Navegando por Palavras-chave "Antimicrobial resistance"

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    Activity of ceftobiprole against methicillin-resistant Staphylococcus aureus strains with reduced susceptibility to daptomycin, linezolid or vancomycin, and strains with defined SCCmec types
    (Elsevier B.V., 2014-04-01) Farrell, David J.; Flamm, Robert K.; Sader, Helio S. [UNIFESP]; Jones, Ronald N.; JMI Labs; Univ Toronto; Universidade Federal de São Paulo (UNIFESP); Tufts Univ
    Ceftobiprole is a broad-spectrum cephalosporin with activity against methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative pathogens including Pseudomonas aeruginosa. the aim of this study was to evaluate the activity of ceftobiprole against MRSA isolates with decreased susceptibility to daptomycin, linezolid or vancomycin as well as isolates from staphylococcal chromosome cassette mec (SCCmec) types I, II, III and IV. Overall, ceftobiprole demonstrated high potency against the 216 isolates tested, with MIC50 and MIC90 values (minimum inhibitory concentrations required to inhibit 50% and 90% of the isolates, respectively) of 1 mg/L and 2 mg/L (97.2% susceptible). the MIC90 for ceftobiprole was 2 mg/L against the linezolid-non-susceptible, daptomycin-non-susceptible and vancomycin-intermediate (VISA and hVISA) subsets and was 1 mg/L against the vancomycin-resistant (VRSA) strains. the MIC50/90 values for ceftobiprole were 214, 112, 212 and 111 mg/L against SCCmec types I, II, III and IV, respectively. SCCmec type I strains had the highest MICs, with six strains exhibiting a ceftobiprole MIC of 4 mg/L and 15 strains at 2 mg/L. Ceftobiprole demonstrated potent activity against MRSA, including subsets of isolates with reduced susceptibility to daptomycin, linezolid and vancomycin. the activity of ceftobiprole against these resistant phenotypes indicates that it may have clinical utility in the treatment of infections caused by multidrug-resistant S. aureus and across strains from prevalent SCCmec types. (C) 2013 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved.
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    Análise da frequência de bactérias com atividade predatória no trato gastrointestinal de diferentes hospedeiros no Brasil
    (Universidade Federal de São Paulo, 2024-06-25) Salgueiro, Arthur Giordano [UNIFESP]; Silva, Rodrigo Cayô da [UNIFESP]; Neto , Francisco Ozório Bessa [UNIFESP]; http://lattes.cnpq.br/0415227863176385; http://lattes.cnpq.br/5699739668358897; http://lattes.cnpq.br/8802889677020827
    A resistência aos antimicrobianos é um grave problema de saúde pública, com cerca de 1,27 milhões de mortes atribuídas a infecções resistentes em 2019. As projeções indicam que, até 2030, a resistência bacteriana poderá custar mais de 1 trilhão de dólares ao PIB global, especialmente em países em desenvolvimento. A resistência pode ocorrer naturalmente, mas é exacerbada pela ação humana e pela transferência horizontal de genes entre bactérias. Bactérias do grupo ESKAPE, frequentemente associadas a infecções hospitalares, são particularmente preocupantes devido à sua capacidade de adquirir e transferir genes de resistência. As bactérias predadoras têm se destacado por sua capacidade de atacar e degradar outras bactérias, oferecendo uma alternativa potencial para combater a resistência antimicrobiana. Elas produzem enzimas líticas que degradam as células bacterianas-alvo, dificultando a transferência de material genético exógeno. Algumas dessas bactérias também apresentam resistência a antimicrobianos específicos, sugerindo um possível sinergismo com terapias antimicrobianas existentes. Este estudo tem como principal objetivo investigar a distribuição e a frequência de espécies bacterianas com atividade predatória (BALOs) em diversas regiões do Brasil, utilizando dados de metagenoma de amostras de fezes de humanos e animais de corte (bovinos, suínos e frangos). A pesquisa, intitulada "Uso da Ferramenta Metagenômica na Detecção de Patógenos de Importância Clínica Produtores de ESβL e Carbapenemases em Diferentes Hospedeiros", foi conduzida pelo Grupo Brasileiro de Saúde Única (GUARANI) e financiada pelo CNPq e pela Fundação Bill & Melinda Gates. A análise de metagenômica revelou as principais espécies de BALOs em diferentes hospedeiros e localidades. Identificou-se que as espécies Labilithrix luteola, Sorangium cellulosum e Sandaracinus amylolyticus foram as mais frequentes. Além disso, o estudo demonstrou que