Opportunistic infections among individuals with HIV-1/AIDS in the highly active antiretroviral therapy era at a Quaternary Level Care Teaching Hospital

INTRODUCTION : In this study, clinical-laboratory and epidemiological characteristics are described for a group of 700 individuals with HIV (human immunodeficiency virus)/AIDS (acquired immunodeficiency syndrome) in the ART (antiretroviral therapy) era at a teaching hospital that provides a quaternary level of care, with an emphasis on opportunistic infections (OIs), co-infections and immune profile. METHODS : A retrospective cross-sectional study of AIDS cases was conducted from 1998 to 2008 by reviewing medical records from the Base Hospital/FUNFARME (Fundação Faculdade Regional de Medicina), São José do Rio Preto, São Paulo, Brazil. RESULTS: The individuals were 14 to 75 years of age, and 458 were males. Heterosexuals accounted for 31.1% of all patients. Eighty-three percent were on ART, and 33.8% of those presented difficulties with treatment adherence. OIs were analyzed from medical records, and Pneumocystis jiroveci pneumonia was the most prevalent, regardless of the LTCD4+ (TCD4+ Lymphocytes) levels. Individuals whose viral loads were ≥10,000 showed a 90% greater chance of neurotoxoplasmosis. For P. jiroveci pneumonia, neurotoxoplasmosis, esophageal candidiasis, pulmonary tuberculosis and neurocryptococcosis, the chances of infection were higher among patients with LTCD4+ levels below 200 cells/mm3. HIV/hepatitis C virus (HCV) and HIV/hepatitis B virus (HBV) co-infections were significantly associated with death. CONCLUSIONS : OIs remain frequent in the ART era even in populations where the access to medical care is considered satisfactory.

Chlamydia trachomatis serotype A infections in the Amazon region of Brazil: prevalence, entry and dissemination

INTRODUCTION: Chlamydia infection is associated with debilitating human diseases including trachoma, pneumonia, coronary heart disease and urogenital diseases. Serotypes of C. trachomatis show a fair correlation with the group of diseases they cause, and their distribution follows a well-described geographic pattern. Serotype A, a trachoma-associated strain, is known for its limited dissemination in the Middle East and Northern Africa. However, knowledge on the spread of bacteria from the genus Chlamydia as well as the distribution of serotypes in Brazil is quite limited. METHODS: Blood samples of 1,710 individuals from ten human population groups in the Amazon region of Brazil were examined for antibodies to Chlamydia using indirect immunofluorescence and microimmunofluorescence assays. RESULTS: The prevalence of antibodies to Chlamydia ranged from 23.9% (Wayana-Apalai) to 90.7% (Awa-Guaja) with a mean prevalence of 50.2%. Seroreactivity was detected to C. pneumoniae and to all serotypes of C. trachomatis tested; furthermore, we report clear evidence of the as-yet-undescribed occurrence of serotype A of C. trachomatis. CONCLUSIONS: Specific seroreactivity not only accounts for the large extent of dissemination of C. trachomatis in the Amazon region of Brazil but also shows an expanded area of occurrence of serotype A outside the epidemiological settings previously described. Furthermore, these data suggest possible routes of Chlamydia introduction into the Amazon region from the massive human migration that occurred during the 1,700s.

Induction and nosocomial dissemination of carbapenem and polymyxin-resistant Klebsiella pneumoniae

INTRODUCTION:Polymyxins are antimicrobial agents capable of controlling carbapenemase-producing Klebsiella pneumoniae infection.METHODS: We report a cluster of four patients colonized or infected by polymyxin-resistant and Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae.RESULTS: Three patients were hospitalized in adjacent wards, and two were admitted to the intensive care unit. The index case maintained prolonged intestinal colonization by KPC-producing K. pneumoniae. Three patients received polymyxin B before the isolation of polymyxin-resistant K. pneumoniae.CONCLUSIONS: Colonization by KPC-producing K. pneumoniae and previous use of polymyxin B may be causally related to the development of polymyxin-resistant microorganisms.

