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Krul D, Rodrigues LS, Siqueira AC, Mesa D, Dos Santos ÉM, Vasconcelos TM, Spalanzani RN, Cardoso R, Ricieri MC, de Araújo Motta F, Conte D, Dalla-Costa LM. High-risk clones of carbapenem resistant Klebsiella pneumoniae recovered from pediatric patients in Southern Brazil. Braz J Microbiol 2024:10.1007/s42770-024-01299-w. [PMID: 38499916 DOI: 10.1007/s42770-024-01299-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 03/03/2024] [Indexed: 03/20/2024] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) exhibit high mortality rates in pediatric patients and usually belong to international high-risk clones. This study aimed to investigate the molecular epidemiology and carbapenem resistance mechanisms of K. pneumoniae isolates recovered from pediatric patients, and correlate them with phenotypical data. Twenty-five CRKP isolates were identified, and antimicrobial susceptibility was assessed using broth microdilution. Carbapenemase production and β-lactamase genes were detected by phenotypic and genotypic tests. Multilocus sequence typing was performed to differentiate the strains and whole-genome sequencing was assessed to characterize a new sequence type. Admission to the intensive care unit and the use of catheters were significantly positive correlates of CRKP infection, and the mortality rate was 36%. Almost all isolates showed multidrug-resistant phenotype, and most frequent resistant gene was blaKPC. We observed the dissemination of ST307 and clones belonging to CG258, which are considered high risk. In pediatric patients, these clones present with high genomic plasticity, favoring adaptation of the KPC and NDM enzymes to healthcare environments.
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Affiliation(s)
- Damaris Krul
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
| | - Luiza Souza Rodrigues
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
| | - Adriele Celine Siqueira
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
| | - Dany Mesa
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
| | - Érika Medeiros Dos Santos
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
- Hospital Pequeno Príncipe (HPP), Curitiba, Paraná, Brazil
| | - Thaís Muniz Vasconcelos
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
| | - Regiane Nogueira Spalanzani
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
| | | | | | | | - Danieli Conte
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil
| | - Libera Maria Dalla-Costa
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil.
- Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Av. Silva Jardim, 1632 -Rebouças, Curitiba, Paraná, CEP 80250-060, Brazil.
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Vasconcelos TM, Mesa D, Rodrigues LS, Medeiros Dos Santos É, Krul D, Siqueira AC, de Abreu RBV, Motta FDA, Conte D, Dalla-Costa LM. Outbreak of vancomycin-resistant Enterococcus faecium ST1133 in paediatric patients with acute lymphoblastic leukaemia from southern Brazil. J Glob Antimicrob Resist 2024; 36:41-44. [PMID: 38000534 DOI: 10.1016/j.jgar.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 10/18/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023] Open
Abstract
OBJECTIVES We aimed to investigate an outbreak of vancomycin-resistant Enterococcus faecium (VREfm) in paediatric patients from Hospital Pequeno Príncipe. The susceptibility profile was determined, and whole-genome sequencing (WGS) was used to analyse the genetic context of the strains. METHODS Five VREfm isolates were recovered from sterile sites and surveillance cultures of two paediatric patients with acute lymphoblastic leukaemia. Species identification was performed using matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS), and the minimum inhibitory concentration (MIC) was assessed according to the European Committee for Antimicrobial Susceptibility Testing (EUCAST). WGS was performed to analyse the genetic context of virulence and resistance genes, and in silico multilocus sequence typing was performed to identify the sequence typing of the strains. RESULTS High-level vancomycin resistance was observed in all isolates (≥256 mg/L). WGS revealed the presence of mobile genetic elements, such as plasmids (rep2, rep11a, repUS15, rep17, and rep18a), insertion sequences, and phages. Multiple resistance genes (aac(6')-aph(2"), dfrG, ermB, and vanA) and virulence genes (acm and efaAfm) were identified. All the isolates were assigned to ST117 (ST1133 - via a novel MLST), an important epidemic lineage associated with nosocomial infections and outbreaks. CONCLUSION Our results show that the ST117 (ST1133) VREfm isolates are circulating in paediatric patients, which raises a great concern. The development of new drugs as well as the implementation of an antimicrobial stewardship program are necessary for their correct management, limiting the spread of resistance in oncohematological patients.
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Affiliation(s)
- Thaís Muniz Vasconcelos
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | - Dany Mesa
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | | | - Érika Medeiros Dos Santos
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil; Hospital Pequeno Príncipe (HPP), Curitiba, Paraná, Brazil
| | - Damaris Krul
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | - Adriele Celine Siqueira
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | | | | | - Danieli Conte
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | - Libera Maria Dalla-Costa
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil.