diferentes espécies de bactérias predatórias fazem parte da microbiota intestinal de humanos e de animais de corte, indicando um provável papel no controle populacional. Por fim e o mais interessante é que a frequência das diferentes espécies de bactérias predatórias varia entre os diferentes hospedeiros, bem como entre o mesmo hospedeiro, porém de localidades diferentes. O estudo também destacou a necessidade de expandir as pesquisas para regiões internacionais e diversos hospedeiros, dada a similaridade climática e geográfica com outras áreas, como as regiões cársticas da Espanha, onde foram encontrados microrganismos semelhantes. Em conclusão, embora estudos de metagenômica sejam importantes para a caracterização de populações microbianas, uma vez que independe de cultivo, estudos voltados a padronização de métodos de cultivos de bactérias predatórias são essenciais para a avaliação do seu potencial biotecnológico.
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    Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on beta-lactams and polymyxins
    (Soc Brasileira Microbiologia, 2016) Mello Sampaio, Jorge Luiz; Gales, Ana Cristina [UNIFESP]
    uring the last 30 years there has been a dissemination of plasmid-mediated beta-lactamases in Enterobacteriaceae in Brazil. Extended spectrum beta-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in Sao Paulo, the largest city in Brazil. New Delhi metallo-beta-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.(C) 2016 Sociedade Brasileira de Microbiologia. Published by Elsevier Editora Ltda.
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    Antimicrobial susceptibility of gram-positive bacteria isolated in brazilian hospitals participating in the SENTRY Program (2005-2008)
    (Brazilian Society of Infectious Diseases, 2009-04-01) Gales, Ana Cristina [UNIFESP]; Sader, Helio Silva [UNIFESP]; Ribeiro, Julival; Zoccoli, Cassia; Barth, Afonso; Pignatari, Antonio Carlos Campos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); JMI Laboratories; Hospital de Base do Distrito Federal; Laboratório Médico Santa Luzia; Hospital de Clínicas de Porto Alegre
    We report the antimicrobial susceptibility patterns of the most frequently isolated Gram-positive bacteria in the Brazilian hospitals participating in the SENTRYAntimicrobial Surveillance Program. The strains were consecutively collected (one per patient) between January 2005 and September 2008 and susceptibility tested by reference broth microdilution methods at the JMI Laboratories (North Liberty, Iowa, USA). A total of 3,907 Gram-positive cocci were analyzed. The Gram-positive organisms most frequently isolated from bloodstream infections were Staphylococcus aureus (2,218 strains; 20.2% of total), coagulase-negative staphylococci (CoNS; 812 strains [14.7%]), and Enterococcus spp. (754 strains; 5.0%). S. aureus ranked first (28.1%) and Enterococcus faecalis ranked 7th (4.5%) among cases of skin and soft tissue infections. S. aureus was also the second most frequently isolated pathogen from patients with lower respiratory tract infections (24.9% of cases) after Pseudomonas aeruginosa (30.5%). Resistance to oxacillin was observed in 31.0% of S. aureus and the vast majority of oxacillin-resistant (MRSA) strains were also resistant to clindamycin, ciprofloxacin and levofloxacin. Vancomycin, linezolid and daptomycin were all very active against S. aureus strains tested (>99.9-100.0% susceptible), but daptomycin (MIC50, 0.25 g/mL and MIC90, 0.5 g/mL) was four- to eight-fold more potent than vancomycin (MIC50 and MIC90 of 1 g/mL) and linezolid (MIC50, 1 g/mL and MIC90, 2 g/mL). Vancomycin resistance increased significantly among enterococci during the study period, but it was restrict to only one medical center until 2007 and emerged in a second medical center in 2008. Daptomycin was the most active antimicrobial tested against enterococci in general (100.0% susceptible), followed by linezolid (99.9% susceptible), ampicillin (87.4%) and vancomycin (84.6%). In conclusion, daptomycin and linezolid showed excellent in vitro activity against contemporary Gram-positive organisms (3,907) collected in Brazilian hospitals monitored by the SENTRY Program, including MRSA, vancomycin-resistant enterococci (VRE) and other multidrugresistant organisms. Although vancomycin resistance rates in Brazil appears to be relatively low compared to those reported in the USA, VRE has emerged and rapidly disseminated in some Brazilian medical centers.
