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- ItemSomente MetadadadosAntimicrobial 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 LabsCarbapenems 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.
- ItemAcesso aberto (Open Access)Antimicrobial susceptibility of gram-positive bacteria isolated in brazilian hospitals participating in the SENTRY Program (2005-2008)(Brazilian Society of Infectious Diseases, 2009-04-01) Gales, Ana Cristina [UNIFESP]; Sader, Helio Silva [UNIFESP]; Ribeiro, Julival; Zoccoli, Cassia; Barth, Afonso; Pignatari, Antonio Carlos Campos [UNIFESP]; Universidade Federal de São Paulo (UNIFESP); JMI Laboratories; Hospital de Base do Distrito Federal; Laboratório Médico Santa Luzia; Hospital de Clínicas de Porto AlegreWe report the antimicrobial susceptibility patterns of the most frequently isolated Gram-positive bacteria in the Brazilian hospitals participating in the SENTRYAntimicrobial Surveillance Program. The strains were consecutively collected (one per patient) between January 2005 and September 2008 and susceptibility tested by reference broth microdilution methods at the JMI Laboratories (North Liberty, Iowa, USA). A total of 3,907 Gram-positive cocci were analyzed. The Gram-positive organisms most frequently isolated from bloodstream infections were Staphylococcus aureus (2,218 strains; 20.2% of total), coagulase-negative staphylococci (CoNS; 812 strains [14.7%]), and Enterococcus spp. (754 strains; 5.0%). S. aureus ranked first (28.1%) and Enterococcus faecalis ranked 7th (4.5%) among cases of skin and soft tissue infections. S. aureus was also the second most frequently isolated pathogen from patients with lower respiratory tract infections (24.9% of cases) after Pseudomonas aeruginosa (30.5%). Resistance to oxacillin was observed in 31.0% of S. aureus and the vast majority of oxacillin-resistant (MRSA) strains were also resistant to clindamycin, ciprofloxacin and levofloxacin. Vancomycin, linezolid and daptomycin were all very active against S. aureus strains tested (>99.9-100.0% susceptible), but daptomycin (MIC50, 0.25 g/mL and MIC90, 0.5 g/mL) was four- to eight-fold more potent than vancomycin (MIC50 and MIC90 of 1 g/mL) and linezolid (MIC50, 1 g/mL and MIC90, 2 g/mL). Vancomycin resistance increased significantly among enterococci during the study period, but it was restrict to only one medical center until 2007 and emerged in a second medical center in 2008. Daptomycin was the most active antimicrobial tested against enterococci in general (100.0% susceptible), followed by linezolid (99.9% susceptible), ampicillin (87.4%) and vancomycin (84.6%). In conclusion, daptomycin and linezolid showed excellent in vitro activity against contemporary Gram-positive organisms (3,907) collected in Brazilian hospitals monitored by the SENTRY Program, including MRSA, vancomycin-resistant enterococci (VRE) and other multidrugresistant organisms. Although vancomycin resistance rates in Brazil appears to be relatively low compared to those reported in the USA, VRE has emerged and rapidly disseminated in some Brazilian medical centers.
- ItemAcesso aberto (Open Access)Cluster of Candida parapsilosis primary bloodstream infection in a neonatal intensive care unit(Brazilian Society of Infectious Diseases, 2001-02-01) Pessoa-Silva, Carmem Lucia [UNIFESP]; Santos, Rosana M. R. Dos; Colombo, Arnaldo Lopes [UNIFESP]; UFRJ Depto. de Medicina Preventiva Disciplina de Doenças Infecciosas e Parasitárias; Hospital da Lagoa; Universidade Federal de São Paulo (UNIFESP)Candida parapsilosis is an increasingly important bloodstream pathogen in neonatal intensive care units (NICU). We investigated a cluster of bloodstream infections in a NICU to determine whether nosocomial transmission occurred. During a 3-day period, 3 premature infants hospitalized in the same unit presented with sepsis caused by C. parapsilosis. Electrophoretic karyotype of the organisms was performed by using pulsed field gel electrophoresis in a countour-clamped homogeneous electric field system. The isolate from 1 newborn could not be typed, and the isolates from the remaining 2 infants had identical patterns. All 3 cases are described. We conclude that nosocomial transmission of C. parapsilosis occurred and that neonates under intensive care may represent a risk group for this pathogen.