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Conte D, Palmeiro JK, Bavaroski AA, Rodrigues LS, Cardozo D, Tomaz AP, Camargo JO, Dalla-Costa LM. Antimicrobial resistance in Aeromonas species isolated from aquatic environments in Brazil. J Appl Microbiol 2020; 131:169-181. [PMID: 33306232 DOI: 10.1111/jam.14965] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Revised: 11/16/2020] [Accepted: 12/07/2020] [Indexed: 11/28/2022]
Abstract
AIM The current study was conducted to determine the antimicrobial resistance profile and genetic relatedness of Aeromonas sp. isolated from healthcare and urban effluents, wastewater treatment plant (WWTP) and river water. METHODS AND RESULTS We detected the presence of genes conferring resistance to β-lactam, quinolone and aminoglycoside. Multilocus sequence typing was carried out to differentiate the strains, and multilocus phylogenetic analysis was used to identify the species. A total of 28 cefotaxime-resistant Aeromonas sp. strains were identified, harbouring uncommon Guiana-extended-spectrum (GES)-type β-lactamases (GES-1, GES-5, GES-7 and GES-16). Multidrug-resistant Aeromonas sp. were found in hospital wastewater, WWTP and sanitary effluent, and A. caviae was identified as the most prevalent species (85·7%). CONCLUSION The release of untreated healthcare effluents, presence of antimicrobials in the environment, in addition to multidrug-resistant Aeromonas sp., are all potential factors for the spread of resistance. SIGNIFICANCE AND IMPACT OF THE STUDY We identified a vast repertoire of antimicrobial resistance genes (ARG) in Aeromonas sp. from diverse aquatic ecosystems, including those that encode enzymes degrading broad-spectrum antimicrobials widely used to treat healthcare-associated infections. Hospital and sanitary effluents serve as potential sources of bacteria harbouring ARG and are a threat to public health.
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Affiliation(s)
- D Conte
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | - J K Palmeiro
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil.,Departamento de Análises Clínicas, Universidade Federal de Santa Catarina (ACL-UFSC), Florianópolis, Santa Catarina, Brazil
| | - A A Bavaroski
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | - L S Rodrigues
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
| | - D Cardozo
- Liga Paranaese de Combate ao Câncer - Hospital Erasto Gaertner (HEG), Curitiba, Paraná, Brazil
| | - A P Tomaz
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil.,Complexo Hospital de Clínicas, Universidade Federal do Paraná (CHC-UFPR), Curitiba, Paraná, Brazil
| | - J O Camargo
- Departamento de Bioquímica e Biologia Molecular, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.,Setor de Educação Profissional e Tecnológica (SEPT), Programa de Graduação em Bioinformática, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil
| | - L M Dalla-Costa
- Faculdades Pequeno Príncipe (FPP), Curitiba, Paraná, Brazil.,Instituto de Pesquisa Pelé Pequeno Príncipe (IPPPP), Curitiba, Paraná, Brazil
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Rodrigues LS, Gazara RK, Passarelli-Araujo H, Valengo AE, Pontes PVM, Nunes-da-Fonseca R, de Souza RF, Venancio TM, Dalla-Costa LM. First Genome Sequences of Two Multidrug-Resistant Candida haemulonii var. vulnera Isolates From Pediatric Patients With Candidemia. Front Microbiol 2020; 11:1535. [PMID: 32719671 PMCID: PMC7350289 DOI: 10.3389/fmicb.2020.01535] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 06/12/2020] [Indexed: 12/20/2022] Open
Abstract
Candida haemulonii is a complex formed by C. haemulonii sensu stricto, C. haemulonii var. vulnera, and C. duobushaemulonii. Members of this complex are opportunistic pathogens closely related to C. pseudohaemulonii, C. lusitaniae, and C. auris, all members of a multidrug-resistant clade. Complete genome sequences for all members of this group are available in the GenBank database, except for C. haemulonii var. vulnera. Here, we report the first draft genomes of two C. haemulonii var. vulnera (isolates K1 and K2) and comparative genome analysis of closely related fungal species. The isolates were biofilm producers and non-susceptible to amphotericin B and fluconazole. The draft genomes comprised 350 and 387 contigs and total genome sizes of 13.21 and 13.26 Mb, with 5,479 and 5,507 protein-coding genes, respectively, allowing the identification of virulence and resistance genes. Comparative analyses of orthologous genes within the multidrug-resistant clade showed a total of 4,015 core clusters, supporting the conservation of 24,654 proteins and 3,849 single-copy gene clusters. Candida haemulonii var. vulnera shared a larger number of clusters with C. haemulonii and C. auris; however, more singletons were identified in C. lusitaniae and C. auris. Additionally, a multiple sequence alignment of Erg11p proteins revealed variants likely involved in reduced susceptibility to azole and polyene antifungal agents. The data presented in this work will, therefore, be of utmost importance for researchers studying the biology of the C. haemulonii complex and related species.