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    Avaliação da sensibilidade a antimicrobianos de 87 amostras clínicas de enterococos resistentes à vancomicina
    (Associação Médica Brasileira, 1997-09-01) Saraiva, I.h. [UNIFESP]; Jones, R.n.; Erwin, M.; Sader, Helio Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade de Iowa Anti-Infective Research Center Departamento de Patologia
    OBJECTIVES. 1) To evaluate the antimicrobial susceptibility pattern of vancomycin-resistant enterococci to the antimicrobial agents that are commonly used to treat enterococci infections and to some alternative drugs. 2) To evaluate the accuracy of E test for susceptibility testing enterococci. MATERIAL AND METHOD. We evaluated 87 clinical VRE isolates that were selected from a previous study which analyzed 1936 clinical isolates collected and processed in 97 US medical centers in the last quarter of 1992. The isolates were identified to the species level by using the API 20S System, the Vitek gram-positive identification cards and a modified version of the conventional method proposed by Facklam and Collins. The in vitro susceptibility testing was performed by broth microdilution, E test and disk diffusion methods, following the criteria described by the National Committee for Clinical Laboratory Standards (NCCLS). The VRE isolates were tested against antimicrobial agents commonly used to treat enterococci infections (vancomycin, teicoplanin, ampicillin, penicillin, gentamicin and streptomycin) and against ten potential alternative drugs (chloramphenicol, doxycycline, sparfloxacin, ciprofloxacin, clinafloxacin, erythromycin, spectinomycin, trospectomycin, trimetoprim-sulfametoxazol and novobiocin). RESULTS. Our results showed a high rate of resistance to ampicillin and penicillin (86%). High level resistance to gentamicin and streptomycin was demonstrated by 82% and 85% respectively. Although teicoplanin and vancomycin belong to the same antibiotic group (glycopeptide), 29% of VRE were susceptible to teicoplanin. Among the alternative drugs, trospectomycin, doxycyclin and chloramphenicol showed the highest in vitro activity, with 94%, 92% and 82% susceptibility respectively. In addition, erythromycin, trimetoprim-sulfametoxazol and ciprofloxacin showed the highest rates of resistance (98%, 83% and 69%, respectively). CONCLUSION. The treatment options for infections caused by vancomycin-resistant enterococci seem to be very narrow since a small percentage of those isolates were susceptible to the other antimicrobial agents commonly used to treat these infections and only a few of the alternative drugs tested showed good in vitro activity. Many regimens using various antibiotic combinations have been tested against VRE, most of them with fluoroquinolones. However further studies are necessary to evaluate the clinical role of these antibiotic combinations.
