Healthcare-Associated Infections-Related Bacteriome and Antimicrobial Resistance Profiling: Assessing Contamination Hotspots in a Developing Country Public Hospital.

Hospital-built environment colonization by healthcare-associated infections-related bacteria (HAIrB) and the interaction with their occupants have been studied to support more effective tools for HAI control. To investigate HAIrB dynamics and antimicrobial resistance (AMR) profile we carried out a 6-month surveillance program in a developing country public hospital, targeting patients, hospital environment, and healthcare workers, using culture-dependent and culture-independent 16S rRNA gene sequencing methods. The bacterial abundance in both approaches shows that the HAIrB group has important representativeness, with the taxa Enterobacteriaceae, Pseudomonas, Staphylococcus, E. coli, and A. baumannii widely dispersed and abundant over the time at the five different hospital units included in the survey. We observed a high abundance of HAIrB in the patient rectum, hands, and nasal sites. In the healthcare workers, the HAIrB distribution was similar for the hands, protective clothing, and mobile phones. In the hospital environment, the healthcare workers resting areas, bathrooms, and bed equipment presented a wide distribution of HAIrB and AMR, being classified as contamination hotspots. AMR is highest in patients, followed by the environment and healthcare workers. The most frequently detected beta-lactamases genes were, bla SHV-like, bla OXA- 23 -like, bla OXA- 51 -like, bla KPC-like, bla CTX-M- 1, bla CTX-M- 8, and bla CTX-M- 9 groups. Our results demonstrate that there is a wide spread of antimicrobial resistance due to HAIrB in the hospital environment, circulating among patients and healthcare workers. The contamination hotspots identified proved to be constant over time. In the fight for patient safety, these findings can reorient practices and help to set up new guidelines for HAI control.

Genomic analysis of an extensively drug-resistant Pseudomonas aeruginosa ST312 harbouring IncU plasmid-mediated blaKPC-2 isolated from ascitic fluid.

OBJECTIVES: The Klebsiella pneumoniae carbapenemase (KPC) is disseminated worldwide mostly by plasmids. However, in Pseudomonas aeruginosa chromosomal mutations are more frequently responsible for resistance to carbapenems than the acquisition of mobile elements harbouring carbapenemases genes. Indeed, although uncommon, KPC-2-producing P. aeruginosa has appeared more frequently, including in Brazil. Here we report the first genomic analysis of a plasmid-mediated KPC-2 in an extensively drug-resistant (XDR) P. aeruginosa isolated in Santa Catarina, Brazil. METHODS: Antimicrobial susceptibility testing was performed according to CLSI 2020 guidelines. The genome was sequenced using an Illumina MiSeq platform and the data were analysed using SPAdes and Prokka. In silico predictions were fulfilled using curated bioinformatics tools. RESULTS: Pseudomonas aeruginosa strain MIMA_PA2.1 (JACGTM000000000) was classified as XDR, belongs to sequence type 312 (ST312) and harbours the blaKPC-2 gene located on a small (7975 bp) IncU plasmid. This plasmid showed 86.3% identity with a non-conjugative plasmid (KC609322) carrying the blaKPC-2 gene from a multidrug-resistant P. aeruginosa (ST1006) from Colombia isolated in 2006. Besides the blaKPC-2 gene, other resistance genes to ß-lactams, aminoglycosides, phenicol, fosfomycin and quinolones were detected, the last two also associated with mobile genetic elements other than the IncU plasmid described here. CONCLUSION: This is the first genomic report of the presence of the blaKPC-2 gene carried by Pseudomonas in Southern Brazil and highlights the adaptability of blaKPC-2 to different mobile elements. This draft genome might be useful for comparative genomic analyses to monitor the spread of plasmid-mediated blaKPC in P. aeruginosa in Latin America.

Avaliação dos indicadores de qualidade de laboratórios de citopatologia cervical / Evaluation of the quality indicators of cervical cytopathology laboratories

Neste trabalho foi avaliado o desempenho dos 13 laboratórios que realizaram o exame citopatológico para o SUS no Paraná, por meio de seis indicadores do monitoramento interno da qualidade (MIQ).Foi realizado estudo retrospectivo, baseado nos dados obtidos no programa do Ministério da Saúde,SISCOLO/CNES, dos laboratórios que efetuaram acima de 1.500 exames de Papanicolaou/ano, de janeiro de 2008 a dezembro de 2012. A avaliação da qualidade dos laboratórios foi feita pela análise do índice de positividade (IP), percentuais de exames compatíveis com ASC entre os exames satisfatórios, ASCentre os exames alterados, exames compatíveis com HSIL, exames insatisfatórios e razão ASC/SIL. Dos laboratórios avaliados, apenas um apresentou produtividade maior que 15 mil exames/ano conforme recomendação da QualiCito, e correspondeu a 82,9 % dos exames realizados no estado. O IP mostrou que 46,1 % dos laboratórios apresentaram resultado muito baixo, 38,5 % baixo, apenas 18,1 % dentro da faixa esperada. Com relação ao percentual de HSIL, 23,1 % dos laboratórios apresentaram percentual igual ou superior a 0,4 %. Portanto, os resultados deste estudo mostraram que os indicadores de qualidade do MIQ, dos laboratórios que realizaram exame citopatológico para o SUS, estão abaixo dos parâmetros recomendado pelo Ministério da Saúde...