Navegando por Palavras-chave "ESBL"

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    Antimicrobial Activity of Doripenem Tested Against Leading Bacterial Pathogens: Results from a Latin American Surveillance Study (2003-2006)
    (Contexto, 2008-10-01) Gales, Ana Cristina [UNIFESP]; Jones, Ronald N.; Sader, Helio Silva [UNIFESP]; Fritsche, Thomas R.; Universidade Federal de São Paulo (UNIFESP); JMI Labs
    Carbapenems have been the therapeutic choice for empirical treatment of serious infections when multidrug-resistant Gram-negative organisms are suspected. Doripenem is a parenteral 1-beta-methyl-carbapenem that was recently approved in the USA for complicated urinary tract and intra-abdominal infections. We performed a longitudinal surveillance study on the in vitro activity of doripenem and comparator agents against patient isolates from Latin America. Consecutive, non-duplicate bacterial isolates (13,809) were collected from patients in 10 medical centers in Brazil (45.2%), Chile (21.1%), Argentina (17.9%), Mexico (12.9%) and Venezuela (2.9%). Isolate identifications were confirmed and susceptibility testing was performed using reference methods at a central laboratory (JMI Laboratories, North Liberty, IA). Doripenem and meropenem were the most active compounds tested against E. coli and Klebsiella spp. (MIC(90) values, <= 0.12 mu g/mL), including against those strains with ESBL phenotypes (15.2% of E. coli and 44.9% of Klebsiella spp.). All Enterobacter spp. strains were inhibited at <= 4 mu g/mL of doripenem, meropenem or imipenem; only ertapenem was less active (94.8% susceptible). Furthermore, only 86.6 and 77.0% of Enterobacter spp. strains were susceptible to amikacin and polymyxin B, respectively. Doripenem and meropenem were equally potent against R aeruginosa (MIC(50) 1 mu g/mL) and Acinetobacter spp. (MIC(50) 2 mu g/mL); however, doripenem inhibited a greater number of R aeruginosa (78.1%) at MIC values of <= 4 mu g/mL compared to meropenem (70.9%) or imipenem (67.9%). Moreover, doripenem inhibited 34.0% of imipenem-non-susceptible P aertiginosa isolates at MIC values <= 4 mu g/mL. Doripenem inhibited all oxacillin-susceptible staphylococci and S. pneumoniae, including penicillin-resistant strains, at <= 2 mu g/mL. In summary, doripenem showed potent activity against Enterobacteriaceae (including ESBL- and/or AmpC-producing strains), oxacillin-susceptible staphylococci and streptococci isolated in Latin American hospitals participating in the international doripenem surveillance program. Doripenem activity was also comparable to that of other carbapenems against P aeruginosa and Acinetobacter spp. Given limited therapeutic choices available, doripenem shows a promising broad-spectrum that should prove useful in geographic regions with problematic emerging resistances.
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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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    Avaliação da acurácia de testes laboratoriais para detecção de amostras de Klebsiella pneumoniae produtora de betalactamase de espectro estendido
    (Sociedade Brasileira de Patologia ClínicaSociedade Brasileira de PatologiaSociedade Brasileira de Citopatologia, 2003-01-01) Pereira, Andrea dos Santos [UNIFESP]; Carmo Filho, José Rodrigues do; Tognim, Maria Cristina Bronharo [UNIFESP]; Sader, Helio Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); Universidade Estadual de Maringá
    Bacterial strains producing extended spectrum beta-lactamases (ESBL) represent a common resistance problem among Brazilian hospitals. Due to the difficulty of ESBL detection in the clinical laboratory, these bacterial isolates require a reproducible, efficient, and low cost detection method. The aim of the present study was to evaluate the efficacy of detection of K. pneumoniae ESBL isolates by two methods: the Etest ESBL strip and the inhibitor potentiated disk diffusion test with clavulanic acid (clavulanate-potentiation test). The sensitivity and the specificity of beta-lactam agents against these isolates were also evaluated. The experiments were performed on a total of 134 K. pneumoniae isolates recovered from blood specimens in our institution from July 1996 to July 2001. The samples were tested for ESBL production by the NCCLS screen test, clavulanate-potentiation test and Etest ESBL strip. Isolates presenting positive results for the screen test and for at least one of the evaluated tests were considered ESBL producers (gold standard). The results of this study yielded a 100% specificity and sensitivity for the clavulanate-potentiation test, and the best indicators of ESBL production were cefotaxime and cefpodoxime. The Etest ESBL strip also turned out to be a very sensitive (96%) and specific (100%) method, being cefotaxime the most efficient substrate. According to the results of this investigation, the clavulanate potentiation disk diffusion test displayed an excellent performance and can be easily implemented in routine clinical laboratories as a practical, reliable, and accurate method.