Over expression of AdeABC and AcrAB-TolC efflux systems confers tigecycline resistance in clinical isolates of Acinetobacter baumannii and Klebsiella pneumoniae

Abstract: INTRODUCTION: Due to the wide use of tigecycline in the treatment of severe infections caused by multidrug-resistant (MDR) bacteria, clinical resistance to tigecycline has increased in recent years. Here, we investigated the relationship between tigecycline resistance and the expression of efflux pumps. METHODS: Clinical isolates of Acinetobacter baumannii and Klebsiella pneumoniae were consecutively collected from hospitalized patients in three hospitals. The minimum inhibitory concentration (MIC) of tigecycline was determined using the broth microdilution method. Expression levels of efflux pump genes and regulators were examined by quantitative real-time reverse transcription polymerase chain reaction. The correlations between tigecycline MICs and gene expression levels were analyzed. RESULTS: Overall, 1,026 A. baumannii and 725 K. pneumoniae strains were collected. Most strains were isolated from sputum. The tigecycline resistance rate was 13.4% in A. baumannii isolates and 6.5% in K. pneumoniae isolates. Overexpression of AdeABC and AcrAB-TolC efflux systems was observed found in clinical tigecycline-resistant isolates. The tigecycline MIC had a linear relationship with the adeB expression level in A. baumannii isolates, but not with the acrB expression level in K. pneumoniae isolates. There were significant linear trends in the overexpression of ramA as the tigecycline MIC increased in K. pneumoniae isolates. CONCLUSIONS: Tigecycline resistance in A. baumannii and K. pneumoniae was strongly associated with the overexpression of efflux systems. More studies are needed to elucidate whether there are other regulators that affect the expression of adeB in A. baumannii and how ramA affects the expression of acrB in K. pneumoniae.

Secular trends in Klebsiella pneumoniae isolated in a tertiary-care hospital: increasing prevalence and accelerated decline in antimicrobial susceptibility

Abstract: INTRODUCTION Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. METHODS This retrospective study examines data obtained from the microbiology laboratory of a Brazilian tertiary-care hospital. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. The relative frequencies of K. pneumoniae isolation were calculated among all Gram-negative bacilli isolated in each period analyzed. Susceptibility tests were performed using automated systems. RESULTS: From 2000-2006, K. pneumonia isolates comprised 10.7% of isolated Gram-negative bacilli (455/4260). From 2007-2013, this percentage was 18.1% (965/5331). Strictly considering isolates from bloodstream infections, the relative annual prevalence of K. pneumoniae increased from 14-17% to 27-32% during the same periods. A progressive decrease in K. pneumoniae susceptibility to all antimicrobial agents assessed was detected. Partial resistance was also observed to antimicrobial drugs that have been used more recently, such as colistin and tigecycline. CONCLUSIONS Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance.

Case report of vancomycin-induced pancytopenia

Abstract: Vancomycin is the first-line agent for the treatment of bacteremia, endocarditis, pneumonia, cellulitis, and osteomyelitis. Pancytopenia is an uncommon adverse effect of vancomycin therapy, with only a few cases of vancomycin-related neutropenia and pancytopenia described in the literature. We describe a case of a 56-year-old man who was diagnosed with chronic paraspinal abscess and started on intravenous vancomycin. He was re-admitted two weeks later with new-onset pancytopenia. Discontinuation of vancomycin resulted in improved cell counts. Physicians should monitor cell counts in patients who are on long-term intravenous vancomycin.

