E. coli of avian and human origin indicates that strains of this ST are candidates for having zoonotic potential.

Correlations of HOMA2-IR and HbA1c with algorithms derived from bioimpedance and spectrophotometric devices.

BACKGROUND: Homeostasis model assessment of insulin resistance (HOMA2-IR) and HbA1c, markers of metabolic syndrome and glycemic control, were compared with Electro Sensor (ES) Complex software algorithms. ES complex software integrates data from Electro Sensor Oxi (ESO; spectrophotometry) and Electro Sensor-Body Composition (ES-BC; bioimpedance). METHODS: One hundred forty-eight Brazilian obese candidates for bariatric surgery underwent complete physical examinations, laboratory tests (fasting plasma glucose, fasting plasma insulin, and HbA1c) and ES complex assessments. HOMA2-IR was calculated from fasting plasma glucose and fasting plasma insulin using free software provided by The University of Oxford Diabetes Trial Unit. ES complex-insulin resistance (ESC-IR) and ES complex-blood glucose control (ESC-BCG) were calculated from ESO and ES-BC data using ES complex software. Correlations between HOMA2-IR and ESC-IR and between ESC-BGC and HbA1c were determined. RESULTS: ESC-BGC was correlated with HbA1c (r = 0.85). ESC-BCG values >3 were predictive of HbA1c > 6.5% (φ = 0.94; unweighted κ = 0.9383). ESC-IR was correlated with HOMA2-IR (r = 0.84). Patients with ESC-IR score >2.5 or >3 were more likely to have metabolic syndrome or insulin resistance, respectively, compared with HOMA2-IR value >1.4 and >1.8, respectively. ESC-IR performance was evaluated by receiver operating characteristic curves. The areas under the curve for metabolic syndrome and insulin resistance were 0.9413 and 0.9022, respectively. CONCLUSION: The results of this study in Brazilian subjects with obesity suggest that ES complex algorithms will be useful in large-scale screening studies to predict insulin resistance, metabolic syndrome, and HbA1c >6.5%. Additional studies are needed to confirm these correlations in non-obese subjects and in other ethnic groups.

Risk factors for recovery of imipenem- or ceftazidime-resistant pseudomonas aeruginosa among patients admitted to a teaching hospital in Brazil.

BACKGROUND: The prevalence of resistance to imipenem and ceftazidime among Pseudomonas aeruginosa isolates is increasing worldwide. OBJECTIVE: Risk factors for nosocomial recovery (defined as the finding of culture-positive isolates after hospital admission) of imipenem-resistant P. aeruginosa (IRPA) and ceftazidime-resistant P. aeruginosa (CRPA) were determined. DESIGN: Two separate case-control studies were conducted. Control subjects were matched to case patients (ratio, 2:1) on the basis of admission to the same ward at the same time as the case patient. Variables investigated included demographic characteristics, comorbid conditions, and the classes of antimicrobials used. SETTING: The study was conducted in a 400-bed general teaching hospital in Campinas, Brazil that has 14,500 admissions per year. Case patients and control subjects were selected from persons who were admitted to the hospital during 1992-2002. RESULTS: IRPA and CRPA isolates were obtained from 108 and 55 patients, respectively. Statistically significant risk factors for acquisition of IRPA were previous admission to another hospital (odds ratio [OR], 4.21 [95% confidence interval {CI}, 1.40-12.66]; P=.01), hemodialysis (OR, 7.79 [95% CI, 1.59-38.16]; P=.01), and therapy with imipenem (OR, 18.51 [95% CI, 6.30-54.43]; P<.001), amikacin (OR, 3.22 [95% CI, 1.40-7.41]; P=.005), and/or vancomycin (OR, 2.48 [95% CI, 1.08-5.64]; P=.03). Risk factors for recovery of CRPA were previous admission to another hospital (OR, 18.69 [95% CI, 2.00-174.28]; P=.01) and amikacin use (OR, 3.69 [95% CI, 1.32-10.35]; P=.01). CONCLUSION: Our study suggests a definite role for several classes of antimicrobials as risk factors for recovery of IRPA but not for recovery of CRPA. Limiting the use of only imipenem and ceftazidime may not be a wise strategy to contain the spread of resistant P. aeruginosa strains.