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Affiliation(s)
- Luiza Souza Rodrigues
- Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisas Pelé Pequeno Príncipe, Curitiba, Brazil
| | - Rajesh Kumar Gazara
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil.,Department of Biotechnology, Indian Institute of Technology Roorkee, Roorkee, India.,Department of Electrical Engineering, Indian Institute of Technology Roorkee, Roorkee, India
| | - Hemanoel Passarelli-Araujo
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil.,Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | | | - Paula Veronesi Marinho Pontes
- Instituto de Biodiversidade e Sustentabilidade, Núcleo em Ecologia e Desenvolvimento Sócio-Ambiental de Macaé, Universidade Federal do Rio de Janeiro, Macaé, Brazil
| | - Rodrigo Nunes-da-Fonseca
- Instituto de Biodiversidade e Sustentabilidade, Núcleo em Ecologia e Desenvolvimento Sócio-Ambiental de Macaé, Universidade Federal do Rio de Janeiro, Macaé, Brazil
| | - Robson Francisco de Souza
- Laboratório de Estrutura e Evolução de Proteínas, Instituto de Ciências Biomédicas, Universidade de São Paulo, São Paulo, Brazil
| | - Thiago Motta Venancio
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil
| | - Libera Maria Dalla-Costa
- Faculdades Pequeno Príncipe, Curitiba, Brazil.,Instituto de Pesquisas Pelé Pequeno Príncipe, Curitiba, Brazil
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Palmeiro JK, de Souza RF, Schörner MA, Passarelli-Araujo H, Grazziotin AL, Vidal NM, Venancio TM, Dalla-Costa LM. Molecular Epidemiology of Multidrug-Resistant Klebsiella pneumoniae Isolates in a Brazilian Tertiary Hospital. Front Microbiol 2019; 10:1669. [PMID: 31396186 PMCID: PMC6664048 DOI: 10.3389/fmicb.2019.01669] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Accepted: 07/08/2019] [Indexed: 12/13/2022] Open
Abstract
Multidrug-resistant (MDR) Klebsiella pneumoniae (Kp) is a major bacterial pathogen responsible for hospital outbreaks worldwide, mainly via the spread of high-risk clones and epidemic resistance plasmids. In this study, we evaluated the molecular epidemiology and β-lactam resistance mechanisms of MDR-Kp strains isolated in a Brazilian academic care hospital. We used whole-genome sequencing to study drug resistance mechanisms and their relationships with a K. pneumoniae carbapenemase-producing (KPC) Kp outbreak. Forty-three Kp strains were collected between 2003 and 2012. Antimicrobial susceptibility testing was performed for 15 antimicrobial agents, and polymerase chain reaction (PCR) was used to detect 32 resistance genes. Mutations in ompk35, ompk36, and ompk37 were evaluated by PCR and DNA sequencing. Pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were carried out to differentiate the strains. Based on distinct epidemiological periods, six Kp strains were subjected to whole-genome sequencing. β-lactamase coding genes were widely distributed among isolates. Almost all isolates had mutations in porin genes, particularly ompk35. The presence of blaKPC promoted a very high increase in carbapenem minimum inhibitory concentration only when ompk35 and ompk36 were interrupted by insertion sequences. A major cluster was identified by PFGE analysis and all isolates from this cluster belonged to clonal group (CG) 258. We have also identified a large repertoire of resistance genes in the sequenced isolates. A blaKPC–2-bearing plasmid (pUFPRA2) was also identified, which was very similar to a plasmid previously described in the first Brazilian KPC-Kp (2005). We found high-risk clones (CG258) and an epidemic resistance plasmid throughout the duration of the study (2003 to 2012), emphasizing a persistent presence of MDR-Kp strains in the hospital setting. Finally, we found that horizontal transfer of resistance genes between clones may have played a key role in the evolution of the outbreak.
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Affiliation(s)
- Jussara Kasuko Palmeiro
- Laboratório de Bacteriologia e Biologia Molecular, Unidade do Laboratório de Análises Clínicas, Complexo Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, Brazil.,Faculdades Pequeno Príncipe, Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, Brazil.,Departamento de Análises Clínicas, Centro de Ciências da Saúde, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Robson Francisco de Souza
- Laboratório de Estrutura e Evolução de Proteínas, Instituto de Ciências Biomédicas II, Universidade de São Paulo, São Paulo, Brazil
| | - Marcos André Schörner
- Hospital Universitário, Universidade Federal de Santa Catarina, Florianópolis, Brazil
| | - Hemanoel Passarelli-Araujo
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil.,Departamento de Bioquímica e Imunologia, Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Ana Laura Grazziotin
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil
| | - Newton Medeiros Vidal
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil.,National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health, Bethesda, MD, United States
| | - Thiago Motta Venancio
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro, Campos dos Goytacazes, Brazil
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Rodrigues LS, Motta FA, Picharski GL, Vasconcelos TM, Riccieri MC, Dalla-Costa LM. Invasive candidiasis: Risk factor for mortality in a pediatric tertiary care hospital in south of Brazil. Medicine (Baltimore) 2019; 98:e15933. [PMID: 31169713 PMCID: PMC6571356 DOI: 10.1097/md.0000000000015933] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 04/23/2019] [Accepted: 05/10/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Invasive candidiasis (IC) is a major cause of morbimortality in children. Previous studies described the clinical characteristics and risk factors for this infection; however, limited data are available on the predictors of mortality in these patients. In this context, we evaluated the risk factors associated with death due to IC in a pediatric tertiary care hospital in South of Brazil. METHODS This is a retrospective, cross-sectional, observational, and analytical study of a series of pediatric patients with clinical and laboratory diagnosis of IC from March 2014 to September 2017. Univariate and multivariate analysis were performed to estimate the association between the characteristics of the patients and death. RESULTS A total of 94 cases of IC were included. The incidence was 1.13 cases per 1000 patients/d, with a mortality rate of 14%. There was a predominance of non-albicans Candida (71.3%) in IC cases and, although there is no species difference in mortality rates, biofilm formation was associated with increased mortality. Clinical characteristics such as male sex, stay in the intensive care unit, and thrombocytopenia; comorbidities such as cardiological disease and renal insufficiency; and risks such as mechanical ventilation and dialysis were associated with increased mortality. CONCLUSION Data from this study suggest that biofilm formation by Candida sp. is associated with increased mortality, and this is the first study to correlate the male sex and cardiological disease as risk factors for death in pediatric IC patients.
