Perfil de susceptibilidade aos carbapenêmicos de bacilos Gram-negativos fermentadores da glicose isolados de hemoculturas / Carbapenem susceptibility profile of Gram-negative glucose fermenting bacilli isolated from hemocultures

As Enterobacteriaceae são bactérias Gram-negativas e frequentes causadoras de infecções hospitalares. Os carbapenêmicos (CROs) são considerados as mais recentes linhas de defesa contra infecções por microrganismos multirresistentes, no entanto o desenvolvimento de bactérias multirresistentes a esta classe medicamentosa tem prejudicado o tratamento farmacológico. Nesse sentido, o presente estudo trata-se de uma análise retrospectiva, tendo como objetivo avaliar o perfil de resistência e susceptibilidade de bacilos Gram-negativos fermentadores da glicose aos carbapenêmicos em isolados de hemoculturas positivas no período de janeiro de 2018 a janeiro 2019. Das 5.733 hemoculturas realizadas nesse período, cerca de 5,4% (311 amostras) foram positivas. Dentre essas, 34,4% (107 amostras) positivas para enterobactérias e 65,6% (204 amostras) positivas para outras espécies. Foi observada uma maior incidência de Klebsiella pneumoniae (34,6% dos casos), seguido pela Klebsiella sp. (28,9%) e a Escherichia coli (26,2%). Contudo, três (03) isolados de hemocultura da espécie Klebsiella pneumoniae se mostraram resistentes aos três antibióticos (ertapenem, meropenem e imipenem). Dois isolados de Enterobacter cloaceae também obtiveram resistência aos antibióticos utilizados e uma espécie de Enterobacter aerogenes mostrou-se resistente apenas ao ertapenem e meropenem e sensibilidade ao imipenem.Enterobacteriaceae are Gram-negative bacteria and frequent causes hospital infections. Carbapenemic (CRO) are considered the latest lines of defense against infections by multidrug-resistant microorganisms, however the development of multidrug-resistant bacteria in this drug class has impaired treatment pharmacological. The present study is a retrospective analysis, with the objective of evaluating the resistance and susceptibility profile from isolates in blood cultures from January 2018 to January 2019, from positive blood cultures with enterobacteria growth and analysis of antibiograms performed from fermenter Gram-negative glucose bacilli to carbapenem antimicrobials. Of the 5,733 blood cultures performed from January 2018 to January 2019, about 5.4% (311 samples) were positive. Among these, 34.4% (107 samples) positive for enterobacteria and 65.6% (204 samples) for other species. A higher incidence of Klebsiella pneumoniae (34.6% of cases) was observed, followed by Klebsiella sp. (28.9%) and Escherichia coli (26.2%), however, three hemoculture isolates of the species Klebsiella pneumoniae, which were resistant to the three antibiotics (ertapenem, meropenem and imipenem). Two (2) isolates of Enterobacter cloaceae also obtained resistance to the antibiotics used and one (1) species of Enterobacter aerogenes proved resistant only to ertapenem and meropenem and sensitivity to imipenem.

As Enterobacteriaceae são bactérias Gram-negativas e frequentes causadoras de infecções hospitalares. Os carbapenêmicos (CROs) são considerados as mais recentes linhas de defesa contra infecções por microrganismos multirresistentes, no entanto o desenvolvimento de bactérias multirresistentes a esta classe medicamentosa tem prejudicado o tratamento farmacológico. Nesse sentido, o presente estudo trata-se de uma análise retrospectiva, tendo como objetivo avaliar o perfil de resistência e susceptibilidade de bacilos Gram-negativos fermentadores da glicose aos carbapenêmicos em isolados de hemoculturas positivas no período de janeiro de 2018 a janeiro 2019. Das 5.733 hemoculturas realizadas nesse período, cerca de 5,4% (311 amostras) foram positivas. Dentre essas, 34,4% (107 amostras) positivas para enterobactérias e 65,6% (204 amostras) positivas para outras espécies. Foi observada uma maior incidência de Klebsiella pneumoniae (34,6% dos casos), seguido pela Klebsiella sp. (28,9%) e a Escherichia coli (26,2%). Contudo, três (03) isolados de hemocultura da espécie Klebsiella pneumoniae se mostraram resistentes aos três antibióticos (ertapenem, meropenem e imipenem). Dois isolados de Enterobacter cloaceae também obtiveram resistência aos antibióticos utilizados e uma espécie de Enterobacter aerogenes mostrou-se resistente apenas ao ertapenem e meropenem e sensibilidade ao imipenem.

