Macrolide resistance among Streptococcus agalactiae during COVID-19 public health emergency in Brazil.

During COVID-19 public health emergence, azithromycin was excessively used in Brazil, as part of a controversial "early treatment", recommended by former national health authorities. Excessive usage of macrolides may increase resistance rates among beta-hemolytic streptococci. Therefore, this study aimed to investigate the occurrence of resistance to erythromycin and clindamycin among Streptococcus agalactiae recovered from February 2020 to May 2023. Bacterial isolates (n = 116) were obtained from pregnant women and submitted to antimicrobial susceptibility testing, investigation of macrolide resistance phenotypes and genotypes, and identification of capsular type. The overall rate of erythromycin not susceptible (NS) isolates was 25.9%, while resistance to clindamycin was 5.2%. Drug efflux, associated with the M phenotype and mef(A) gene, was the prevalent mechanism of resistance (80%). Capsular type Ia was predominant (39.8%), followed by II, III, and V (17.7% each). A higher diversity of types was observed in the last years of the study. Type IV has had an increasing trend over time, being the fourth most common in 2023. The majority of the isolates that expressed the M phenotype presented capsular type Ia, while those with iMLS phenotype presented capsular type V. Despite no causal relationship can be established, azithromycin excessive usage may be a possible factor associated with this higher rate of erythromycin NS isolates, compared with most previous national studies. On the other hand, resistance to clindamycin has not changed significantly. Therefore, in the studied clinical setting, clindamycin remains a useful alternative to intrapartum prophylaxis among penicillin-allergic pregnant women.

Virulence-Associated Characteristics of Serotype 14 and Serogroup 9 Streptococcus pneumoniae Clones Circulating in Brazil: Association of Penicillin Non-susceptibility With Transparent Colony Phenotype Variants.

Streptococcus pneumoniae remains a major agent of invasive diseases, especially in children and the elderly. The presence of pneumococcal capsule, pneumococcal surface protein A (PspA), and pilus type 1 (PI-1) and the ability of colony phase variation are assumed to play important roles in the virulence potential of this microorganism. Differences in the capsular polysaccharide allow the characterization of more than 90 pneumococcal serotypes; among them, serotype 14 and serogroup 9 stand out due to their prevalence in the pre- pneumococcal conjugate vaccine era and frequent association with penicillin non-susceptibility. Here we investigated the distribution of PI-1 and pspA genes and colony phase variants among 315 S. pneumoniae isolates belonging to serotype 14 and serogroup 9, recovered over 20 years in Brazil, and correlated these characteristics with penicillin susceptibility and genotype as determined by multilocus sequence typing. All strains were shown to carry pspA genes, with those of family 2 (pspA2) being the most common, and nearly half of the strains harbored P1-1 genes. The pspA gene family and the presence of PI-1 genes were conserved features among strains belonging to a given clone. A trend for increasing the occurrence of pspA2 and PI-1 genes over the period of investigation was observed, and it coincided with the dissemination of CC156 (Spain9V -3) clone in Brazil, suggesting a role for these virulence attributes in the establishment and the persistence of this successful clone. Opaque variant was the colony phenotype most frequently observed, regardless of clonal type. On the other hand, the transparent variant was more commonly associated with penicillin-non-susceptible pneumococci and with strains presenting evidence of recombination events involving the genes coding for polysaccharide capsule and PspA, suggesting that pneumococcal transparent variants may present a higher ability to acquire exogenous DNA. The results bring to light new information about the virulence potentials of serotype 14 and serogroup 9 S. pneumoniae isolates representing the major clones that have been associated with the emergence and the dissemination of antimicrobial resistance in our setting since the late 1980s.