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    Comparative activities of cefepime and piperacillin/tazobactam tested against a global collection of Escherichia coli and Klebsiella spp. with an ESBL phenotype
    (Elsevier B.V., 2007-03-01) Sader, Helio S.; Hsiung, Andre; Fritsche, Thomas R.; Jones, Ronald N.; JMI Labs; Universidade Federal de São Paulo (UNIFESP); Hardy Diagnost; Tufts Univ
    Cefepime exhibits more stability to hydrolysis by extended-spectrum beta-lactamases (ESBLs) compared with other cephalosporins, and piperacillin/tazobactam may be active against these pathogens because of the enzyme inhibitory activity of tazobactam. Thus, we evaluated the in vitro activity of these 2 antimicrobials against a large collection of isolates with an ESBL phenotype. A total of 50,637 clinical isolates (34,367 Escherichia coli and 16,270 Klebsiella spp.) collected from more than 80 medical centers (1998-2004) were tested by reference broth microdilution methods, and isolates with an ESBL phenotype (MIC, >= 2 mu g/mL for aztreonam or ceftazidime or ceftriaxone) were submitted to a clavulanate inhibition test (confirmation of ES13L production). Among isolates from North America, 3.9% of E. coli and 8.6% of Klebsiella spp. showed an ES13L phenotype, whereas among isolates from the rest of the world (ROW) (Europe, Latin America, and Asia), 7.7% of E. coli and 28.3% of Klebsiella spp. exhibited this pattern. Confrmation rates varied from 21.6% of E. coli in North America to 52.8% of Klebsiella spp. in the row. Among E. coli from North America, cefepime (90.3% susceptibility) was generally more active than piperacillin/tazobactam (82.7%), especially among ESBL-not-confirmed (97.0% versus 85.5%). Cefepime also showed reasonable activity against Klehsiella spp. from North America (89.4% susceptibility). in general, isolates from North America exhibited higher susceptibility rates to both beta-lactams compared with isolates from the ROW, and ESBL-not-confirmed strains showed generally higher susceptibility rates than ESBL-confirmed organisms. (c) 2007 Elsevier Inc. All rights reserved.
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    Draft genome sequence of a multidrug-resistant Aeromonas hydrophila ST508 strain carrying rmtD and bla(CTX-M-131) isolated from a bloodstream infection
    (Elsevier Sci Ltd, 2017) Moura, Quezia; Fernandes, Miriam R.; Cerdeira, Louise; Santos, Ana Carolina M. [UNIFESP]; de Souza, Tiago A.; Ienne, Susan; Pignatari, Antonio Carlos C. [UNIFESP]; Gales, Ana C. [UNIFESP]; Silva, Rosa M. [UNIFESP]; Lincopan, Nilton
    Here we report the draft genome sequence of a multidrug-resistant (MDR) Aeromonas hydrophila strain belonging to sequence type 508 (ST508) isolated from a human bloodstream infection. Assembly and annotation of this draft genome resulted in 5 028 498 bp and revealed the presence of 16S rRNA methylase rmtD and bla(CTX-M-131) genes encoding high-level resistance to aminoglycosides and cephalosporins, respectively, as well as multiple virulence genes. This draft genome can provide significant information for understanding mechanisms on the establishment and treatment of infections caused by this pathogen. (C) 2017 International Society for Chemotherapy of Infection and Cancer. Published by Elsevier Ltd. All rights reserved.