Evaluation of Phenotypic and Genotypic Characteristics of Carbapnemases-producing Enterobacteriaceae and Its Prevalence in a Referral Hospital in Tehran City.

BACKGROUND & OBJECTIVE: Carbapenem-resistant Enterobacteriaceae is a growing concern worldwide including Iran. The emergence of this pathogen is worrying as carbapenem is one of the 'last-line' antibiotics for treatment of infections caused by multi drug resistant gram- negative bacteria. The main objective of this study was to determine the prevalence of carbapenem-resistant Enterobacteriaceae in a referral hospital in Tehran, Iran. METHODS: In this study, all positive isolates of Enterobacteriaceae recorded in blood, urine, and other body fluids were studied during April 2017 to April 2018 in a referral hospital in Tehran. All cases of resistance to carbapenems were first tested by modified Hodge test. All cases with positive or negative test, after gene extraction, were examined genotypically based on the primers designed for the three Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-ß-lactamase (NDM), and OXA-48 genes by conventional PCR method. RESULTS: 108 isolates (13.6%) were resistant to all cephalosporins as well as to imipenem and meropenem. In a genotypic study, including 45 isolates, 13 isolates were positive for OXA-48 gene, 11 isolates for OXA-48 and NDM genes, 11 isolates for OXA-48, NDM and KPC genes, 4 isolates for OXA-48 genes and KPC, 3 isolates for NDM, one isolate for KPC. On the other hand, two isolates were negative for all three genes examined. CONCLUSION: OXA-48 gene was one of the most common genes resistant to carbapenems in Iran. According to studies, the prevalence of antibiotic resistance in Iran is rising dramatically, which reduces the choice of antibiotics to treat severe infections in the future.

Wild Birds in Live Birds Markets: Potential Reservoirs of Enzootic Avian Influenza Viruses and Antimicrobial Resistant Enterobacteriaceae in Northern Egypt.

Wild migratory birds are often implicated in the introduction, maintenance, and global dissemination of different pathogens, such as influenza A viruses (IAV) and antimicrobial-resistant (AMR) bacteria. Trapping of migratory birds during their resting periods at the northern coast of Egypt is a common and ancient practice performed mainly for selling in live bird markets (LBM). In the present study, samples were collected from 148 wild birds, representing 14 species, which were being offered for sale in LBM. All birds were tested for the presence of AIV and enterobacteriaceae. Ten samples collected from Northern Shoveler birds (Spatula clypeata) were positive for IAV and PCR sub-typing and pan HA/NA sequencing assays detected H5N8, H9N2, and H6N2 viruses in four, four, and one birds, respectively. Sequencing of the full haemagglutinin (HA) gene revealed a high similarity with currently circulating IAV in Egypt. From all the birds, E.coli was recovered from 37.2% and Salmonella from 20.2%, with 66%-96% and 23%-43% isolates being resistant to at least one of seven selected critically important antimicrobials (CIA), respectively. The presence of enzootic IAV and the wide prevalence of AMR enterobacteriaceae in wild birds highlight the potential role of LBM in the spread of different pathogens from and to wild birds. Continued surveillance of both AIV and antimicrobial-resistant enterobacteriaceae in wild birds' habitats is urgently needed.

Risk factors for acquisition of multidrug-resistant Enterobacterales among international travellers: a synthesis of cumulative evidence.