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Schuertz KF, Tuon FF, Palmeiro JK, Conte D, Telles JPM, Trevisoli LE, Dalla-Costa LM. Bacteremia and meningitis caused by OXA-23-producing Acinetobacter baumannii - molecular characterization and susceptibility testing for alternative antibiotics. Braz J Microbiol 2018; 49 Suppl 1:199-204. [PMID: 29720352 PMCID: PMC6328846 DOI: 10.1016/j.bjm.2018.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Revised: 04/02/2018] [Accepted: 04/03/2018] [Indexed: 11/29/2022] Open
Abstract
Background Carbapenem-resistant Acinetobacter baumannii infection is a concern in developing countries due to high incidence, few therapeutic options, and increasing costs. Objective Characterize and analyze the antibiotic susceptibility patterns of carbapenem-resistant A. baumannii isolates and evaluate clinical data of meningitis and bacteremia caused by this microorganism. Methods Twenty-six A. baumannii isolates from 23 patients were identified by MALDI-TOF and automated methods and genotyped using pulsed field genotyping electrophoresis. Clinical data and outcomes were evaluated. Susceptibility of isolates to colistin, tigecycline, meropenem, imipenem, and doxycycline was determined. Results Mortality due to A. baumannii infections was 73.91%; all patients with meningitis and 7/8 patients with ventilator-associated pneumonia died. All isolates were susceptibility to polymyxin (100%; MIC50, MIC90: 1 μg/mL, 1 μg/mL) and colistin (100%; MIC50, MIC90: 2 μg/mL, 2 μg/mL), and 92% were susceptible to tigecycline (MIC50, MIC90: 1 μg/mL, 1 μg/mL) and doxycycline (MIC50, MIC90: 2 μg/mL, 2 μg/mL). blaOXA-23 was identified in 24 isolates. Molecular typing showed 8 different patterns: 13 isolates belonged to pattern A (50%). Conclusion Carbapenem-resistant A. baumannii infections mortality is high. Alternative antimicrobial therapy (doxycycline) for selected patients with carbapenem-resistant A. baumannii infection should be considered.
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Affiliation(s)
| | - Felipe Francisco Tuon
- Pontifícia Universidade Católica do Paraná, Escola de Medicina, Curitiba, PR, Brazil.
| | | | - Danieli Conte
- Instituto de Pesquisa Pele Pequeno Principe, Curitiba, PR, Brazil
| | | | | | - Libera Maria Dalla-Costa
- Instituto de Pesquisa Pele Pequeno Principe, Curitiba, PR, Brazil; Universidade Federal do Paraná, Hospital de Clinicas, Curitiba, PR, Brazil
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Trevisoli LE, Bail L, Rodrigues LS, Conte D, Palmeiro JK, Dalla-Costa LM. Matrix-assisted laser desorption ionization-time of flight: a promising alternative method of identifying the major coagulase-negative Staphylococci species. Rev Soc Bras Med Trop 2018. [DOI: 10.1590/0037-8682-0026-2017] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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Motta FA, Dalla-Costa LM, Muro MD, Cardoso MN, Picharski GL, Jaeger G, Burger M. Risk factors for candidemia mortality in hospitalized children. J Pediatr (Rio J) 2017; 93:165-171. [PMID: 27712962 DOI: 10.1016/j.jped.2016.05.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Revised: 04/26/2016] [Accepted: 05/11/2016] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To evaluate risk factors associated with death due to bloodstream infection caused by Candida spp. in pediatric patients and evaluate the resistance to the main anti-fungal used in clinical practice. METHODS This is a cross-sectional, observational, analytical study with retrospective collection that included 65 hospitalized pediatric patients with bloodstream infection by Candida spp. A univariate analysis was performed to estimate the association between the characteristics of the candidemia patients and death. RESULTS The incidence of candidemia was 0.23 cases per 1000patients/day, with a mortality rate of 32% (n=21). Clinical outcomes such as sepsis and septic shock (p=0.001), comorbidities such as acute renal insufficiency (p=0.01), and risks such as mechanical ventilation (p=0.02) and dialysis (p=0.03) are associated with increased mortality in pediatric patients. The resistance and dose-dependent susceptibility rates against fluconazole were 4.2% and 2.1%, respectively. No resistance to amphotericin B and echinocandin was identified. CONCLUSION Data from this study suggest that sepsis and septic shock, acute renal insufficiency, and risks like mechanical ventilation and dialysis are associated with increased mortality in pediatric patients. The mortality among patients with candidemia is high, and there is no species difference in mortality rates. Regarding the resistance rates, it is important to emphasize the presence of low resistance in this series.
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Affiliation(s)
- Fabio Araujo Motta
- Hospital Pequeno Príncipe, Curitiba, PR, Brazil; Faculdades Pequeno Príncipe, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil.