Invasive Haemophilus influenzae disease in the vaccine era in Rio de Janeiro, Brazil

BACKGROUND Haemophilus influenzae (Hi) serotype b (Hib) conjugate vaccine was incorporated into the infant immunisation schedule in Brazil in 1999, where Hib was one of the major etiologic sources of community-acquired bacterial meningitis. OBJECTIVES The purpose of this study is to describe the molecular epidemiology of invasive Hi disease in Rio de Janeiro state, Brazil, before and after vaccine introduction. METHODS Surveillance data from 1986 to 2014 were analysed. Hi isolates recovered from cerebrospinal fluid (CSF) or blood from 1993 to 2014 were serotyped by slide agglutination, genotyped by multilocus sequence typing (MLST), and the capsule type evaluation, differentiation of serologically non-typeable isolates, and characterisation of the capsule (cap) locus was done by polymerase chain reaction. Antimicrobial susceptibility testing was performed using E-test. FINDINGS From 1986 to 1999 and from 2000 to 2014, 2580 and 197 (42% without serotype information) confirmed cases were reported, respectively. The case fatality rate was 17% and did not correlate with the strain. Hib and b- variant isolates belonged to ST-6, whereas serotype a isolates belonged to the ST-23 clonal complex. Serotype a appeared to emerge during the 2000s. Non-encapsulated isolates were non-clonal and distinct from the encapsulated isolates. Ampicillin-resistant isolates were either of serotype b or were non-encapsulated, and all of them were β-lactamase-positive but amoxicillin-clavulanic acid susceptible. MAIN CONCLUSIONS Although Hi meningitis became a relatively rare disease in Rio de Janeiro after the introduction of the Hib conjugate vaccine, the isolates recovered from patients have become more diverse. These results indicate the need to implement an enhanced surveillance system to continue monitoring the impact of the Hib conjugate vaccine.

Invasive Haemophilus influenzae disease in the vaccine era in Rio de Janeiro, Brazil.

BACKGROUND: Haemophilus influenzae (Hi) serotype b (Hib) conjugate vaccine was incorporated into the infant immunisation schedule in Brazil in 1999, where Hib was one of the major etiologic sources of community-acquired bacterial meningitis. OBJECTIVES: The purpose of this study is to describe the molecular epidemiology of invasive Hi disease in Rio de Janeiro state, Brazil, before and after vaccine introduction. METHODS: Surveillance data from 1986 to 2014 were analysed. Hi isolates recovered from cerebrospinal fluid (CSF) or blood from 1993 to 2014 were serotyped by slide agglutination, genotyped by multilocus sequence typing (MLST), and the capsule type evaluation, differentiation of serologically non-typeable isolates, and characterisation of the capsule (cap) locus was done by polymerase chain reaction. Antimicrobial susceptibility testing was performed using E-test. FINDINGS: From 1986 to 1999 and from 2000 to 2014, 2580 and 197 (42% without serotype information) confirmed cases were reported, respectively. The case fatality rate was 17% and did not correlate with the strain. Hib and b- variant isolates belonged to ST-6, whereas serotype a isolates belonged to the ST-23 clonal complex. Serotype a appeared to emerge during the 2000s. Non-encapsulated isolates were non-clonal and distinct from the encapsulated isolates. Ampicillin-resistant isolates were either of serotype b or were non-encapsulated, and all of them were ß-lactamase-positive but amoxicillin-clavulanic acid susceptible. MAIN CONCLUSIONS: Although Hi meningitis became a relatively rare disease in Rio de Janeiro after the introduction of the Hib conjugate vaccine, the isolates recovered from patients have become more diverse. These results indicate the need to implement an enhanced surveillance system to continue monitoring the impact of the Hib conjugate vaccine.

Streptococcus pneumoniae Serotypes 9 and 14 Circulating in Brazil over a 23-Year Period Prior to Introduction of the 10-Valent Pneumococcal Conjugate Vaccine: Role of International Clones in the Evolution of Antimicrobial Resistance and Description of a Novel Genotype.