BACKGROUND: Recent studies have shown that over 50% of people travelling to Southeast Asia return colonized with multidrug-resistant Enterobacterales (MRE) including carbapenemase-producing Enterobacterales. Importation of MRE by travellers and subsequent spread to family members, communities and healthcare facilities poses real risks that have not yet been adequately assessed. This systematic review and meta-analysis aims to quantify the risk factors and interventions for reducing the risk of MRE acquisition among international travellers. METHODS: A systematic search was conducted in PubMed, Web of Science and Scopus for analytical epidemiological studies containing data post-2000 that assessed the risk factors to acquire and/or interventions to reduce the risk of MRE acquisition in travellers. Two researchers independently screened all the studies and extracted the information, and disagreements were resolved through consensus. The proportions of MRE acquisition by the region of destination and the odds ratio (OR) for the different risk factors and/or interventions were pooled using the inverse variance heterogeneity model. RESULTS: A total of 20 studies (5253 travellers from high-income countries) were included in the meta-analysis. South Asia [58.7%; 95% confidence interval (CI), 44.5-72.5%] and Northern Africa (43.9%; 95% CI 37.6-50.3%) were the travel destinations with the highest proportion of MRE acquisition. Inflammatory bowel disease (OR 2.1; 95% CI 1.2-3.8), use of antibiotics (OR 2.4; 95% CI 1.9-3.0), traveller's diarrhoea (OR 1.7; 95% CI 1.3-2.3) and contact with the healthcare system overseas (OR 1.5; 95% CI 1.1-2.2) were associated with MRE colonization. Vegetarians (OR 1.4; 95% CI 1.0-2.0) and backpackers (OR 1.5; 95% CI 1.2-1.8) were also at increased odds of MRE colonization. Few studies (n = 6) investigated preventive measures and found that consuming only bottled water/beverages, meticulous hand hygiene and probiotics had no protective effect on MRE colonization. CONCLUSIONS: International travel is an important driver for MRE spread worldwide. Future research needs to identify effective interventions to reduce the risk of MRE acquisition as well as design strategies to reduce local transmission on return.

Antibiotic resistance and virulence factors among Escherichia coli isolates from avian organic fertilizer / Resistência a antibióticos e fatores de virulência entre isolados de Escherichia coli provenientes de fertilizante orgânico aviário

ABSTRACT: Brazilian poultry industry generates large amounts of organic waste, such as chicken litter, which is often used in agriculture. Among the bacteria present in organic fertilizer are members of the Enterobacteriaceae family, such as Escherichia coli. The aim of this study was to analyze the profile of virulence factors and antimicrobial resistance of E. coli isolates from avian organic fertilizer. A total of 47 E. coli strains were tested through Polymerase chain reaction to detect virulence genes (hlyF, iss, ompT, iutA and iroN). Fourteen antimicrobials were used to test antimicrobial susceptibility in the strains. Genes characteristic of Avian Pathogenic E. coli (APEC) were reported among the strains, with the hlyF, iss and ompT genes being the most prevalent. The isolates showed high resistance (˃50%) to tetracycline, gentamicin, cefotaxime, nitrofurantoin, trimethoprim-sulfamethoxazole and ampicillin. Multidrug resistance was reported in a great number of strains (>70%). The results showed the presence of APEC cells with virulence genes and antimicrobial resistance after 15 days of the windrowing process in poultry houses, it means this process should be improved to eliminate these cells.

RESUMO: A indústria avícola brasileira gera grandes quantidades de resíduos orgânicos, como a cama de frango, utilizada frequentemente na agricultura. Entre as bactérias presentes neste fertilizante orgânico estão os membros da família Enterobacteriaceae, entre eles a Escherichia coli. O objetivo deste estudo foi analisar o perfil de fatores de virulência e resistência antimicrobiana de isolados de E. coli provenientes do fertilizante orgânico aviário. Um total de 47 cepas de E. coli foram testadas por meio da reação em cadeia da polimerase para detectar genes de virulência (hlyF, iss, ompT, iutA e iroN). Quatorze antimicrobianos foram utilizados para testar a susceptibilidade antimicrobiana nos isolados. Genes característicos de E. coli Patogênica Aviária (APEC) foram encontrados entre os isolados, sendo os genes hlyF, iss e ompT os mais prevalentes. Os isolados apresentaram alta resistência (˃50%) à tetraciclina, gentamicina, cefotaxima, nitrofurantoína, trimetoprima-sulfametoxazole e ampicilina. Múltipla resistência a drogas antimicrobianas foi encontrada em grande número de isolados (>70%). Os resultados obtidos mostraram a presença de células APEC portando genes de virulência e resistência a antimicrobianos após 15 dias de processo de empilhamento nas granjas, indicando que o processo necessita de um aperfeiçoamento para eliminar estas células.

Bactericidal efficacy of meropenem in combination with cefmetazole against IMP-producing carbapenem-resistant Enterobacteriaceae.