| | - Libera Maria Dalla-Costa
- Faculdades Pequeno Príncipe, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil; Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Curitiba, PR, Brazil
| | - Marisol Dominguez Muro
- Faculdades Pequeno Príncipe, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil; Universidade Federal do Paraná (UFPR), Hospital de Clínicas, Curitiba, PR, Brazil
| | | | - Gledson Luiz Picharski
- Faculdades Pequeno Príncipe, Curitiba, PR, Brazil; Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil
| | | | - Marion Burger
- Secretaria Municipal da Saúde de Curitiba, Curitiba, PR, Brazil
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10
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Conte D, Palmeiro JK, da Silva Nogueira K, de Lima TMR, Cardoso MA, Pontarolo R, Degaut Pontes FL, Dalla-Costa LM. Characterization of CTX-M enzymes, quinolone resistance determinants, and antimicrobial residues from hospital sewage, wastewater treatment plant, and river water. Ecotoxicol Environ Saf 2017; 136:62-69. [PMID: 27816836 DOI: 10.1016/j.ecoenv.2016.10.031] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 10/21/2016] [Accepted: 10/25/2016] [Indexed: 05/09/2023]
Abstract
Multidrug-resistant (MDR) bacteria are widespread in hospitals and have been increasingly isolated from aquatic environments. The aim of the present study was to characterize extended-spectrum β-lactamase (ESBL) and quinolone-resistant Enterobacteriaceae from a hospital effluent, sanitary effluent, inflow sewage, aeration tank, and outflow sewage within a wastewater treatment plant (WWTP), as well as river water upstream and downstream (URW and DRW, respectively), of the point where the WWTP treated effluent was discharged. β-lactamase (bla) genes, plasmid-mediated quinolone resistance (PMQR), and quinolone resistance-determining regions (QRDRs) were assessed by amplification and sequencing in 55 ESBL-positive and/or quinolone-resistant isolates. Ciprofloxacin residue was evaluated by high performance liquid chromatography. ESBL-producing isolates were identified in both raw (n=29) and treated (n=26) water; they included Escherichia coli (32), Klebsiella pneumoniae (22) and Klebsiella oxytoca (1). Resistance to both cephalosporins and quinolone was observed in 34.4% of E. coli and 27.3% of K. pneumoniae. Resistance to carbapenems was found in 5.4% of K. pneumoniae and in K. oxytoca. Results indicate the presence of blaCTX-M (51/55, 92.7%) and blaSHV (8/55, 14.5%) ESBLs, and blaGES (2/55, 3.6%) carbapenemase-encoding resistance determinants. Genes conferring quinolone resistance were detected at all sites, except in the inflow sewage and aeration tanks. Quinolone resistance was primarily attributed to amino acid substitutions in the QRDR of GyrA (47%) or to the presence of PMQR (aac-(6')-Ib-cr, oqxAB, qnrS, and/or qnrB; 52.9%) determinants. Ciprofloxacin residue was absent only from URW. Our results have shown strains carrying ESBL genes, PMQR determinants, and mutations in the gyrA QRDR genes mainly in hospital effluent, URW, and DRW samples. Antimicrobial use, and the inefficient removal of MDR bacteria and antibiotic residue during sewage treatment, may contribute to the emergence and spreading of resistance in the environment, making this a natural reservoir.
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Affiliation(s)
- Danieli Conte
- Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe (FPP/IPPPP), Curitiba, Paraná, Brazil.
| | - Jussara Kasuko Palmeiro
- Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe (FPP/IPPPP), Curitiba, Paraná, Brazil; Hospital de Clínicas, Universidade Federal do Paraná (HC-UFPR), Curitiba, Paraná, Brazil.
| | - Keite da Silva Nogueira
- Departamento de Patologia Básica, Setor de Ciências Biológicas, Universidade Federal do Paraná, Curitiba, Paraná, Brazil.
| | | | - Marco André Cardoso
- Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe (FPP/IPPPP), Curitiba, Paraná, Brazil; Pharmacy Department, Health Sciences Sector, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
| | - Roberto Pontarolo
- Pharmacy Department, Health Sciences Sector, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
| | - Flávia Lada Degaut Pontes
- Pharmacy Department, Health Sciences Sector, Universidade Federal do Paraná (UFPR), Curitiba, Paraná, Brazil.
| | - Libera Maria Dalla-Costa
- Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe (FPP/IPPPP), Curitiba, Paraná, Brazil; Hospital de Clínicas, Universidade Federal do Paraná (HC-UFPR), Curitiba, Paraná, Brazil.
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11
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Grazziotin AL, Vidal NM, Palmeiro JK, Dalla-Costa LM, Venancio TM. Genome Sequencing of Four Multidrug-Resistant Enterobacter aerogenes Isolates from Hospitalized Patients in Brazil. Front Microbiol 2016; 7:1649. [PMID: 27833588 PMCID: PMC5081556 DOI: 10.3389/fmicb.2016.01649] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2016] [Accepted: 10/04/2016] [Indexed: 11/13/2022] Open
Affiliation(s)
- Ana Laura Grazziotin
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro Campos dos Goytacazes, Brazil
| | - Newton M Vidal
- National Center for Biotechnology Information, National Library of Medicine, National Institutes of Health Bethesda, MD, USA
| | - Jussara K Palmeiro
- Laboratório de Bacteriologia, Unidade Laboratório de Análises Clínicas, Hospital de Clínicas, Universidade Federal do ParanáCuritiba, Brazil; Faculdades e Instituto de Pesquisa Pelé Pequeno PríncipeCuritiba, Brazil
| | - Libera Maria Dalla-Costa
- Laboratório de Bacteriologia, Unidade Laboratório de Análises Clínicas, Hospital de Clínicas, Universidade Federal do ParanáCuritiba, Brazil; Faculdades e Instituto de Pesquisa Pelé Pequeno PríncipeCuritiba, Brazil
| | - Thiago M Venancio
- Laboratório de Química e Função de Proteínas e Peptídeos, Centro de Biociências e Biotecnologia, Universidade Estadual do Norte Fluminense Darcy Ribeiro Campos dos Goytacazes, Brazil
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12
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Vicenzi FJ, Pillonetto M, Souza HAPHDMD, Palmeiro JK, Riedi CA, Rosario-Filho NA, Dalla-Costa LM. Polyphasic characterisation of Burkholderia cepaciacomplex species isolated from children with cystic fibrosis. Mem Inst Oswaldo Cruz 2016; 111:37-42. [PMID: 26814642 PMCID: PMC4727434 DOI: 10.1590/0074-02760150314] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 12/01/2015] [Indexed: 05/28/2023] Open
Abstract
Cystic fibrosis (CF) patients with Burkholderia cepacia complex
(Bcc) pulmonary infections have high morbidity and mortality. The aim of this study
was to compare different methods for identification of Bcc species isolated from
paediatric CF patients. Oropharyngeal swabs from children with CF were used to obtain
isolates of Bcc samples to evaluate six different tests for strain identification.