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    Health and economic outcomes of the detection of Klebsiella pneumoniae-produced extended-spectrum beta-lactamase (ESBL) in a hospital with high prevalence of this infection
    (Elsevier B.V., 2006-01-01) Marra, Alexandre Rodrigues; Castelo Filho, Adauto [UNIFESP]; Carmo Filho, José Rodrigues do; Cal, Ruy Guilherme Rodrigues [UNIFESP]; Sader, Helio Silva [UNIFESP]; Wey, Sergio Barsanti [UNIFESP]; Pereira, Carlos Alberto Pires [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Klebsiella pneumoniae is of high prevalence in hospital infections, mainly in bloodstream infections (BSI), and some produce extended-spectrum beta-lactamase (ESBL). for hospitals with a high prevalence of strains producing this enzyme, there is no reference material to show whether the use of the E-test method for their detection, which can be quite expensive, is actually required.Objective: To evaluate the cost-benefit of the disk diffusion and E-test methods for the detection of ESBL-producing K. pneumoniae strains in hospitals where a high prevalence of this resistance mechanism in BSI is found.Methods: One hundred and eight patients with K. pneumoniae BSI were evaluated retrospectively. ESBL-producing strains were identified by the disk diffusion method and by the E-test method. We estimated the costs of both diagnostic methods based on antimicrobial therapy adequacy.Results: Fifty-two percent of K. pneumoniae infections were due to ESBL-producing strains. the disk diffusion method yielded a positive predictive value (PPV) of 94.7% (95% Cl: 88.9-100%) and a negative predictive value (NPV) of 96.1% (CI 95%: 90.8-101.4%) in relation to the E-test. We evaluated cost-effectiveness, i.e., we analyzed the cost of both E-test and disk diffusion methods with carbapenem and cephalosporins, and found that the use of the disk diffusion method accounts for approximately US$3300.Conclusions: in hospitals with a high prevalence of ESBL-producing strains, the disk diffusion method can be used to detect ESBL-producing K. pneumoniae without compromising the clinical progression of patients with BSI. the E-test showed higher accuracy but this method was more expensive than the disk diffusion method. However, the use of the E-test method was demonstrated to be more cost-effective, as we evaluated cost based on antimicrobial therapy adequacy. (C) 2005 International Society for Infectious Diseases. Published by Elsevier B.V. All rights reserved.
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    Tigecycline activity tested against multidrug-resistant Enterobacteriaceae and Acinetobacter spp. isolated in US medical centers (2005-2009)
    (Elsevier B.V., 2011-02-01) Sader, Helio S. [UNIFESP]; Farrell, David J.; Jones, Ronald N.; JMI Labs; Universidade Federal de São Paulo (UNIFESP); Tufts Univ
    We evaluated the activity of tigecycline against Enterobacteriaceae (9563 isolates) and Acinetobacter spp. (835) with various resistance phenotypes collected from 31 US medical centers in 2005-2009. the isolates were tested for susceptibility by the reference broth microdilution method against tigecycline and various comparators. Among Escherichia coli and Klebsiella spp., 6.8% and 15.4% exhibited an extended-spectrum beta-lactamase (ESBL) phenotype, respectively; and 22.2% of Enterobacter spp. strains were ceftazidime-resistant. Tigecycline was active against E. coli [minimum inhibitory concentration (MIC(50/90)), 0.12/0.25 mu g/mL; 100.0% susceptible] independent of ESBL phenotype or resistance to other antimicrobials. Among Klebsiella spp., 97.9% of ESBL-producing Klebsiella spp. and 98.2% of imipenem-non-susceptible strains were susceptible to tigecycline (MIC(50/90), 0.5/1 mu g/mL for both subsets). Tigecycline was active against Enterobacter spp. (MIC(50/90), 0.25/1 mu g/mL; 98.4% susceptible), including ceftazidime-resistant strains (MIC(50/90), 0.5/2 mu g/mL; 97.1% susceptible). Tigecycline inhibited 94.4% of Acinetobacter spp. overall (MIC(50/90), 0.5/2 mu g/mL) and 86.2% of imipenem non-susceptible (MIC(50/90), 1/4 mu g/mL) strains at <= 2 mu g/mL. No trend toward decreased tigecycline activity overtime was observed for any of the organisms or resistant subsets during the study period. These results indicate that tigecycline has sustained potent in vitro activity and a broad spectrum against these clinically important Gram-negative pathogens causing infections in US medical centers, including multidrug-resistant organism subsets. (C) 2011 Elsevier Inc. All rights reserved.