OBJECTIVE: Carbapenem-resistant Enterobacteriaceae (CRE) are among the most severe threats to public and clinical health because of their high levels of resistance to various antibiotics. We assessed the efficacy of combination therapy with meropenem (MEM) and cefmetazole (CMZ) against Imipenemase (IMP)-producing CRE, using the checkerboard method and time-killing assay on 13 Enterobacteriaceae isolates harboring blaIMP-1 (4 Enterobacter hormaechei, 5 Escherichia coli, and 4 Klebsiella pneumoniae isolates) and 13 isolates harboring blaIMP-6 (8 E. coli and 5 K. pneumoniae isolates). RESULTS: Minimum inhibitory concentrations (MICs) of MEM and CMZ ranged from 2 to 64 and 64 to 2048 µg/mL, respectively. Checkerboard method demonstrated the synergy of the MEM/CMZ combination in all the tested IMP-producing CRE isolates, and the time-kill assay indicated a bactericidal effect for both blaIMP-1 and blaIMP-6 positive CRE when MEM/CMZ combination was used. In vitro, the MEM/CMZ combination was potentially effective against IMP-1- or IMP-6-producing CRE. Further investigations including in vivo animal studies and clinical studies are warranted to corroborate the clinical utility of the novel combination therapy.

A new rapid method for detecting extended-spectrum beta-lactamase/AmpC-producing Enterobacteriaceae directly from positive blood cultures using the Uro4 HB&L™ system.

PURPOSE: To evaluate the performance of the Uro4 HB&L™ system in screening ESBL/AmpC-producing Enterobacteriaceae as compared with the resistant test by VITEK 2. The resistance profile of the ESBL-producing bacteria was also evaluated. METHODOLOGY: Blood culture samples were collected at bedside, inoculated directly into BD BACTEC™ culture bottles, and incubated. When microbial growth was found, samples were prepared for identification using MALDI-ToF. The Uro4 HB&L™ system was used for direct detection of ESBL/AmpC-producing bacteria compared with conventional methods. RESULTS: A total of 103 positive blood cultures containing Gram-negative bacteria were tested. Uro4™ HB&L screening results were obtained in up to 6.5 h, with 91.3% concordance with the VITEK2 system, with 85% sensitivity, 95.2% specificity, and 91.1% positive and 90.9% negative predictive values. The resistance profile of ESBL-producing bacteria tested in the present study showed increased resistance ratio to ciprofloxacin, gentamicin, and trimethoprim/sulfamethoxazole. In parallel, susceptibility to amikacin and meropenem was not affected. CONCLUSIONS: The performance of the Uro4 HB&L™ system is acceptable for rapid screening ESBL/AmpC-producing Enterobacteriaceae. The data related to detecting ESBL-producing bacteria are crucial for managing antimicrobial therapy.

Dietary supplementation of different parts of Andrographis paniculata affects the fatty acids, lipid oxidation, microbiota, and quality attributes of longissimus muscle in goats.

The effects of dietary supplementation of different parts of Andrographis paniculata on fatty acids, lipid oxidation, microbiota and quality attributes of Longissimus thoracis et lumborum (LTL) muscle in goats were assessed. Twenty four, entire Boer bucks (4 months old; 20.18 ±â€¯0.19 kg BW) were randomly allotted to either a basal diet without additive (AP0), a basal diet + 1.5% Andrographis paniculata leaves (APL) or a basal diet + 1.5% Andrographis paniculata whole plant (APW). The bucks were fed the diets for 100 d and slaughtered. The LTL muscle was subjected to a 7 d chill storage. The AP0 meat had higher (p < .05) concentration of C16:0 and C18:0 than the APW and APL meat. The concentrations of total C18:1trans, total CLA, C18:1n-9, C18:2n-6, C18:3n-3 and C20:5n-3 were higher (p < .05) in APL and APW meat than the AP0 meat. Diets had no effect (p > .05) on muscle glycogen, pH, drip loss, chemical composition and lactic acid bacteria count. Cooking loss, shear force, and TBARS values were lower (p < .05) in APL (23.98%, 0.76 kg, 0.12 mg MDA/kg) and APW (24.53%, 0.80 kg, 0.15 mg MDA/kg) meat compared with AP0 (26.49%, 1.13 kg, 0.23 mg MDA/kg) meat. Meat redness was higher (p < .05) in APL (13.49) and APW (12.98) than AP0 (10.86). Sensory scores for juiciness, tenderness, and overall acceptability of APL (7.92, 7.88, 7.89) and APW (7.90, 7.08, 7.77) meat were higher (p < .05) than that of the AP0 (5.38, 5.95, 5.41) meat. Total viable counts and populations of Pseudomonas spp, Escherichia coli and Enterobacteriacea were higher (p < .05) in AP0 meat than in APL and APW meat. The APL exhibited higher (p < .05) antimicrobial potential than the APW. Chill storage affected (p < .05) the physicochemical properties, lipid oxidation and microbial counts in chevon. Dietary APL and APW enhanced the beneficial fatty acids, quality attributes and oxidative stability, and reduced microbial counts in chevon.