Conventional (CPT) and automatised (APT) phenotypic tests, polymerase chain reaction
(PCR)-recA, restriction fragment length
polymorphism-recA, recAsequencing, and
matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) were applied.
Bacterial isolates were also tested for antimicrobial susceptibility.
PCR-recA analysis showed that 36 out of the 54 isolates were Bcc.
Kappa index data indicated almost perfect agreement between CPT and APT, CPT and
PCR-recA, and APT and PCR-recA to identify Bcc,
and MALDI-TOF and recAsequencing to identify Bcc species. The
recAsequencing data and the MALDI-TOF data agreed in 97.2% of the
isolates. Based on recA sequencing, the most common species
identified were Burkholderia cenocepacia IIIA
(33.4%),Burkholderia vietnamiensis (30.6%), B.
cenocepaciaIIIB (27.8%), Burkholderia multivorans
(5.5%), and B. cepacia (2.7%). MALDI-TOF proved to be a useful tool
for identification of Bcc species obtained from CF patients, although it was not able
to identify B. cenocepacia subtypes.
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Affiliation(s)
| | - Marcelo Pillonetto
- Departamento de Microbiologia, Escola de Saúde e Biociências, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brasil
| | | | - Jussara Kasuko Palmeiro
- Instituto de Pesquisa Pelé Pequeno Principe, Faculdades Pequeno Príncipe, Curitiba, PR, Brasil
| | - Carlos Antônio Riedi
- Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Paraná, Curitiba, PR, Brasil
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13
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Kussen GMB, Dalla-Costa LM, Rossoni A, Raboni SM. Interferon-gamma release assay versus tuberculin skin test for latent tuberculosis infection among HIV patients in Brazil. Braz J Infect Dis 2015; 20:69-75. [PMID: 26706018 PMCID: PMC9425390 DOI: 10.1016/j.bjid.2015.10.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 10/04/2015] [Accepted: 10/25/2015] [Indexed: 12/03/2022] Open
Abstract
Setting Patients HIV+ attending in a reference clinic, Southern Brazil. Objective To compare the interferon-gamma-release assay (IGRA – QuantiFERON® TB Gold In-Tube) with the tuberculin skin test (TST – PPD-Rt 23) for latent tuberculosis infection (LTBI) in patients with HIV. Design Cohort study. Patients were simultaneously submitted to the TST and blood collection for the IGRA. Results A total of 140 subjects were included. Nine (6.4%) were IGRA+/TST+, 12 (8.6%) were IGRA+/TST−, 4 (3%) were IGRA−/TST+, and 115 (82%) IGRA−/TST−. There was poor agreement between tests (kappa = 0.2), and no correlation between these results and CD4+ T lymphocyte counts. During follow-up, one patient with negative results on both tests died from sepsis, and another with discordant results (IGRA+/TST−) exhibited TST seroconversion. Compared to the TST, IGRA showed a sensitivity and specificity of 69% and 90%, respectively. The IGRA detected 8% more positive results than the TST. All patients were followed up for 2 years. Conclusion The higher accuracy of the IGRA would result in LTBI treatments being administered to patients who would have otherwise been overlooked, decreasing the number of active tuberculosis cases. The long-term survival of HIV carriers requires further evaluation.
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Affiliation(s)
- Gislene Maria Botão Kussen
- Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, PR, Brazil; Bacteriology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Libera Maria Dalla-Costa
- Bacteriology Laboratory, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil; Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe, Curitiba, PR, Brazil
| | - Andrea Rossoni
- Department of Pediatrics, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil
| | - Sonia Mara Raboni
- Internal Medicine and Health Science, Universidade Federal do Paraná, Curitiba, PR, Brazil; Infectious Diseases Division, Universidade Federal do Paraná, Curitiba, PR, Brazil.
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Nogueira KDS, Conte D, Maia FV, Dalla-Costa LM. Distribution of extended-spectrum β-lactamase types in a Brazilian tertiary hospital. Rev Soc Bras Med Trop 2015; 48:162-9. [DOI: 10.1590/0037-8682-0009-2015] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 04/01/2015] [Indexed: 01/09/2023] Open
Affiliation(s)
| | - Danieli Conte
- Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe, Brazil
| | | | - Libera Maria Dalla-Costa
- Universidade Federal do Paraná, Brazil; Faculdades e Instituto de Pesquisa Pelé Pequeno Príncipe, Brazil
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15
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Homem de Mello de Souza HAP, Dalla-Costa LM, Vicenzi FJ, Camargo de Souza D, Riedi CA, Filho NAR, Pilonetto M. MALDI-TOF: A useful tool for laboratory identification of uncommon glucose non-fermenting Gram-negative bacteria associated with cystic fibrosis. J Med Microbiol 2014; 63:1148-1153. [DOI: 10.1099/jmm.0.076869-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The predisposition of patients with cystic fibrosis (CF) for recurrent pulmonary infections can result in poor prognosis of the disease. Although the clinical significance in CF of micro-organisms, such as Staphylococcus aureus, Haemophilus influenzae and Pseudomonas aeruginosa, is well established, the implication of uncommon glucose non-fermenting Gram-negative bacilli (UGNF-GNB) in respiratory samples from CF patients is still unclear. Because of limitations of traditional methods used in most clinical laboratories, the accurate identification of these microbes is a challenge. Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) is an alternative tool for efficient identification of bacteria. This was a retrospective study to evaluate different identification methods in a collection of UGNF-GNB isolated from children with CF during a period of three years. The performance of MALDI-TOF was compared to that of 16S rDNA gene sequencing and to a conventional and automated phenotypic identification. The discriminatory power of MALDI-TOF (75.0 % agreement) was superior to automated techniques (67.1 % agreement) and to conventional phenotypical identification (50.0 % agreement). MALDI-TOF also demonstrated high accuracy in identifying Stenotrophomonas maltophilia, Achromobacter xylosoxidans and Chryseobacterium indologenes, but had limited utility in identifying Pandoraea spp. and some species of Acinetobacter and Chryseobacterium (other than C. indologenes). Although MALDI-TOF identified only 75 % of the isolates in comparison with 16S rDNA gene sequencing, the prompt identification and high discriminatory power exhibited by MALDI-TOF make it a useful tool for the characterization of micro-organisms that are difficult to identify using routine methods.