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    Comparison of phenotypic tests for detecting BKC-1-producing Enterobacteriaceae isolates
    (Elsevier Science Inc, 2016) Martins, Willames M. B. S. [UNIFESP]; Cordeiro-Moura, Jhonatha R. [UNIFESP]; Ramos, Ana C. [UNIFESP]; Fehlberg, Lorena C. [UNIFESP]; Nicoletti, Adriana G. [UNIFESP]; Gales, Ana C. [UNIFESP]
    Carbapenemase-producing Enterobacteriaceae may exhibit in vitro susceptibility to carbapenems, especially those producing weak carbapenemases. Routine clinical laboratories have employed phenotypic tests for screening such isolates. BKC-1 is a recently reported carbapenemase that shows weak carbapenemase activity. In this study, we aimed to evaluate the behavior of distinct phenotypic methods against SKC-1-producing Enterobacteriaceae. (C) 2016 Elsevier Inc. All rights reserved.
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    Determinação de resíduos de antimicrobianos clinicamente importantes e verificação de microrganismos resistentes em águas das Represas Guarapiranga e Billings, SP
    (Universidade Federal de São Paulo, 2024-03-24) Santos, Felipe Rafael Guedes dos [UNIFESP]; Moraes, Maria de Lourdes Leite de [UNIFESP]; Minarini, Luciene Andrade da Rocha [UNIFESP]; http://lattes.cnpq.br/5226657617185982; http://lattes.cnpq.br/1133302125160725; https://lattes.cnpq.br/3137963591870787
    O uso indiscriminado de antibióticos na saúde humana e no crescimento de animais de criação levou à contaminação ambiental, especialmente das águas superficiais. Esse fato contribuiu para o aumento da resistência antimicrobiana, pois a exposição constante a subdoses de antibióticos pode criar uma pressão seletiva favorável à ocorrência e sobrevivência de bactérias resistentes, uma preocupação global da OMS. Novas abordagens que possibilitem o desenvolvimento de métodos de análise acessíveis e estudos associados à resistência antimicrobiana são prioridades para as agências ambientais estabelecerem programas de monitoramento desses compostos na água. Neste trabalho, foi desenvolvido um método utilizando cromatografia líquida de alta performance por absorção no ultravioleta e fluorescência (HPLC-DAD-FLD) para avaliação de antibióticos (amoxicilina, ceftazidima, cefalexina e ciprofloxacino) priorizados na região metropolitana de São Paulo e foi determinada a diversidade de espécies de bactérias gram-negativas resistentes a antimicrobianos clinicamente importantes nas águas das represas Billings e Guarapiranga. O método foi otimizado utilizando uma coluna RP18 Kinetex (150 mm x 4,6 mm, 5 µm). A fase móvel consistiu de água acidificada (pH 3,0):MeOH 25:75 (v/v), vazão 0,8 mLmin-1; 40ºC; detecção DAD a 237 nm e FLD (λex 350nm e λem 450nm). O LOD e LOQ variaram de 0,014 e 0,27 µg/mL e 0,044 e 0,83 µg/mL, respectivamente, para a faixa de 0,1-100 µg/mL. A avaliação da pré-concentração foi realizada por meio do SPE testando cartuchos HLB e Strata C-18 e a microextração em filme fino (TFME). As fases de extração PAN/C18; PAN/PS-DVB; PAN/C18/SCX e PAN/HLB foram testadas usando três solventes diferentes. PAN/PS-DVB apresentou melhor recuperação utilizando acetonitrila:água (25:75 v/v) como solvente de dessorção. Os testes de sensibilidade aos antimicrobianos foram realizados usando difusão em disco, de acordo com o BRCast. Espécies bacterianas foram selecionadas a partir de colônias recuperadas das represas e identificadas por MALDI-TOF. Cerca de 196 micro-organismos gram negativos foram isolados e identificados, com a presença de 6 diferentes famílias observadas. O perfil de sensibilidade das enterobactérias, considerado de prioridade crítica pela OMS, mostrou resistência a pelo menos um antimicrobiano de aminoglicosídeos, fluoroquinolonas e carbapenemas, respectivamente: Enterobacter spp. (24%, 54% e 67%), Escherichia coli (39%, 87% e 9,8%) e Klebsiella pneumoniae (100%, 50%, 77%). Foi observada triagem positiva para ESBL em isolados de E. coli (96%) e K. pneumoniae (46%). Essa abordagem permitiu a otimização dos esforços para o monitoramento de antibióticos na água, pois sua presença pode aumentar a taxa de transferência horizontal de genes de resistência entre diferentes cepas bacterianas, permitindo que bactérias sensíveis adquiram resistência aos antimicrobianos.
