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- ItemAcesso aberto (Open Access)Acinetobacter spp resistente a antimicrobianos carbapenêmicos isolados de Infecções Hospitalares de Corrente Sanguínea: Estudo do Projeto SCOPE Brasil(Universidade Federal de São Paulo (UNIFESP), 2010-03-31) Luz, Adryella de Paula Ferreira [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Main Objective: To evaluate the susceptibility profile to antibiotics carbapenems and ampicillin/sulbactam, and the carbapenemases production among bloodstream isolates of Acinetobacter spp. from hospitalized patients participating in the SCOPE Program, period of june 2007 to July 2009. Specific objectives: (i) to evaluate the susceptibility to imipenem, meropenem and ampicillin/sulbactam by agar dilution; (ii) to characterize the frequency and types of metalo-B-lactamases in the carbapenem resistant isolates; (iii) to determine the frequency of oxacillinases coding genes among the carbapenem resistant isolates. Material and Methods: 206 isolates from the first blood stream nosocomial infection from 16 medical centers from the 5 regions of the country were susceptibility tested by agar dilution for imipenem, meropenem and ampicillin/sulbactam. The carbapenem resistant isolates were submitted to Real time multiplex PCR for detection of MBL genes (blaIMP, blaVIM, blaSIM, blaSPM, blaGIM) and oxacillinases coding genes (blaOXA23-like, blaOXA24-like, blaOXA51-like, blaOXA58-like). The isolates carring blaIMP were typed by PFGE . Results and Conclusion: 63% of the isolates were resistant to carbapenems (imipenem CIM50 64 μg/mL e CIM90 256 μg/mL); meropenem (CIM50 32 μg/mL e CIM90 256 μg/mL) and 45% to ampicillin/sulbactam (CIM50 8 μg/mL e CIM90 64 μg/mL). 24 (18%) carbapenem resistant isolates showed blaIMP. 94 (74%) showed blaOXA23 and 26 (20%) showed only blaOXA51. The highest resistant rate to carbapenem was observed in the Northeast region and the lowest rate in the South region. Clonal hospital and inter-hospital dissemination was observed for IMP carring isolates but not among the different regions.
- ItemSomente MetadadadosAntimicrobial resistance among Gram-negative bacilli isolated from Latin America: results from SENTRY Antimicrobial Surveillance Program (Latin America, 2008-2010)(Elsevier B.V., 2012-08-01) Gales, Ana C. [UNIFESP]; Castanheira, Mariana; Jones, Ronald N.; Sader, Helio S. [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); JMI LabsThis study updates the frequency and resistance rates of Gram-negative bacilli isolated from Latin American medical centers enrolled in the SENTRY Antimicrobial Surveillance Program. A total of 12,811 bacterial organisms, including 5704 Gram-negative bacilli (44.5%), were consecutively collected (1 per patient) between January 2008 and December 2010 from 10 Latin American medical centers located in Argentina, Brazil, Chile, and Mexico. Antimicrobial susceptibility testing was performed and interpreted by the Clinical and Laboratory Standards Institute broth microdilution method at a central laboratory. All Gram-negative organisms with reduced susceptibility to imipenem or meropenem (MIC, >= 2 mu g/mL) were screened for carbapenemase production by the modified Hodge test and by polymerase chain reaction. ESBL rates were 18.1%, 12.8%, 23.8%, and 48.4% among Escherichia coli and 60.4%, 49.9%, 59.2%, and 33.3% among Klebsiella spp. from Argentina, Brazil, Chile, and Mexico, respectively. Meropenem-nonsusceptible Klebsiella spp. rate was highest in Brazil (11.1%), followed by Argentina (8.2%), Chile (5.0%), and Mexico (0.8%). Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae was not detected in 2008, but emerged in 2009 (10 strains) and increased significantly in 2010 (44: P < 0.0001). bla(KPC-2) was detected in 54 (65.9%) of 85 carbapenem-nonsusceptible K. pneumoniae. Meropenem-nonsusceptible P. aeruginosa was observed in 53.8%, 46.7%, 33.3%, and 28.8% of strains from Argentina, Brazil, Chile, and Mexico, respectively. Imipenem-resistant Acinetobacter spp. rates increased from 6.4%, 12.6%, and 0.0% in the 1997-1999 period to 84.9%, 71.4%, and 50.0% in 2008-2010 in Argentina, Brazil, and Chile, respectively. Oxacillinase (OXA)-producing Acinetobacter spp. was documented in Argentina (OXA-23 and -24), Brazil (0)(A-23), Chile (OXA-58), and Mexico (OXA-24). Only colistin showed >77% overall coverage against the 5 most frequently isolated Gram-negative bacilli from Latin American Medical centers participating in the SENTRY Program. (C) 2012 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Avaliação da atividade in