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Affiliation(s)
| | - Libera Maria Dalla-Costa
- Pele Pequeno Príncipe Research Institute, Faculdades Pequeno Príncipe, Curitiba, PR, Brazil
- Bacteriology Section, Hospital de Clínicas – Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Fernando José Vicenzi
- Immunochemistry Section, Laboratório Municipal de Curitiba, Curitiba, PR, Brazil
- Pele Pequeno Príncipe Research Institute, Faculdades Pequeno Príncipe, Curitiba, PR, Brazil
| | - Dilair Camargo de Souza
- Bacteriology Section, Hospital de Clínicas – Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | - Carlos Antônio Riedi
- Department of Pediatrics – Universidade Federal do Paraná (UFPR), Curitiba, PR, Brazil
| | | | - Marcelo Pilonetto
- Molecular Bacteriology Section, Laboratório Central de Saúde Pública do Estado LACEN-PR, Curitiba, PR, Brazil
- Department of Microbiology, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná (PUC), Curitiba, PR, Brazil
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16
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Martins AF, Borges A, Pagano M, Dalla-Costa LM, Barth AL. False-positive results in screening for metallo-β-lactamase are observed in isolates of Acinetobacter baumannii due to production of oxacilinases. Braz J Infect Dis 2013; 17:500-1. [PMID: 23850322 PMCID: PMC9428052 DOI: 10.1016/j.bjid.2013.01.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/06/2013] [Indexed: 11/30/2022] Open
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17
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Nogueira KDS, Paganini MC, Conte A, Cogo LL, Taborda de Messias Reason I, da Silva MJ, Dalla-Costa LM. Emergence of extended-spectrum β-lactamase producing Enterobacter spp. in patients with bacteremia in a tertiary hospital in southern Brazil. Enferm Infecc Microbiol Clin 2013; 32:87-92. [PMID: 23587705 DOI: 10.1016/j.eimc.2013.02.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 02/07/2013] [Accepted: 02/12/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Extended-spectrum β-lactamases (ESBLs) are increasingly prevalent in Enterobacter spp., posing a challenge to the treatment of infections caused by this microorganism. The purpose of this retrospective study was to evaluate the prevalence, risk factors, and clinical outcomes of inpatients with bacteremia caused by ESBL and non ESBL-producing Enterobacter spp. in a tertiary hospital over the period 2004-2008. METHODS The presence of blaCTX-M, blaTEM, blaSHV, and blaPER genes was detected by polymerase chain reaction (PCR) and nucleotide sequence analysis. Genetic similarity between strains was defined by pulsed-field gel electrophoresis (PFGE). RESULTS Enterobacter spp. was identified in 205 of 4907 of the patients who had positive blood cultures during hospitalization. Of those cases, 41 (20%) were ESBL-producing Enterobacter spp. Nosocomial pneumonia was the main source of bacteremia caused by ESBL-producing Enterobacter spp. The presence of this microorganism was associated with longer hospital stays. The ESBL genes detected were: CTX-M-2 (23), CTX-M-59 (10), CTX-M-15 (1), SHV-12 (5), and PER-2 (2). While Enterobacter aerogenes strains showed mainly a clonal profile, Enterobacter cloacae strains were polyclonal. CONCLUSION Although no difference in clinical outcomes was observed between patients with infections by ESBL-producing and non-ESBL-producing strains, the detection of ESBL in Enterobacter spp. resulted in the change of antimicrobials in 75% of cases, having important implications in the decision-making regarding adequate antimicrobial therapy.
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Affiliation(s)
- Keite da Silva Nogueira
- Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil; Postgraduate Program in Pharmaceutical Sciences of UFPR, Curitiba, Brazil
| | | | | | - Laura Lúcia Cogo
- Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil
| | - Iara Taborda de Messias Reason
- Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil; Postgraduate Program in Pharmaceutical Sciences of UFPR, Curitiba, Brazil
| | - Márcio José da Silva
- Plant Molecular Biology and Genomics of Campinas University (Unicamp), Campinas, Brazil
| | - Libera Maria Dalla-Costa
- Clinics Hospital, Federal University of Paraná (UFPR), Curitiba, Brazil; Pelé Pequeno Príncipe Faculty and Research Institute (FPP/IPPPP), Curitiba, Brazil.