Diet breadth and exploitation of exotic plants shift the core microbiome of Cephaloleia, a group of tropical herbivorous beetles.

The beetle genus Cephaloleia has evolved in association with tropical ginger plants and for many species their specific host plant associations are known. Here we show that the core microbiome of six closely related Costa Rican Cephaloleia species comprises only eight bacterial groups, including members of the Acinetobacter, Enterobacteriacea, Pseudomonas, Lactococcus, and Comamonas. The Acinetobacter and Enterobacteriacea together accounted for 35% of the total average 16S rRNA ribotypes recovered from all specimens. Further, microbiome diversity and community structure was significantly linked to beetle diet breadth, between those foraging on less than two plant types (specialists) versus over nine plant types (generalists). Moraxellaceae, Enterobacteriaceae, and Pseudomonadaceae were highly prevalent in specialist species, and also present in eggs, while Rickettsiaceae associated exclusively with generalist beetles. Bacteria isolated from Cephaloleia digestive systems had distinct capabilities and suggested a possible beneficial role in both digestion of plant-based compounds, including xylose, mannitol, and pectin, and possible detoxification, via lipases. Cephaloleia species are currently expanding their diets to include exotic invasive plants, yet it is unknown whether their microbial community plays a role in this transition. In this study, colonization of invasive plants was correlated with a dysbiosis of the microbiome, suggesting a possible relationship between gut bacteria and niche adaptation.

Comparison of antibacterial effects of a carrier produced in microemulsion system from aqueous extract of Aloe vera with selected antibiotics on Enterobacteriacea.

BACKGROUND AND OBJECTIVES: Antibiotics resistance has recently increased. The aim of this study was the evaluation of antibacterial efficacy of Aloe vera carrier produced in microemulsion system in comparison with ordinary antibiotics against some Enterobacteriacea. MATERIALS AND METHODS: The aquatic extract of Aleo vera was produced by the Soxhlet method and a nonocarrier in the microemulsion system was prepared by two emulsifiers. The clinical isolates of Escherichia coli, Klebsiella pneumoniae, Salmonella enterica, Shigella dysenteriae, Salmonella Typhimurium, Salmonella Paratyphi, Serratia marcescens, Proteus mirabilis, Enterobacter aerogenes, Citrobacter freundii and Morganella morganii were obtained from patients and were identified by microbiological methods. Diffusion disk was used for evaluation of antibacterial properties in comparison with selected ordinary antibiotics. Minimum Inhibitory Concentration (MIC) and Minimum Bactericidal Concentration (MBC) for tested materials were determined using MTT in the Micro Broth dilution method. RESULTS: The results proved that effect of carrier on studied isolates is dependent on concentration level. The inhibitory effect of carrier in concentration of 15 µg/ml by 18 mm zone of inhibition for Klebsiella pneumoniae was comparable to Ceftazidime and Cefalothin. The lowest MIC and MBC determined by the Microbroth dilution method with MTT belonged to Klebsiella pneumoniae as 0.1 and 3 µg/ml and higher concentrations belonged to Enterobacter aerogenes at 7 and 15 µg/ml. The greatest effect of carrier of Aleo vera aquatic extract was observed for Klebsiella pneumoniae and the lowest effect belonged to Enterobacter aerogenes, Citrobacter freundii and Morganella morganii. CONCLUSION: It was concluded that the carrier of Aloe vera produced in microemulsion system was most effective and had equal effects in comparison with ordinary antibiotics against Enterobacteriacea.