Antimicrobial-resistant pneumococcal strains have been detected worldwide since the 1960s. In Brazil, the first penicillin-nonsusceptible pneumococci (PNSP) were reported in the 1980s, and their emergence and dissemination have been mainly attributed to serogroup 9 and serotype 14 strains, especially those highly related to recognized international clones. In the present study, antimicrobial susceptibility testing and multilocus sequence typing were performed on 315 pneumococcal isolates belonging to serogroup 9 (n = 99) or serotype 14 (n = 216), recovered from patients or asymptomatic carriers between 1988 and 2011 in Brazil, in order to trace changes in antimicrobial resistance and genotypes prior to the full introduction of the pneumococcal conjugate vaccine in the country. Over the 23-year study period, the PNSP levels increased, and four clonal complexes (CC156, CC66, CC15, and CC5401) have played important roles in the evolution and dissemination of pneumococcal isolates belonging to serogroup 9 and serotype 14, as well as in the emergence of antimicrobial resistance, in the pre-pneumococcal-vaccination era. The earliest PNSP strains detected in this study belonged to serotype 9N/ST66 and were single locus variants of the international clone Tennessee14-18 ST67 (CC66). The first serotype 14 PNSP isolates were identified in 1990 and were related to the England14-9 ST9 (CC15) clone. Serotype 14 PNSP variants of the Spain9V-3 ST156 clone with elevated penicillin MICs and nonsusceptibility to other beta-lactams were detected in 1995 and showed an increasing trend over the years. The results also indicated that introduction of ST156 in our region was preceded by the emergence of trimethoprim-sulfamethoxazole resistance and by the dissemination of ST162. In addition to the presence of successful international clones, a novel regional serotype 14 genotype (CC5401) has emerged in 1996.

Antimicrobial susceptibility and genetic diversity of Streptococcus agalactiae recovered from newborns and pregnant women in Brazil.

BACKGROUND: Streptococcus agalactiae is known to be the major cause of neonatal infections and also causes complications during pregnancy. METHODS: One hundred and six strains of Streptococcus agalactiae recovered from clinical specimens of newborns (n = 18) and pregnant women (n = 88) were submitted to antimicrobial susceptibility testing and investigation of genetic determinants of macrolide resistance, capsular type, and virulence factors. Genetic diversity was evaluated by pulsed-field gel electrophoresis (PFGE) analysis. RESULTS: Strains were susceptible to ceftriaxone, levofloxacin, penicillin G, and vancomycin and resistant to tetracycline (85.8%) and erythromycin (4.7%). Erythromycin-resistant strains presented iMLSB phenotype, harbored the ermA gene, and were closely related by PFGE. Both bac and bca genes were found in low frequencies. PFGE analysis yielded 11 DNA restriction profiles among 35 selected isolates. The major clonal group, designated as A, was composed predominantly of strains belonging to capsular type Ia. Clonal group B was composed predominantly of strains with capsular type V, including all erythromycin-resistant isolates. CONCLUSIONS: Although low levels of erythromycin resistance have been observed, this is a fact of concern because this phenotype also confers resistance to clindamycin, an alternative agent for intrapartum prophylaxis. Despite the diversity of capsular types, Ia and V were among the most common and were significantly associated with distinct clonal groups. In a few cases, different capsular types were clustered into a single clonal group, which may be related to capsular switching.

Etiologia dos casos de candidíase cutânea atendidos no serviço de micologia da Universidade Federal Fluminense, Brasil / Etiología de casos de candidiasis cutánea atendidos en el servicio de micología de la Universidad Federal Fluminense, Brasil / Etiology of cutaneous candidiasis cases seen at the mycology service of the Universidade Federal Fluminense, Brazil

Neste trabalho foram estudadas 64 amostras oriundas de 56 pacientes com suspeita clínica de candidíase cutânea, coletadas de novembro de 2008 a agosto de 2009, no serviço de Diagnóstico Micológico Humano e Veterinário do Departamento de Microbiologia e Parasitologia, Instituto Biomédico da Universidade Federal Fluminense. Foram isoladas espécies de Candida em 58 amostras de 51 pacientes, trinta e oito mulheres e treze homens, com a seguinte distribuição: 15 C. parapsilosis, 11 C. famata, 9 C. albicans, 7 C. haemulonii, 5 C. ciferrii, 4 C. guilliermondii, 4 C. lipolytica e 3 C . tropicalis. As onicomicoses representaram mais de 75% das manifestações clínicas. Nos casos em que não foi Candida isolada como o agente etiológico, foram identificados dois Cryptococcus laurentii, um Trichosporon mucoides e um Trichosporon asahii. Este trabalho é uma contribuição para o entendimento da etiologia de candidíase cutânea no serviço de Micologia da Universidade Federal Fluminense.

