RESUMO
BACKGROUND: Bacteria that produce Klebsiella pneumoniae carbapenemases (KPCs) are resistant to broad-spectrum ß-lactam antibiotics. The objective of this study was to phenotypically and genotypically characterize the antibiotic susceptibility to carbapenems of 297 isolates recovered from clinical samples obtained from inpatients at 16 hospitals in São Luis (Maranhão, Brazil). METHODS: The study was conducted using phenotypic tests and molecular methods, including polymerase chain reaction (PCR), sequencing and enterobacterial repetitive intergenic consensus (ERIC)-PCR. The nonparametric chi-square test of independence was used to evaluate the associations between the bacterial bla KPC gene and the modified Hodge test, and the chi-square adherence test was used to assess the frequency of carbapenemases and their association with the bla KPC gene. RESULTS: The most frequently isolated species were Acinetobacter baumannii (n = 128; 43.0%), K. pneumoniae (n = 75; 25.2%), and Pseudomonas aeruginosa (n = 42; 14.1%). Susceptibility assays showed that polymixin B was active against 89.3% of the bacterial isolates. The Acinetobacter spp. and K. pneumoniae strains were susceptible to amikacin and tigecycline, and Pseudomonas spp. were sensitive to gentamicin and amikacin. Among the 297 isolates, 100 (33.7%) were positive for the bla KPC gene, including non-fermentative bacteria (A. baumannii) and Enterobacteriaceae species. Among the isolates positive for the bla KPC gene, K. pneumoniae isolates had the highest positivity rate of 60.0%. The bla KPC gene variants detected included KPC-2, which was found in all isolates belonging to species of the Enterobacteriaceae family. KPC-2 and KPC-3 were observed in A. baumannii isolates. Importantly, the bla KPC gene was also detected in three Raoultella isolates and one isolate of the Pantoea genus. ERIC-PCR patterns showed a high level of genetic diversity among the bacterial isolates; it was capable of distinguishing 34 clones among 100 strains that were positive for bla KPC and were circulating in 11 of the surveyed hospitals. CONCLUSIONS: The high frequency of the bla KPC gene and the high degree of clonal diversity among microorganisms isolated from patients from different hospitals in São Luis suggest the need to improve the quality of health care to reduce the incidence of infections and the emergence of carbapenem resistance in these bacteria as well as other Gram-negative pathogens.
Assuntos
Proteínas de Bactérias/genética , Enterobacteriaceae/efeitos dos fármacos , Enterobacteriaceae/genética , Klebsiella pneumoniae/genética , beta-Lactamases/genética , Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Brasil , Carbapenêmicos/farmacologia , Farmacorresistência Bacteriana/efeitos dos fármacos , Farmacorresistência Bacteriana/genética , Enterobacteriaceae/isolamento & purificação , Hospitais , Humanos , Pacientes Internados , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Epidemiologia Molecular/métodos , Reação em Cadeia da Polimerase/métodos , Pseudomonas aeruginosa/efeitos dos fármacos , Pseudomonas aeruginosa/genética , Pseudomonas aeruginosa/isolamento & purificação , beta-Lactamases/metabolismo , beta-Lactamas/farmacologiaRESUMO
Fueron aisladas especies del género candida y otras levaduras de la cavidad oral de pacientes con SIDA y se las relacionó con las manifestaciones clínicas. Fueron estudiadas 58 pacientes internados en el Hospital Estatal Getúlio Vargas en Sao Luis Maranhao, entre julio y diciembre de 2000. Se aislaron levaduras de la cavidad oral de 45 pacientes con la siguiente distribución: C. albicans en 58,4 por ciento; C. krusei y C. parapsilosis, se verificó en 8,3 por ciento, C. tropicalis en 6,7 por ciento, C. glabrata y S. cerevisiae en 5,0 por ciento, C. guilliermondii y Trichosporon spp2 en 3,3 por ciento, y menos frecuentemente C. lusitaniae en 1,7 por ciento. Se encontró en el 26,7 por ciento de los pacientes, conjuntamente con C. albicans, otras especies. En el 73,3 por ciento de los pacientes se encontró sólo un tipo de levadura. La forma clínica de candidiasis oral predominante fue la forma eritematosa en el 33,3 por ciento de los enfermos, seguida por la forma pseudomembranosa asociada a la eritematosa en 22,2 por ciento. Se comprobó que en los pacientes con SIDA portadores de C. albicans se presentaba con mayor frecuencia manifestaciones clínicas (66,7 por ciento) que los portadores de otra especie de levaduras (22,2 por ciento). Se observó que, el 75,5 por ciento de los pacientes presentaron uno o más episodios de infección. El aislamiento de levaduras fue mayor en pacientes que presentaron recuentos de linfocitos T CD4 entre <50 y 200 céls/mm3 (64,5 por ciento)
