RESUMEN
The study aim was to describe the emergence of carbapenem resistance and clonal complexes (CC), defined by multilocus sequence typing (MLST), in Acinetobacter baumannii in a surveillance system for meningitis. Starting in 1996 in an urban setting of Brazil, surveillance detected meningitis by Acinetobacter sp for the first time in 2002. Up to 2008, 35 isolates were saved. Carbapenem resistance emerged in 2006, reaching 70% of A. baumannii isolates in 2008, including one that was colistin resistant. A. baumannii belonged to CC113/79 (University of Oxford/Institute Pasteur schemes), CC235/162 and CC103/15. Dissemination of infections resistant to all antimicrobial agents may occur in the future.
Asunto(s)
Infecciones por Acinetobacter/epidemiología , Acinetobacter baumannii/aislamiento & purificación , Meningitis Bacterianas/epidemiología , Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/clasificación , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/genética , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Brasil/epidemiología , Carbapenémicos/farmacología , Niño , Preescolar , Colistina/farmacología , Farmacorresistencia Bacteriana Múltiple , Monitoreo Epidemiológico , Femenino , Humanos , Masculino , Meningitis Bacterianas/microbiología , Persona de Mediana Edad , Epidemiología Molecular , Tipificación de Secuencias Multilocus , Población Urbana , Adulto JovenRESUMEN
Active hospital-based surveillance in the city of Salvador, Brazil, from December 1995 through October 1998, identified 221 patients with confirmed pneumococcal meningitis. Of these 221 patients, 29 (13%) had isolates with intermediate-level resistance to penicillin. Infection with these penicillin-nonsusceptible isolates was significantly associated with age of <2 years (P<.0019), previous antibiotic use (P<.0006), and coresistance to trimethoprim-sulfamethoxazole (P<.0000). Serotype 14 was the most prevalent serotype (55.2%) of penicillin-nonsusceptible isolates. Strain typing by repetitive element BOX polymerase chain reaction (PCR) analysis showed that penicillin-nonsusceptible serotype 14 isolates had closely related BOX PCR patterns, whereas penicillin-susceptible serotype 14 isolates each had distinct, unrelated patterns. Penicillin-nonsusceptible serotype 14 isolates from Salvador and other Brazilian cities had similar BOX PCR patterns. These observations indicate that in Brazil a large proportion of cases of penicillin-nonsusceptible pneumococcal meningitis appear to be caused by a closely related group of serotype 14 strains that may have disseminated to widely separate geographic areas.
Asunto(s)
Meningitis Neumocócica/epidemiología , Meningitis Neumocócica/microbiología , Resistencia a las Penicilinas , Streptococcus pneumoniae/clasificación , Streptococcus pneumoniae/efectos de los fármacos , Adolescente , Adulto , Antibacterianos/farmacología , Brasil/epidemiología , Niño , Preescolar , Humanos , Lactante , Recién Nacido , Pruebas de Sensibilidad Microbiana , Reacción en Cadena de la Polimerasa/métodos , Vigilancia de la Población , Factores de Riesgo , Serotipificación , Streptococcus pneumoniae/genética , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
The authors compared the names of the subjects that form the official curriculum to those offered by the schools of nursing in the South East of Brazil. Forty eight schools replied to the questionnaire, a variance in the names and numbers of the subjects offered was found, indicating a difference in the way each school performs the curriculum.