En este trabajo se estudiaron 64 muestras procedentes de 56 pacientes con sospecha clínica de candidiasis cutánea, recolectadas entre noviembre de 2008 a agosto de 2009 en el servicio de Diagnóstico Micológico Humano y Veterinario del Departamento de Microbiología y Parasitología, Instituto Biomédico de la Universidad Federal Fluminense. Se aislaron especies del género Candida en 58 muestras de 51 pacientes, treinta y ocho mujeres y trece hombres, con la siguiente distribución: 15 C. parapsilosis, 11 C. famata, 9 C. albicans, 7 C. haemulonii, 5 C. ciferrii, 4 C. guilliermondii, 4 C. lipolytica y 3 C . tropicalis. Las onicomicosis representaron más del 75% de las manifestaciones clínicas. En los casos donde no se aisló Candida como agente etiológico se identificaron dos Cryptococcus laurentii, un Trichosporon mucoides y un Trichosporon asahii. Este trabajo es una contribución al conocimiento de la etiología de la candidiasis cutánea en el Servicio de Micología de la Universidad Federal Fluminense.

This work corresponds to the study of 64 samples from 56 patients with clinical suspicion of cutaneous candidiasis, collected between November 2008 and August 2009 at the Human and Veterinarian Diagnostic Service of the Department of Microbiology and Parasitology of the Instituto Biomédico of the Universidad Federal Fluminense, Brazil. Candida genus species were isolated in 58 samples from 51 patients (38 women and 13 men), with the following distribution: C. parapsilosis 15, C. famata 11, C. albicans 9, C. haemulonii 7, C. guilliermondii 4, C. ciferrii 5, C. lipolytica 4, and C. tropicalis 3. Onicomycoses represented over 75% of the clinical manifestations. In cases where Candida was not isolated as etiologic agent, two Cryptococcus laurentii, one Trichosporum mucoides, and one Trichosporum asahii were identified. This work is a contribution to the knowledge of the etiology of cutaneous candidiasis at the Mycology Service of the Universidade Federal Fluminense.

Molecular characterization of the first fluoroquinolone resistant strains of Streptococcus agalactiae isolated in Brazil.

Three isolates of Streptococcus agalactiae, recovered from residents of the metropolitan area of Rio de Janeiro with significant bacteriuria, were found to be resistant to levofloxacin. Determination of the minimal inhibitory concentration (MIC) confirmed one isolate as intermediate and two as resistant to levofloxacin. No reduction in levofloxacin MIC was observed with reserpine, indicating that resistance was not caused by an efflux mechanism. Typical point mutations were observed in the quinolone resistance determinant region of gyrA and parC. Other point mutations in parC generated novel altered codons: Ser80→Pro in the intermediate resistance isolate, and Gly128→Asp in a resistant isolate. Through molecular modeling, it was possible to observe that these novel substitutions might not play a role in resistance, since these amino acids were not involved in the antibiotic binding site. Pulsed field gel electrophoresis profiles revealed a non-clonal trend among these isolates. This is the first report of genetic characterization of levofloxacin-resistant S. agalactiae strains in Brazil.

Saccharomyces boulardii: novas perspectivas para a terapêutica em diarreia aguda / Saccharomyces bourlardii: new approaches for treatment of acute diarrhea

Probióticos contendo Saccharomyces boulardii têm sido utilizados no tratamento de diarreias de etiologias diversas, incluindo infecciosa e inflamatória. Os mecanismos de ação e efeitos benéficos desses microrganismos no controle do quadro diarreico consistem na redução da hipersecreção de água e eletrólitos, estimulação da atividade de dissacaridases dos enterócitos, produção de aminopeptidases, secreção de IgA, atividade antitoxina, antiinflamatória, metabólica, e antimicrobiana. Tais propriedades biológicas desses microrganismos não patogênicos permitem a sua utilização no tratamento de doenças gastrintestinais endêmicas especialmente em países em desenvolvimento como gastroenterites por rotavírus, diarreia dos viajantes, além de doenças inflamatórias intestinais como a doença de Crohn e colite ulcerativa. Os objetivos dessa revisão consistem em discutir os aspectos significativos e a aplicabilidade do uso de Saccharomyces boulardii no tratamento das diarreias agudas e o racional para a dose de ataque na fase aguda.