Characterisation of plasmid-mediated rmtB-1 in Enterobacteriaceae clinical isolates from São Paulo, Brazil

OBJECTIVES The emergence of 16S rRNA methyltranferases (16 RMTAses) has jeopardised the clinical use of aminoglycosides. RmtB is one of the most frequently reported in Gram-negatives worldwide. In this study, we aimed to estimate the frequency of 16S RMTAses encoding genes in Enterobacteriaceae isolated in a three-month period from a tertiary Brazilian hospital. METHODS All Gram-negatives classified as resistant to amikacin, gentamicin, and tobramycin by agar screening were selected for analysis. The presence of 16SRMTases encoding genes was verified by polymerase chain reaction (PCR). Antimicrobial susceptible profile was determined by broth microdilution. The genetic relationship among these isolates was accessed by pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Selected RmtB-producing isolates were characterised by whole genome sequencing (WGS) analysis. RESULTS Twenty-two of 1,052 (2.1%) Enterobacteriaceae were detected as producers of RmtB-1 [Klebsiella pneumoniae (n = 21) and Proteus mirabilis (n = 1)]. blaKPC-2 was identified among 20 RmtB-1-producing K. pneumoniae isolates that exhibited an identical PFGE and MLST (ST258) patterns. Two K. pneumoniae isolates, the A64216 (not harboring bla KPC-2), A64477 (harboring bla KPC-2) and one P. mirabilis isolate (A64421) were selected for WGS. rmtB-1 and bla KPC-2 genes were carried by distinct plasmids. While a plasmid belonging to the IncFIIk group harbored rmtB-1 in K. pneumoniae, this gene was carried by a non-typable plasmid in P. mirabilis. In the three analysed plasmids, rmtB-1 was inserted on a transposon, downstream a Tn2. CONCLUSION Our findings suggested that the rmtB-1 was harbored by plasmids distinct from those previously reported in Bolivia and China. It suggests that multiple mobilization events might have occurred in South America.

Inactivación del carbapenémico, un método alternativo para detectar carbapenemasa tipo KPC en Enterobacteriaceae / Carbapenem inactivation, an alternative method to detect carbapenemase type KPC in Enterobacteriacea

Objetivo: Evaluar al método de inactivación del carbapenémico (MIC*) frente a técnicas como el Test de Hodge modificado (THM), ácido 3-aminofenilborónico (APB) y la reacción en cadena de la polimerasa en enterobacterias productoras de carbapenemasas (EPC) tipo KPC. Materiales y métodos: Se seleccionaron 88 aislados clínicos de K. pneumoniae, K. oxytoca, E.coli, S. marcescens, C. freundii sensibles y 91 resistentes a los carbapenémicos. El APB y el método MIC* se realizaron siguiendo las publicaciones originales. El THM se realizó de acuerdo al CLSI 100S Edición 26-2016. El gen blaKPC se identificó por multiplex PCR. Resultados: El MIC* en EPC tipo KPC presentó una sensibilidad/especificidad cercana al 100% y kappa de 1 comparado con la PCR; se observó la ausencia de halo en todas los aislados EPC tipo KPC a diferencia de los aislados sensibles a los cabapenémicos que presentaron halo > 19mm. Se observó el 3 % de resultados falsos positivos y el 5 % de falsos negativos en THM y ABP respectivamente. Discusión y conclusiones: El MIC* y la PCR demuestran superioridad al THM y ABP para identificar carbapenemasas tipo KPC en EPC. Se recomienda su uso de forma rutinaria dentro del algoritmo para la contención de infecciones por este tipo de patógenos.

Objective: To compare the carbapenem inactivation method (CIM *) with the Modified Hodge Test (MHT), the acid 3-aminophenylboronic test(APB) and the polymerase chain reaction (PCR) detection of the blaKPC gene for the identification of KPC carbapenemase producing Enterobacteriaceae (ECP). Materials and Methods: We selected 88 susceptible and 91 carbapenems resistant clinical isolates of Klebsiella pneumoniae, Klebsiella oxytoca, Escherichia coli, Serratia marcescens and Citrobacter freundii. We performed APB and CIM* according to previously published methods and the MHT according to CLSI 100S Edition 26-2016. The blaKPC gene was identified by PCR multiplex. Results: The CIM* had a sensitivity and specificity close to 100% and a kappa score of 1 compared with gold standard PCR. The absence of zone diameter was observed in all isolated KPC producers, unlike in isolates susceptible to carbapenems, where a zone diameter >19mm was observed. Three percent of false positive and five percent of false negative was observed in THM and ABP respectively. Discussion and conclusions: The CIM* and the PCR were better than MHT and ABP at identifying carbapenemases in ECP. We recommend the routine use of the CIM* within the algorithm for ECP infection control.

High burden of Carbapenem-resistant Enterobacteriaceae (CRE) fecal carriage at a teaching hospital: cost-effectiveness of screening in low-resource setting.