- ItemAcesso aberto (Open Access)¿Es aplicable el sistema de vigilancia epidemiológica de las infecciones intrahospitalarias que recomienda el CDC- americano (sistema NNIS) en un hospital chileno?(Soc Medica Santiago, 2001-12-01) Febré, Naldy; Medeiros, Eduardo Alexandrino Servolo de [UNIFESP]; Wey, Sergio Barsanti [UNIFESP]; Larrondo Prieto, Maruza; Silva, Victor; Univ Chile; Universidade Federal de São Paulo (UNIFESP)Background: The National Nosocomial Infections Surveillance System (NNIS system) is the method for surveying nosocomial infections used by the Centers for Disease Control (CDC). This strategy allows the comparison of different hospitals, using rate adjustments. In Chile, this system is not used Aim: TO report the application of this system in a tertiary reference hospital in Chile. Materials and methods: Me performed a six months prospective cohort study, The active surveillance was carried out by using the intensive care unit and surgery components of the NNIS system. Tabulation and analysis of the data were done according to the NNIS system. In a parallel prevalence study, we determined the NNIS system sensitivity to detect nosocomial infections. Results: A total of 492 patients were followed with a global nosocomial infection rate of 14%, for discharged patients. The calculated sensitivity and specificity of the system was 84.2 and 97% respectively, In the intensive care unit, 45 of 169 patients bad nosocomial infections, with an adjusted rate of 2.8% for mean hospitalization time and severity of illness. In the cardiovascular and thoracic surgical units, 216 and 107 procedures were surveyed, respectively. The global rates of nosocomial infections were 7.4 and 7.5%, respectively. The adjusted rates according to risk factors were 0.9 and 2.3%, respectively, Conclusions: These data indicate that the surgical units bad surgical site infections rates similar to those reported by the CDC Nosocomial infections rates in Chile can be compared with rates observed in other countries. The epidemiological data collected can be useful to focus intervention or preventive strategies.
- ItemAcesso aberto (Open Access)Genomic epidemiology of a national outbreak of post-surgical Mycobacterium abscessus wound infections in Brazil(Microbiology Soc, 2017) Everall, Izzy; Nogueira, Christiane Lourenco [UNIFESP]; Bryant, Josephine M.; Sanchez-Buso, Leonor; Chimara, Erica; Duarte, Rafael da Silva; Ramos, Jesus Pais; Batista Lima, Karla Valeria; Lopes, Maria Luiza; Palaci, Moises; Kipnis, Andre; Monego, Fernanda; Andres Floto, R.; Parkhill, Julian; Leao, Sylvia Cardoso [UNIFESP]; Harris, Simon R.An epidemic of post-surgical wound infections, caused by a non-tuberculous mycobacterium, has been on-going in Brazil. It has been unclear whether one or multiple lineages are responsible and whether their wide geographical distribution across Brazil is due to spread from a single point source or is the result of human-mediated transmission. 188 isolates, collected from nine Brazilian states, were whole genome sequenced and analysed using phylogenetic and comparative genomic approaches. The isolates from Brazil formed a single clade, which was estimated to have emerged in 2003. We observed temporal and geographic structure within the lineage that enabled us to infer the movement of sub-lineages across Brazil. The genome size of the Brazilian lineage was reduced relative to most strains in the three subspecies of Mycobacterium abscessus and contained a novel plasmid, pMAB02, in addition to the previously described pMAB01 plasmid. One lineage, which emerged just prior to the initial outbreak, is responsible for the epidemic of post-surgical wound infections in Brazil. Phylogenetic analysis indicates that multiple transmission events led to its spread. The presence of a novel plasmid and the reduced genome size suggest that the lineage has undergone adaptation to the surgical niche.
- ItemAcesso aberto (Open Access)Inter-hospital dissemination of glycopeptide-resistant Enterococcus faecalis in Brazil(Blackwell Publishing Ltd, 2004-03-01) Cordeiro, JCR [UNIFESP]; Silbert, Suzane [UNIFESP]; Reis, A. O. [UNIFESP]; Sader, Helio Silva [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)The antimicrobial susceptibility patterns of 73 glycopeptide-resistant Enterococcus faecalis isolates from nine hospitals in Brazil were analysed by the disk diffusion method and Etests. Isolates were typed by pulsed-field gel electrophoresis (PFGE), and vancomycin resistance genes were detected by PCR. the isolates shared a single major PFGE pattern, with six subtypes, and all were positive for vanA. These results indicate the occurrence of inter-hospital dissemination of glycopeptide-resistant E. faecalis in São Paulo, and raise concerns about the rapid dissemination of this pathogen throughout Brazil.