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18
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Nogueira-Miranda KDS, Palmeiro JK, Conte D, Maia FV, Reason ITDM, Monteiro CL, Dalla-Costa LM. Detection of Extended-Spectrum β-Lactamase inEnterobacterspp.– Evaluation of Six Phenotypic Tests. Microb Drug Resist 2012; 18:66-70. [DOI: 10.1089/mdr.2011.0055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Keite da Silva Nogueira-Miranda
- Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
- Programa de Pós-graduação em Ciências Farmacêuticas da UFPR, Curitiba, Brazil
| | | | | | | | - Iara Taborda de Messias Reason
- Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
- Programa de Pós-graduação em Ciências Farmacêuticas da UFPR, Curitiba, Brazil
| | - Cristina Leise Monteiro
- Programa de Pós-graduação em Microbiologia, Parasitologia e Patologia da UFPR, Curitiba, Brazil
| | - Libera Maria Dalla-Costa
- Hospital de Clínicas, Universidade Federal do Paraná (UFPR), Curitiba, Brazil
- Faculdades Pequeno Príncipe–Instituto de Pesquisa Pelé Pequeno Príncipe (FPP/IPPPP), Curitiba, Brazil
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19
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Scheffer MC, Gales AC, Barth AL, Carmo Filho JRD, Dalla-Costa LM. Carbapenem-resistant Pseudomonas aeruginosa: clonal spread in southern Brazil and in the state of Goiás. Braz J Infect Dis 2010. [DOI: 10.1590/s1413-86702010000500014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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20
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Scheffer MC, Gales AC, Barth AL, Carmo Filho JRD, Dalla-Costa LM. Carbapenem-resistant Pseudomonas aeruginosa: clonal spread in southern Brazil and in the state of Goiás. Braz J Infect Dis 2010; 14:508-509. [PMID: 21221481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Accepted: 08/12/2010] [Indexed: 05/30/2023] Open
Abstract
This study evaluated the clonal spread of carbapenem-resistant P. aeruginosa producing SPM-1 type metallo-β-lactamase (MBL), at the university hospital of Florianópolis, Santa Catarina, Brazil, compared to an epidemic clone previously reported, as well as strains collected in other three Brazilian states. Among the isolates, 17 (62%) were clonal and highly related to strains from other regions of Brazil. Six clonal strains harbored the blaSPM-1 gene. The finding of a unique SPM-1 producer clone suggests that its dissemination has contributed to the high resistance to carbapenems in Brazilian hospitals.
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21
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Scheffer MC, Bazzo ML, Steindel M, Darini AL, Clímaco E, Dalla-Costa LM. Intrahospital spread of carbapenem-resistant Pseudomonas aeruginosa in a University Hospital in Florianópolis, Santa Catarina, Brazil. Rev Soc Bras Med Trop 2010; 43:367-71. [DOI: 10.1590/s0037-86822010000400006] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Accepted: 05/12/2010] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) has been isolated with increasing frequency in Brazilian hospitals. Since June 2003, its detection in a teaching hospital in the city of Florianópolis, Brazil, has increased. This study aimed to investigate the minimal inhibitory concentration (MIC), presence of Metallo-β-lactamase (MβL) and a possible clonal relationship among the isolates. METHODS: The study included 29 CRPA and seven isolates with reduced susceptibility. The MIC was determined by agar-dilution. Detection of MβL was performed by Double Disk Sinergism (DDS) and Combined Disk (CD). The MβL gene was verified by PCR and nucleotide sequence analysis. Epidemiological typing was performed by pulsed-field gel electrophoresis. RESULTS: Among the 29 carbapenem-resistant isolates, polymyxin B presented 100% susceptibility and piperacillin/tazobactam 96.7%. Seventeen (62%) strains were verified as clonal (A clone) and among these, six isolates indicated phenotypically positive tests for MβL and harbored the blaSPM-1 gene. The first CRPA isolates were unrelated to clone A, harbored blaIMP-16 and were phenotypically positive only by CD. CONCLUSIONS: The spread of a high-level of resistance clone suggests cross transmission as an important dissemination mechanism and has contributed to the increased rate of resistance to carbapenems. This study emphasizes the need for continuous surveillance and improved strategies.
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Dalla-Costa LM, Irino K, Rodrigues J, Rivera IN, Trabulsi LR. Characterisation of diarrhoeagenic Escherichia coli clones by ribotyping and ERIC-PCR. J Med Microbiol 1998; 47:227-34. [PMID: 9511828 DOI: 10.1099/00222615-47-3-227] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The ability of ribotyping and enterobacterial repetitive intergenic concensus-polymerase chain reaction (ERIC-PCR) to discriminate diarrhoeagenic Escherichia coli clones of 122 strains belonging to 26 distinct serotypes was evaluated. The 26 serotypes corresponded to 24 ribotypes and 25 ERIC-types. Correlation between multilocus enzyme electrophoresis, ERIC-PCR and ribotyping was c. 90% for the dominant ribotypes. Related clones such as O55:H7 and O157:H7 presented similar ribotypes and clustered together in a dendrogram, and the two divergent clonal groups of enteropathogenic E. coli (EPEC) and enterohaemorrhagic E. coli (EHEC) were included in distinct branches. The results suggest the possibility of applying these two simpler techniques as tools to identify clones of diarrhoeagenic E. coli.
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Affiliation(s)
- L M Dalla-Costa
- Departamento de Microbiologia, Instituto de Ciências Biomédicas, Universidade de São Paulo, SP, Brazil
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