vitro dos novos antimicrobianos da classe das fluoroquinolonas, cefalosporinas e carbapenens contra 569 amostras clínicas de bactérias gram-negativas(Associação Médica Brasileira, 1997-06-01) Gales, Ana Cristina [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; Jones, R.n. [UNIFESP]; Baretta, M. [UNIFESP]; Sader, Helio Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)OBJECTIVE. Evaluation of the in vitro activity of new fluoroquinolones, cephalosporins and carbapenems against gram-negative bacteria. MATERIAL AND METHOD. A total of 569 clinical isolates were obtained from inpatients at São Paulo Hospital - UNIFESP/EPM in June and July of 1992. The species distribution was as follows: Enterobacter sp. (62), Escherichia coli (308), Klebsiella pneumoniae (27), Klebsiella sp. (9), Proteus mirabilis (23), Pseudomonas aeruginosa (88), Pseudomonas sp. (4), Serratia sp. (30) and other gram-negatives (7). Susceptibility tests were performed by broth microdilution. The antimicrobials agents tested were: ciprofloxacin, ofloxacin, levofloxacin, grepafloxacin, DU 6859-a, ceftazidime, cefepime, FK 037, imipenem, meropenem and biapenem. RESULTS. DU 6859-a showed the highest antimicrobial activity among the fluoroquinolones. It was two- to four-fold more active than ciprofloxacin against some species. The potency and antimicrobial spectrum were similar between the fourth-generation cephalosporins against Enterobacteriaceae, except for Enterobacter sp. strains which were more susceptible to cefepime than they were to cefetazidime or FK 037. When testing Pseudomonas aeruginosa, ceftazidime was slightly more active than the other cephalosporins. Against Enterobacteriaceae and Pseudomonas aeruginosa strains, meropenem was more active than imipenem or biapenem. In addition, the percentage of strains, susceptible to meropenem was higher than the percentage susceptible to the other cerbapenems against these species. CONCLUSION. The new antimicrobial agents demonstrated in vitro activity higher than that of agents commercially avaliable. However, more studies are necessary to further evaluate the in vivo activity and the clinical benefit of these compounds.
- ItemAcesso aberto (Open Access)Comparação das atividades antimicrobianas de meropenem e imipenem/cilastatina: o laboratório necessita testar rotineiramente os dois antimicrobianos?(Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2002-01-01) Gales, Ana Cristina [UNIFESP]; Mendes, Rodrigo Elisandro [UNIFESP]; Rodrigues, José [UNIFESP]; Sader, Helio Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Meropenem and imipenem are the most active and potent ß-lactams against gram-negative bacteria and the only carbapenems commercially available in Brazil, USA, and Europe. Meropenem has higher in vitro activity against gram-negative bacteria, while imipenem has slightly higher in vitro activity against gram-positive. The objectives of this study are to compare the in vitro activities of these carbapenems and to evaluate the necessity of susceptibility testing both compounds at the routine of the microbiology laboratory. The broth microdilution results of 2,144 gram-negative bacilli were analyzed. Against Enterobacteriaceae meropenem was at least eight-fold more potent than imipenem. Against Pseudomonas aeruginosa meropenem (MIC50, 1mug/ml) was also more potent than imipenem (MIC50, 2mug/ml), and against Acinetobacter baumannii both carbapenems presented similar in vitro activities (MIC50, 1mug/ml for both). Only 2.7% of the isolates presented discrepant category results between the carbapenems; i.e. susceptible to one and resistant to the other. Forty-six isolates (2.14%) were susceptible to meropenem and resistant to imipenem; while only 12 isolates (0.55%) were susceptible to imipenem and resistant to meropenem. The vast majority of discordant results (91.4%) occur among non-fermentative bacilli (NF-BGN). Five discordant results were detected among 1,350 Enterobacteriaceae evaluated (0.37%); while 53 discrepant results were detected among 794 NF-BGN (6.64%). Isolates showing susceptibility to meropenem and resistance to imipenem account for 80% of the discrepant results. The results of this study indicate that the microbiology laboratory may susceptibility test only one of the carbapenems for Enterobacteriaceae and use the same category result for the other one. It is important that the results for both carbapenems are sent to the physicians in order for them to be able to choose the most appropriated for the case. On the other hand, for NF-BGN the laboratory should susceptibility test both carbapenems.
