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- ItemAcesso aberto (Open Access)Detecção de resistência a antimicrobiano em amostras de vigilância de doentes renais crônicos: comparação de métodos fenotípicos e moleculares(Universidade Federal de São Paulo (UNIFESP), 2016-04-29) Rezende, Thais Freitas Teles [UNIFESP]; Pignatari, Antonio Carlos Campos [UNIFESP]; http://lattes.cnpq.br/9461346610553865; http://lattes.cnpq.br/4149593220799749; Universidade Federal de São Paulo (UNIFESP)Background: Multidrug resistant (MDR) bacteria colonization is a serious health care problem that improves the risk for infection and contribute for dissemination of antimicrobial resistance in health care associated environments. Among chronic renal failure patients, where the risk for acquisition and dissemination of these resistant bacteria are higher, surveillance culture is recommended as a component of infection control programs Objective: The aim of this study is to compare the performance of phenotypic methods for surveillance of MDR bacteria with real time PCR (qPCR) in large population of chronic renal failure patients. Methods: We included a total of 546 CRFP from a tertiary and University center specialized in chronic renal failure care. These patients were divided in 3 groups: conservative treatment (129), patients under dialysis (217) and transplanted patients (200). We collected nasal swabs for MRSA detection and rectal swabs for carbapenemase and VRE detection, in two different moments; total of 1092 samples (ESwabTM). For phenotypic screening we used the CHROMagar for KPC, MRSA and VRE. For the molecular analysis we used the qPCR for detection of the genes: blaKPC, blaNDM, blaSPM, blaGES, blaVIM, blaOXA48, vanA, mecA and aur (S. aureus identification). Conventional PCR were also performed when necessary. Results: Among the 1,092 samples we found 13.8% of KPC positives according to chromogenic agar (AC). Only 26 were confirmed as KPC positive according conventional PCR. On the other hand, according to qPCR direct from swab were 31 (2,8%) positives to KPC, 39 (3,6%) for GES and 3 (0,3%) for SPM with a concordance index Kappa of 0,256. For VRE the AC was positive in XXX 16 (1,5%) of the patients and the qPCR positive in 20 (1,8%) of the patients, Kappa 0,135. For MRSA we tested only 298 samples, and we observed 4 (1,3%) of positivity with AC and 15 (5%) according to qPCR. Conclusions: We observed for carbapenemase an increased rate of false positives results using AC (than qPCR) with a low agreement between methods. For VRE we observed a better sensitivity using the AC once qPCR could not detect confirmed strains of VRE. However, for MRSA the molecular method had better performance. We conclude that among this high-risk population molecular methods had better results than the culture for carbapenemases detection and MRSA. Besides, it can provide results faster than cultures allowing the early implementation of control and prevention measures to reduce the dissemination of MDR bacteria among patients and health care environment.