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    In vitro susceptibility of Burkholderia cepacia complex isolates: Comparison of disk diffusion, Etest (R), agar dilution, and broth microdilution methods
    (Elsevier Science Inc, 2016) Fehlberg, Lorena Cristina Corrêa [UNIFESP]; Nicoletti, Adriana Gianinni [UNIFESP]; Ramos, Ana Carolina [UNIFESP]; Rodrigues-Costa, Fernanda [UNIFESP]; Matos, Adriana Pereira de [UNIFESP]; Girardello, Raquel [UNIFESP]; Marques, Elizabeth Andrade; Gales, Ana Cristina [UNIFESP]
    Broth microdilution, agar dilution, Etest (R) and disk diffusion techniques were compared to evaluate the susceptibility profile of 82 Bcc clinical isolates against six antimicrobials as recommended by CLSI. Broth microdilution was considered the "gold standard" method. The regression analysis was applied to determine the essential (EA) and categorical (CA) agreement rates. STX (MIC50, 1 mg/L) was the most potent antimicrobial tested against Bcc isolates. The worst in vitro activity was observed for chloramphenicol (MIC50, 16 mg/L) and ticarcillin-clavulanic acid (MIC50, >256 mg/L). The EA among broth microdilution and agar dilution results was good for the majority of antimicrobial tested. When comparing broth microdilution and Etest (R), ceftazidime, SXT and chloramphenicol exhibited EA rates below 90%. SXT showed an excellent CA (100%) when dilution methodologies were compared. However, a low CA rate was found for this agent between dilution and disk diffusion methodologies resulting in unacceptable very major and minor error rates. (C) 2016 Elsevier Inc. All rights reserved.
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    Microbiological and epidemiological characterization of imipenem-resistant Pseudomonas aeruginosa strains from a Brazilian tertiary hospital: Report from the SENTRY Antimicrobial Surveillance Program
    (Esift Srl, 2006-10-01) Ribeiro, Julival; Mendes, Rodrigo Elisandro [UNIFESP]; Domingos, R.; Franca, E.; Silbert, Suzane [UNIFESP]; Jones, Ronald N.; Sader, Helio Silva [UNIFESP]; Hosp Base Distrito Fed; Universidade Federal de São Paulo (UNIFESP); JMI Labs
    OBJECTIVES: To evaluate the antimicrobial susceptibility profile, the genetic similarity, and the mechanisms of carbapenem resistance among imipenem-resistant Pseudomonas aeruginosa isolates collected from a Brazilian tertiary teaching hospital.METHODS: Seventy-eight consecutive samples of P. aeruginosa were evaluated during 2000 and 2001. The antimicrobial susceptibility was evaluated by reference broth microdilution methods and the imipenem-resistant isolates were screened for metallo-p-lactamase (MPL) production throughout disc approximation test and MOL Etest (R) strips and isolates with positive screen test result were submitted to PCR assays using primers bla(IMP-1), bla(VIM-1), bla(VIM-2) e bla(SPM-1). The genetic similarity of MOL-producing strains was evaluated by automated ribotyping for epidemiological typing purpose.RESULTS: Resistance rates were high to the majority of antimicrobial agents tested except polymyxin B, which inhibited all samples at the Clinical and Laboratory Standards Institute breakpoint (<= 2 mu g/ml). Twenty-nine (37.2%) isolates were resistant to imipenem and these isolates showed great genomic variability. MPL production was demonstrated in two imipenem-resistant isolates, which were detected using bla(SPM-1) and bla(IMP-2)-specific primers. Sequence analysis revealed the presence of bla(SPM-1) and a novel biamp-type gene, bla(IMP)-typeCONCLUSION: The results of this study showed high resistance rates to the majority of antimicrobial agents among P. aeruginosa samples. High imipenem resistance rates were probably due to continuous selection of resistant mutants. The production of MOL did not represent a frequent mechanism of carbapenem resistance in this medical center; but a novel MPL was identified. Continued antimicrobial surveillance and infection control measures should be emphasized to minimize the emergence and dissemination of antimicrobial resistance.