- ItemSomente MetadadadosDiversity of mechanisms conferring resistance to beta-lactams among OXA-23-producing Acinetobacter baumannii clones(Elsevier Science Inc, 2016) Cardoso, Juliana Provasi [UNIFESP]; Cayo, Rodrigo [UNIFESP]; Girardello, Raquel [UNIFESP]; Gales, Ana Cristina [UNIFESP]A total of 31 unrelated OXA-23-producing Acinetobacter baumannii strains isolated from 14 hospitals located in distinct Brazilian regions were evaluated in this study. These isolates were grouped into 12 different sequence types (STs), of which 7 had unique allelic sequences (ST188, ST189, ST190, ST191, ST192, ST228, and ST299). Most isolates belonged to the clonal complex CC79 followed by CC15 and CC1. Only polymyxin B and minocycline showed good activity against the OXA-23-producing A. baumannii clones. The ISAba1 upstream bla(OXA-23), bict(OXA-51)-like, or ampC was found in 100%, 54.8%, and 77.4% of the isolates, respectively. High resistance rates to ceftazidime and cefotaxime were observed among those isolates possessing ISAba1 upstream ampC, in contrast to those isolates that did not carry this configuration. Moreover, a >= 2 Log(2) decrease in the MICs of meropenem and ceftazidime was observed in the presence of phenyl-arginine-beta-naphthylamide for 80.6% and 54.8% of isolates, respectively. Overexpression of the adeB was observed in 61.3% of isolates, particularly among those isolates belonging to the ST1 (CC1). It was also verified that ompW was down -regulated in all isolates belonging to the ST15 (CC15). On the other hand, carO and omp33-36 genes were overexpressed in 48.4% and 58.1% of the isolates, respectively. In this study, we show that overexpression of AdeABC system could significantly contribute for resistance to meropenem and ceftazidime among OXA-23-producing A. baumannii clones in Brazil, demonstrating the complexity involved in the p-lactam resistance in such isolates. (C) 2016 Elsevier Inc. All rights reserved.
- ItemAcesso aberto (Open Access)Infecção da corrente sanguínea causada por Pseudomonas aeruginosa resistente aos carbapenêmicos: fatores associados a mortalidade e influência da terapia combinada com polimixina B e imipenem(Universidade Federal de São Paulo (UNIFESP), 2011-07-27) Teixeira, Jane de Oliveira Gonzaga [UNIFESP]; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)Pseudomonas aeruginosa is an important pathogen causing nosocomial bloodstream infections. The treatment of carbapenem-resistant P. aeruginosa is a challenge as the drugs used for this purpose, the polymyxins, have lower activity compared with carbapenems. However, it has been suggested that polymyxins have the ability to make gram-negative bacteria more susceptible to other antibiotics. As carbapenems are considered the main drugs against P. aeruginosa, it would be interesting to demonstrate the efficacy of this combination in vivo, targeting a more effective therapy. Objectives: To evaluate the response of the treatment with polymyxin B versus polymyxin B and carbapenem in patients with nosocomial bloodstream infection caused by carbapenenresistant Pseudomonas aeruginosa and identify factors associated with mortality among those patients Methods: A retrospective cohort study was performed at Hospital São Paulo - UNIFESP, from January 1st, 2000 to December 31, 2009. The identification of patients was done through data collection from the blood cultures report. Patients were initially divided into deaths and survivors, and assessed for exposure to various factors potentially associated with in-hospital mortality and infection-related mortality. Presence of metalobetalactamase was tested trough PCR technique. Results: We studied 69 bloodstream infections caused by carbapenems-resistant P. aeruginosa. Thirthy-five were treated with polymyxin B monotherapy and 34 with combined therapy. In- hospital mortality was 77.1% and 79.4% in the monotherapy group and combined therapy group, respectively (p = 0.819). The infection-related mortality was 42.8% among patients who received monotherapy, and 44.1% in those receiving combined therapy (p = 0.917). Factors associated with mortality were previous use of glycopeptides (OR 10.71, CI95% 1.20 to 95.34, p = 0.033) and Charlson score (OR 1.9, CI95% 1, 22 to 2.94, p = 0.004). Infection-related mortality was associated with the presence of septic shock (OR 9.99, CI95% 1.81 to 55.22, p = 0.006) and parenteral nutrition (OR 7.45, CI95% 1.23 - 45.24, p = 0.029). No statistically significant difference was found between patients with MBLharboring and non-MBL-harboring strains treated with combined therapy. Conclusions: No difference was found between the monotherapy and combined therapy group regarding mortality. Independent factors related to in- hospital mortality were prior use of glycopeptides and the Charlson score. Presence of septic shock and use of parenteral nutrition were independently associated with infection-related mortality.