BACKGROUND: Infections by multidrug-resistant gram-negative bacteria (MDR-GNB) have been continuously growing and pose challenge to health institution globally. Carbapenem-resistant Enterobacteriacea (CRE) was identified as one of the MDR-GNB which has limited treatment options and higher mortality compared to those of sensitive strains. We report an increased burden of CRE fecal carriage at a hospital in the North-eastern region of Malaysia. METHODS: A retrospective descriptive study from August 2013 to December 2015 was conducted in the Medical Microbiology & Parasitology laboratory of Hospital Universiti Sains Malaysia, which is a tertiary teaching hospital with more than 700 beds. This hospital treats patients with various medical and surgical conditions. Suspected CRE from any clinical specimens received by the laboratory was identified and confirmed using standard protocols. Polymerase chain reaction (PCR) assay was performed to determine the genotype. RESULTS: Altogether, 8306 Enterobacteriaceae was isolated from various clinical specimens during the study period and 477/8306 (5.74%) were CRE. Majority of the isolated CRE were Klebsiella [408/477, (85.5%)], of which Klebsiella pneumoniae was the predominant species, 388/408 (95%). CRE were mainly isolated from rectal swab (screening), 235/477 (49.3%); urine, 76/477 (15.9%); blood, 46/477 (9.6%) and about 7.1% from tracheal aspirate. One hundred and thirty-six isolates were subjected to genotype determination and., 112/136 (82.4%) showed positive detection of New Delhi metallo-ß-lactamase 1 (NDM-1) gene (blaNDM1). CONCLUSION: The study noted a high numbers of CRE isolated especially from rectal swabs. Active screening results in significant cost pressures and therefore should be revisited and revised, especially in low resource settings.

Multidrug-resistant bacteria in unaccompanied refugee minors arriving in Frankfurt am Main, Germany, October to November 2015.

Many refugees arriving in Germany originate or have travelled through countries with high prevalence of multidrug-resistant Gram-negative organisms. Therefore, all unaccompanied refugee minors (<18 years-old) arriving in Frankfurt am Main between 12 October and 6 November 2015, were screened for multidrug-resistant Enterobacteriaceae in stool samples. Enterobacteriaceae with extended spectrum beta-lactamases (ESBL) were detected in 42 of 119 (35%) individuals, including nine with additional resistance to fluoroquinolones (8% of total screened), thus exceeding the prevalences in the German population by far.

Próteses totais removíveis como reservatório de microrganismos oportunistas / Removable total prostheses as reservoir of oportunists microrganisms

Este estudo avaliou a ocorrência de leveduras do gênero Candida sp além dos principais microrganismos periodontopatogênicos e enterobactérias na saliva, em mucosa e no biofilme aderido à prótese total, correlacionando com aspectos clínicos e condição de higiene bucal de 90 indivíduos edêntulos e portadores de prótese total, por meio de métodos moleculares (PCR). Espécimes clínicos intrabucais foram coletados desses indivíduos após avaliação das condições sócio-econômicas e comportamentais. A microbiota bucal dos pacientes foi caracterizada por meio da obtenção de amostras de biofilme aderido às próteses totais, mucosa e saliva, as quais foram processadas, por meio de PCR. As inter-relações entre os diferentes microrganismos foram determinadas por meio dos testes de Qui-quadrado e Mann- Whitney. Verificaram-se diferenças na ocorrência de Prevotella intermedia e Enterobacteriaceae na saliva dos pacientes edêntulos, o mesmo ocorrendo com Enterobacteriaceae, Camphylobacter rectus e gênero Pseudomonas no biofilme aderido às próteses totais. As condições de higiene bucal e estado de conservação da prótese total precários favoreceram a ocorrência de leveduras do tipo Candida sp, em especial Candida albicans, em níveis estatisticamente significante nas amostras de mucosa e biofilme aderido à prótese total, tornando este dispositivo protético um potencial reservatório de leveduras e bactérias entéricas que podem ser de relevância na patogênese das infecções oportunistas