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    Padrão de sensibilidade de 117 amostras clínicas de Staphylococcus aureus isoladas em 12 hospitais
    (Associação Médica Brasileira, 1997-09-01) Farias, W.v.l. [UNIFESP]; Sader, Helio Silva [UNIFESP]; Leme, Ivani Lucia [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    OBJECTIVE. To evaluate the antimicrobial susceptibility pattern of oxacillin susceptible (OSSA) and resistant Staphylococcus aureus (ORSA) isolates to other antimicrobial agents that can be used for the treatment of staphylococcal infections. MATERIAL AND METHOD. We evaluated 117 clinical S. aureus isolates from several São Paulo hospitals. Clinical isolates from Campinas, SP and from João Pessoa, PB, were also included. The in vitro susceptibility testing was performed by broth microdilution as described by the National Committee for Clinical Laboratory Standards (NCCLS). The minimum inhibitory concentration (MIC) was evaluated for 24 antimicrobial agents, including beta-lactams, fluoroquinolones, aminoglycosides, glycopeptides, macrolides, lincosamides and streptogramins. Both commercially available and experimental drugs were included in the study. Cross-resistance among fluoroquinolones was evaluated by susceptibility testing 24 isolates to 10 fluoroquinolones. RESULTS. The antimicrobial agents that showed the highest in vitro activity were the glycopeptides, the streptogramin RP-59.500, and the mupirocin (100% susceptibility). Eighty-seven percent of the OSSA and only 38% of the ORSA isolates were susceptible to ciprofloxacin (MIC50 0.25mug/mL and > 4mug/mL, respectively). Cross-resistance among fluoroquinolones were noted even for the experimental drugs. Two fluoroquinolones remained active against ciprofloxacin-resistant isolates, clinafloxacin and WIN-57.273. However, the ciprofloxacin-resistant isolates had MICs eight-to 64-fold higher than the ciprofloxacin-susceptible isolates, suggesting that the MICs may continue to increase when these fluoroquinolones become commercially available. CONCLUSION. Our results showed a high rate of antimicrobial resistance among S. aureus from the Brazilian hospitals. Very few drugs can still be used for the treatment of staphylococcal infections.
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    Phenotypic and molecular characterization of Salmonella Enteritidis strains isolated in São Paulo, Brazil
    (Instituto de Medicina Tropical, 2003-04-01) Fernandes, Sueli A.; Ghilardi, Ângela C.r.; Tavechio, Ana T.; Machado, Antonia M.o. [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Instituto Adolfo Lutz Seção de Bacteriologia; Universidade Federal de São Paulo (UNIFESP)
    In São Paulo State, Brazil, the epidemic increase in isolation of Salmonella Enteritidis has been observed since 1994. A total of 105 S. Enteritidis strains (72 from human and 33 from non-human sources) isolated during the period 1975-1995, previously characterized by phage typing, was analyzed by antimicrobial susceptibility, plasmid profile, and ribotyping. Over 70% of the strains were susceptible to all antimicrobial agents tested, however, multiple resistance to antimicrobials was observed among the studied strains, mainly those from hospitalized patients. Phage type 8 (PT-8) was predominant among the strains isolated during the period of 1975-1992, but in the following years, PT-4 was the most frequent phage type identified. Seven different plasmid profiles were detected and 96% of the isolates harbored a plasmid of approximately 36 MDa. Ribotyping discriminated fourteen ribotypes (R1 to R14) among the strains examined. By analysis of dendrogram the strains were included in three groups with similarity level of 60%. The obtained results indicate that, a single ribotype (R11), determined for PT-4 strains isolated from 1993, characterizes the epidemic clone of S. Enteritidis in our region.
