Amostras de Pseudomonas aeruginosa resistentes a carbapenens isoladas em hospitais brasileiros: perfil de sensibilidade, detecção de metalo-beta-lactamase e análise da similaridade genética
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2005
Authors
Menezes, Liana Carballo [UNIFESP]
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Gales, Ana Cristina [UNIFESP]
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Dissertação de mestrado
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Abstract
As infecções causadas por P. aeruginosa são freqüentemente de difícil tratamento devido à virulência e a resistência a vários antimicrobianos apresentados por este patógeno. Os carbapenens são geralmente o tratamento de escolha para infecções causadas por P. aeruginosa multirresistentes, porém, a resistência a estes compostos tem aumentado rapidamente, principalmente, devido ao surgimento de amostras produtoras de metalo-ß-lactamases. Os objetivos deste estudo foram: i) avaliar o perfil de sensibilidade a antimicrobianos das amostras de P. aeruginosa resistentes aos carbapenens isoladas de hospitais brasileiros; ii) avaliar a freqüência da produção de MPL entre as amostras de P. aeruginosa resistentes aos carbapenens; iii) avaliar o perfil de sensibilidade a antimicrobianos das amostras de P. aeruginosa produtoras de MβL pela técnica de microdiluição em caldo; iv) detectara presença dos genes biasSPM-1, blaIMP-1, blaVIM-1, e blaVIM-2 entre as amostras de P. aeruginosa produtoras de MßL; v) avaliar a presença de variantes alélicos do gene blasIPM-1, entre as amostras de P. aeruginosa produtoras da MPL do tipo SPM-1, e vi) avaliar a similaridade genética entre as amostras de P. aeruginosa resistentes aos carbapenens produtoras de MßL. Foram avaliadas 206 amostras de P. aeruginosa resistentes aos carbapenens isoladas entre 2001 e 2003, de 25 centros médicos. As 206 amostras foram testadas pelo método de disco-difusão. Os testes de sensibilidade foram realizados de acordo com a padronização do "National Committee for Clinical Laboratory Standards" (NCCLS). Os isolados resistentes aos carbapenens foram triados para a produção de metalo-ß-lactamases pelo teste de aproximação de discos utilizando dois inibidores enzimáticos (EDTA e ácido 2mercaptopropiônico). A produção de MßL foi confirmada pela metodologia do Etest® (fita Etest©MBL). Em seguida foi realizada a técnica de PCR para a pesquisa dos genes blaIMP-1, blaVIM-1, bIaVIM-2 e blaSPM-1. A avaliação da similaridade genética entre as amostras produtoras de MßL foi realizada pela técnica da ribotipagem automatizada e PFGE. Para fins comparativos, também foram selecionadas para análise da similaridade genéticaamostras não produtoras de MßL isoladas em centros médicos, que apresentavam amostras de P. aeruginosa produtoras de MPL. Altas taxas de resistência a maioria dos antimicrobianos foram observadas entre as amostras de P. aeruginosa resistentes aos carbapenes…(au).
Infections caused by Pseudomonas aeruginosa are often difficult to treat because of its virulence and antimicrobial resistance. Carbapenems are usually active against multiresistant P. aeruginosa, but resistant to these compounds has been increasing rapidly. High-level resistance to carbapenems is still uncommon in P. aeruginosa and is usually indicative of metallo-β-lactamases (MβL). The purpose of the study were to evaluate the antimicrobial susceptibility profiles of carbapenems resistant P. aeruginosa isolated from Brazilian Hospitals, were to detect the presence of gene blaSPM-1, blaIMP-1, blaVIM-1 e blaVIM-2 and to evaluate the genetic similarity of P. aeruginosa resistant to carbapenems. Were evaluated 206 P. aeruginosa resistant to carbapenems collected during 2001 – 2003 from 25 medical centers. Antimicrobial susceptibilities testing to selected agents were determined by disk diffusion to 206 strains. The suscepptibility testing were to using the reference “National Committee for Clinical Laboratory Standards” (NCCLS). Carbapenems resistant isolates were screened for MβL production by disk approximation test using 2 enzyme inhibitors (EDTA and 2-mercaptopropionic acid). The procedure was confirmed by Etest (Etest MBL strip) and also by PCR assays using the following primers blaIMP-1, blaVIM-1, blaVIM-2 e blaSPM-1. The genetic similarity was performed in MβL producers strains and one negative-MβL strains for medical centers by automated ribotyping and PFGE. High resistance rates to majority of the antimicrobial agents were demonstrated. The polymyxins were the most active antimicrobial agents evaluated with 100,0% of susceptibility rate to all strains. The MβL production was detected in 98 (47,6%) of 206 strains. The blaSPM-1 gene was detected in 82 strains (83,7%) and blaIPM-1 gene in 3 strains (16,3%). Thirteen isolates did not show PCR amplification for none of the primers used. The analysis of genetic similarity showed a clonal diversity among the 98 carbapenems-resistant strains (46 ribogroups). CONCLUSION: This study indicates high prevalence of MβL producing in carbapenems-resistant P. aeruginosa and clonal dissemination these microrganism to a wide geographic area of Brazil.
Infections caused by Pseudomonas aeruginosa are often difficult to treat because of its virulence and antimicrobial resistance. Carbapenems are usually active against multiresistant P. aeruginosa, but resistant to these compounds has been increasing rapidly. High-level resistance to carbapenems is still uncommon in P. aeruginosa and is usually indicative of metallo-β-lactamases (MβL). The purpose of the study were to evaluate the antimicrobial susceptibility profiles of carbapenems resistant P. aeruginosa isolated from Brazilian Hospitals, were to detect the presence of gene blaSPM-1, blaIMP-1, blaVIM-1 e blaVIM-2 and to evaluate the genetic similarity of P. aeruginosa resistant to carbapenems. Were evaluated 206 P. aeruginosa resistant to carbapenems collected during 2001 – 2003 from 25 medical centers. Antimicrobial susceptibilities testing to selected agents were determined by disk diffusion to 206 strains. The suscepptibility testing were to using the reference “National Committee for Clinical Laboratory Standards” (NCCLS). Carbapenems resistant isolates were screened for MβL production by disk approximation test using 2 enzyme inhibitors (EDTA and 2-mercaptopropionic acid). The procedure was confirmed by Etest (Etest MBL strip) and also by PCR assays using the following primers blaIMP-1, blaVIM-1, blaVIM-2 e blaSPM-1. The genetic similarity was performed in MβL producers strains and one negative-MβL strains for medical centers by automated ribotyping and PFGE. High resistance rates to majority of the antimicrobial agents were demonstrated. The polymyxins were the most active antimicrobial agents evaluated with 100,0% of susceptibility rate to all strains. The MβL production was detected in 98 (47,6%) of 206 strains. The blaSPM-1 gene was detected in 82 strains (83,7%) and blaIPM-1 gene in 3 strains (16,3%). Thirteen isolates did not show PCR amplification for none of the primers used. The analysis of genetic similarity showed a clonal diversity among the 98 carbapenems-resistant strains (46 ribogroups). CONCLUSION: This study indicates high prevalence of MβL producing in carbapenems-resistant P. aeruginosa and clonal dissemination these microrganism to a wide geographic area of Brazil.
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MENEZES, Liana Carballo. Amostras de Pseudomonas aeruginosa resistentes a carbapenens isoladas em hospitais brasileiros: perfil de sensibilidade, detecção de metalo-beta-lactamase e análise da similaridade genética. 2005. 118 f. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2005.