The aim of this study was to evaluate the occurrence of major periodontopathogenic microorganisms and Enterobacteriaceae and biofilm adhered to the denture, mucosa and saliva in 90 edentulous subjects with complete dentures, using molecular methods (PCR). Clinical specimens were collected from these individuals after assessing the socio-economic circumstances and behavioral. The oral microbiota of patients was characterized by obtaining samples of the biofilm adhered to the dental prothesis and saliva, for detection of major pathogens using PCR. The possibility of inter-relationships between different microorganisms was determined using the chi-square test and Mann-Whitney test. There were differences in the occurrence of Prevotella intermedia and Enterobacteriaceae in the saliva of edentulous patients, likewise, Enterobacteriaceae, Pseudomonas, Camphylobacter rectus and the biofilm attached to denture patients. The conditions for oral hygiene and stat of preservation of prosthesis total precarious favored the occurrence of yeasts of the Candida sp, particularly Candida albicans, statistically significant levels in samples of mucosa and biofilm acceded to total prosthesis, prothetic device, making it a potential reservoir of enteric bacteria and yeasts that may be of relevance in the pathogenesis of opportunistic infections

Próteses totais removíveis como reservatório de microrganismos oportunistas / Removable total prostheses as reservoir of oportunists microrganisms

Este estudo avaliou a ocorrência de leveduras do gênero Candida sp além dos principais microrganismos periodontopatogênicos e enterobactérias na saliva, em mucosa e no biofilme aderido à prótese total, correlacionando com aspectos clínicos e condição de higiene bucal de 90 indivíduos edêntulos e portadores de prótese total, por meio de métodos moleculares (PCR). Espécimes clínicos intrabucais foram coletados desses indivíduos após avaliação das condições sócio-econômicas e comportamentais. A microbiota bucal dos pacientes foi caracterizada por meio da obtenção de amostras de biofilme aderido às próteses totais, mucosa e saliva, as quais foram processadas, por meio de PCR. As inter-relações entre os diferentes microrganismos foram determinadas por meio dos testes de Qui-quadrado e Mann- Whitney. Verificaram-se diferenças na ocorrência de Prevotella intermedia e Enterobacteriaceae na saliva dos pacientes edêntulos, o mesmo ocorrendo com Enterobacteriaceae, Camphylobacter rectus e gênero Pseudomonas no biofilme aderido às próteses totais. As condições de higiene bucal e estado de conservação da prótese total precários favoreceram a ocorrência de leveduras do tipo Candida sp, em especial Candida albicans, em níveis estatisticamente significante nas amostras de mucosa e biofilme aderido à prótese total, tornando este dispositivo protético um potencial reservatório de leveduras e bactérias entéricas que podem ser de relevância na patogênese das infecções oportunistas

The aim of this study was to evaluate the occurrence of major periodontopathogenic microorganisms and Enterobacteriaceae and biofilm adhered to the denture, mucosa and saliva in 90 edentulous subjects with complete dentures, using molecular methods (PCR). Clinical specimens were collected from these individuals after assessing the socio-economic circumstances and behavioral. The oral microbiota of patients was characterized by obtaining samples of the biofilm adhered to the dental prothesis and saliva, for detection of major pathogens using PCR. The possibility of inter-relationships between different microorganisms was determined using the chi-square test and Mann-Whitney test. There were differences in the occurrence of Prevotella intermedia and Enterobacteriaceae in the saliva of edentulous patients, likewise, Enterobacteriaceae, Pseudomonas, Camphylobacter rectus and the biofilm attached to denture patients. The conditions for oral hygiene and stat of preservation of prosthesis total precarious favored the occurrence of yeasts of the Candida sp, particularly Candida albicans, statistically significant levels in samples of mucosa and biofilm acceded to total prosthesis, prothetic device, making it a potential reservoir of enteric bacteria and yeasts that may be of relevance in the pathogenesis of opportunistic infections

Diagnóstico microbiológico e histopatológico de mortalidade em avestruzes (Struthio camelus) / Microbiological and histological diagnosis in mortality of ostrich (Struthio camelus)

Several young ostrich, including nestlings, with lassitude and inappetence followed by death or victim of sudden death were immediately brought to diagnosis at an Animal Health Laboratory. At necropsy, animals presented hemorrhage and altered content of the vitelline sac, and necrotic foci in the small intestine; one animal showed necrotic pleuropneumonia with psammomatosus bodies in the lung parenchyma. The cultures from different samples revealed Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Serratia marcescens, Enterobacter aglomerans, and Pseudomonas mendocina. It was suggested one case of septicemia in an animal with exclusive growth of K. pneumoniae isolated from samples of small intestine, lung, and liver.