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    Prevalence and clinical outcomes of episodes of ventilator-associated pneumonia caused by SPM-1-producing and non-producing imipenem-resistant Pseudomonas aeruginosa
    (Sociedade Brasileira de Medicina Tropical - SBMT, 2011-10-01) Furtado, Guilherme Henrique Campos [UNIFESP]; Gales, Ana Cristina [UNIFESP]; Perdiz, Luciana Baria [UNIFESP]; Santos, Anderson Fernandes [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    INTRODUCTION: Pseudomonas aeruginosa is a leading cause of ventilator-associated pneumonia (VAP) and exhibits high rates of resistance to several antimicrobial drugs. The carbapenens are usually the drugs of choice against this microorganism. However, the carbapenem resistance has increased among these strains worldwide. The presence of metallo-β-lactamases (MBL) has been pointed out as a major mechanism of resistance among these strains. No previous study addressed outcomes of respiratory infections caused by these strains. METHODS: Our group sought to analyze the epidemiology and clinical outcomes of patients with VAP caused by imipenem-resistant P. aeruginosa. A total of 29 clinical isolates of carbapenem-resistant Pseudomonas aeruginosa were screened for metallo-β-lactamase (MBL) genes. RESULTS: Demographic and clinical variables were similar between the SPM-1-producing and non-SPM-1-producing group. Five (17.2%) isolates were positive for blaSPM-1. No other MBL gene was found. All patients were treated with polymyxin B. The infection-related mortality was 40% and 54.2% for SPM-1-producing and -non-producing isolates, respectively. CONCLUSIONS: There were no differences in epidemiological and clinical outcomes between the two groups.
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    SPM-1-producing Pseudomonas aeruginosa ST277 clone recovered from microbiota of migratory birds
    (Elsevier Science Inc, 2018) Martins, Willames M. B. S. [UNIFESP]; Narciso, Ana Clara [UNIFESP]; Cayo, Rodrigo [UNIFESP]; Santos, Stefanie Vanessa; Fehlberg, Lorena C. C. [UNIFESP]; Ramos, Patricia Locosque; da Cruz, Joao Batista; Gales, Ana Cristina [UNIFESP]
    The production of Sao Paulo metallo-O-lactamase (SPM-1) is the most common carbapenem resistance mechanism detected among multidrug-resistant Pseudomonas aeruginosa clinical isolates in Brazil. Dissemination of SPM-1-producing P. aeruginosa has been restricted to the nosocomial settings, with sporadic reports of environmental isolates due to contamination by hospital sewage. Herein, we described the detection and molecular characterization of SPM-1-producing P. aeruginosa recovered from the microbiota of migratory birds in Brazil. Three hundred gram-negative bacilli were recovered from cloacal and choanal swabs of Dendrocygna viduata during a surveillance study for detection of carbapenem-resistant isolates. All isolates were identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. MICs were determined by agar dilution, except for polymyxin B. Antibiotic resistance genes were detected by polymerase chain reaction (PCR) followed by DNA sequencing. Transcriptional levels of oprD and efflux system encoding genes were also carried out by quantitative real-time PCR. Nine imipenem-resistant P. aeruginosa isolates were recovered with 7 of them carrying bla(SPM-1). Additional resistance genes (rmtD-1, bla(OXA-56), aacA4, and aac(6')-Ib-cr) were also detected in all 9 isolates. The SPM-1-producing isolates showed high MICs for all beta-lactams, fluoroquinolones, and aminoglycosides, being susceptible only to polymyxin B. Interestingly, all isolates showed the same PFGE pattern and belonged to ST277. Overexpression of MexXY-OprM and MexAB-OprM was observed in those isolates that did not harbor bla(SPM-1). Our results suggest that migratory birds might have played a role in the dissemination of SPM-1-producing P. aeruginosa within the Brazilian territory. (C) 2017 Elsevier Inc. All rights reserved.