Epidemiologia de Pseudomonas aeruginosa produtoras de metalo-beta-lactamases isoladas de pacientes no Hospital São Paulo em 2004
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2007
Tipo
Dissertação de mestrado
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No Hospital São Paulo, um hospital terciario de 600 leitos, a presenca de P. aeruginosa produtora de metalo-β-lactamase tem sido encontrada desde 2000 (a primeira, SPM-1, foi isolada em 1997). Durante a periodo entre 2000 e 2001, 25 das 128 amostras avaliadas produziam SPM au IMP (88 por cento e 12 por cento das P. aeruginosa resistentes a imipenem, respectivamente). Durante o ano de 2004, as 10 primeiras amostras consecutivas de P. aeruginosa isoladas par mes foram selecionadas para a producao de MβL. Um total de 120 isolados foram submetidas ao teste de hidro1ise contra imipenem, PCR para a identificacao do gene de MβL seguido de sequenciamento de DNA. Todos as isolados produtores de IMP foram avaliados para a presenca de integrons de c1asse 1. A similaridade genetica dos isolados produtores de MβL foram avaliados pelo PFGE. Entre os 120 isolados de P. aeruginosa, 46 (38,1 por cento) foram capazes de hidrolizar imipenem. 0 sequenciamento dos amplicons demonstrou que 20 por cento dos 80 por cento dos isolados de P. aeruginosa carreavam blaIMP-1 e blaSPM-1, respectivamente. Todos os isolados produtores de IMP-1 pertenciam ao mesmo clone, enquanto os isolados produtores de SPM-1 apresentaram uma grande diversidade genetica. A analise dos dados c1inicos dos pacientes que apresentaram infeccao por P. aeruginosa mostrou que a urina parece ter um papel importante na aquisicao de P. aeruginosa resistentes a carbapenemicos no Hospital São Paulo e que o uso previa de carbapenemicos e um fator de risco importante na aquisicao de amostras produtoras de MI3L. Os dados sugerem que as medidas de prevencao de disseminacao de P. aeruginosa carreadoras de MβL no Hospital São Paulo no ano de 2004 foram ineficazes
At Hospital São Paulo, a 600-bed tertiary care university hospital, the presence of metallo-β-lactamase producing P. aeruginosa has been detected since 2000 (the first strain, a SPM producer, was isolated in 1997). During the 2000-2001 period, 25 of 183 evaluated strains produced SPM or IMP (88% and 12% of the imipenem-resistant P. aeruginosa, respectively). During 2004, the 10 first consecutive imipenem resistant P. aeruginosa strains isolated monthly were screened for the production of MβL. A total of 120 isolates were submitted to hydrolysis test against imipenem, PCR for described MßL genes, and DNA sequencing. IMP-producing isolates were further evaluated with primers targeting class 1 integrons. The genetic relatedness of MßL-producing isolates was evaluated by PFGE. Among the 120 P. aeruginosa isolates, 46 (38,1%) were able to hydrolyze imipenem. Sequencing of the amplicons showed that 20% and 80% of the P. aeruginosa isolates carried blaIMP-1 and blaSPM-1, respectively. All IMP-1-producingisolates belonged to the same genotype, while the SPM-1-producing isolates showed a great genetic diversity. Analysis of the clinical data of patients with P. aeruginosa infections reveals that the urinary site seems to be important in the acquisition of carbapenem-resistant P. aeruginosa at Hospital São Paulo and that the previous use of carbapenens is an important risk factor for the acquisition of MßL-producing strains. These data show that the nosocomial infection control measures for prevention of dissemination of P. aeruginosa carring MßL in patients hospitalized at Hospital São Paulo in 2004 were not effective.
At Hospital São Paulo, a 600-bed tertiary care university hospital, the presence of metallo-β-lactamase producing P. aeruginosa has been detected since 2000 (the first strain, a SPM producer, was isolated in 1997). During the 2000-2001 period, 25 of 183 evaluated strains produced SPM or IMP (88% and 12% of the imipenem-resistant P. aeruginosa, respectively). During 2004, the 10 first consecutive imipenem resistant P. aeruginosa strains isolated monthly were screened for the production of MβL. A total of 120 isolates were submitted to hydrolysis test against imipenem, PCR for described MßL genes, and DNA sequencing. IMP-producing isolates were further evaluated with primers targeting class 1 integrons. The genetic relatedness of MßL-producing isolates was evaluated by PFGE. Among the 120 P. aeruginosa isolates, 46 (38,1%) were able to hydrolyze imipenem. Sequencing of the amplicons showed that 20% and 80% of the P. aeruginosa isolates carried blaIMP-1 and blaSPM-1, respectively. All IMP-1-producingisolates belonged to the same genotype, while the SPM-1-producing isolates showed a great genetic diversity. Analysis of the clinical data of patients with P. aeruginosa infections reveals that the urinary site seems to be important in the acquisition of carbapenem-resistant P. aeruginosa at Hospital São Paulo and that the previous use of carbapenens is an important risk factor for the acquisition of MßL-producing strains. These data show that the nosocomial infection control measures for prevention of dissemination of P. aeruginosa carring MßL in patients hospitalized at Hospital São Paulo in 2004 were not effective.
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Citação
BALAN, Ana Paula Rangel Takano.Epidemiologia de Pseudomonas aeruginosa produtoras de metalo-beta-lactamases isoladas de pacientes no Hospital São Paulo em 2004. 2007. 68 p. Dissertação (Mestrado em Ciências) - Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, 2007.