Determinants of mortality in oncology patients colonized or infected with Staphylococcus aureus

Oxacillin-resistant Staphylococcus aureus (ORSA) infection is an important cause of hospital morbidity and mortality. The objective of this study was to identify the main factors associated with death in patients colonized or infected with Staphylococcus aureus in a cancer center. A matched-pair case-control study enrolled all patients infected or colonized with ORSA (cases) admitted to the Hospital do Câncer in Rio de Janeiro from 01/01/1992 to 12/31/1994. A control was defined as a patient hospitalized during the same period as the case-patients and colonized or infected with oxacillin-susceptible Staphylococcus aureus (OSSA). The study enrolled 95 cases and 95 controls. Patient distribution was similar for the two groups (p > or = 0.05) with respect to gender, underlying diseases, hospital transfer, prior infection, age, temperature, heart and respiratory rates, neutrophil count, and duration of hospitalization. Univariate analysis of putative risk factors associated with mortality showed the following significant variables: admission to the intensive care unit (ICU), presence of bacteremia, use of central venous catheter (CVC), ORSA colonization or infection, pneumonia, use of urinary catheter, primary lung infection, prior use of antibiotics, mucositis, and absence of cutaneous abscesses. Multivariate analysis showed a strong association between mortality and the following independent variables: admission to ICU (OR [odds ratio]=7.2), presence of Staphylococcus bacteremia (OR=6.8), presence of CVC (OR=5.3), and isolation of ORSA (OR=2.7). The study suggests a higher virulence of ORSA in comparison to OSSA in cancer patients.

Internamentos hospitalares da população com mais de 65 anos em Portugal – Análise Descritiva

RESUMO - As mudanças na saúde são cada vez mais rápidas e os serviços de saúde têm cada vez mais dificuldade em dar resposta aos problemas de saúde dos portugueses. Responsáveis por grande parte da despesa em saúde, os idosos são a população que mais utiliza os serviços de saúde e as respetivas unidades hospitalares e serviços de urgência. Estes têm estadias mais prolongadas e consomem mais recursos durante essas permanências nas instituições de saúde. Sabendo isto revelou-se oportuno encontrar as principais causas de internamento hospitalar, os principais diagnósticos secundários, demoras médias e a sua relação com as principais causas de morte na população portuguesa com mais de 65 anos no período de 2003-2012. Para tal, optou-se por uma análise descritiva de 3375817 episódios de internamento referentes a dez anos. Daqui retirou-se que os diagnósticos principais mais frequentes para todos os anos e todas as faixas etárias são o acidente vascular cerebral isquémico e a pneumonia, sendo que o primeiro é o mais frequente até 2006, passando depois a ser a pneumonia o mais frequente. A demora média é maior quanto mais diagnósticos secundários associados houver e aumenta com a idade. Os diagnósticos secundários mais frequentes são a hipertensão essencial e a diabetes mellitus. Estes dados são relevantes para o conhecimento da saúde em Portugal, podendo-se alterar e uniformizar e melhorar práticas hospitalares e com isso progredir na qualidade dos tratamentos e aumentar a qualidade de vida com hipótese de diminuição da demora média.

Healthcare- Associated infections: An analysis of costs in a Portuguese Hospital

Hospital-acquired infections (HAIs) delay healing, prolong Hospital stay, and increase both Hospital costs and risk of death. This study aims to estimate the extra length of stay and mortality rate attributable to each of the following HAIs: wound infection (WI); bloodstream infection (BSI); urinary infections (UI); and Hospital-acquired pneumonia (HAP). The study population consisted of patients discharged in CHLC in 2014. Data was collected to identify demographic information, surgical operations, development of HAIs and its outputs. The study used regressions and a matched strategy to compare cases (infected) and controls (uninfected). The matching criteria were: age, sex, week and type of admission, number of admissions, major diagnostic category and type of discharge. When compared to matched controls, cases with HAI had a higher mortality rate and greater length of stay. WI related to hip or knee surgery, increased mortality rate by 27.27% and the length of stay by 74.97 days. WI due to colorectal surgery caused an extra mortality rate of 10.69% and an excess length of stay of 20.23 days. BSI increased Hospital stay by 28.80 days and mortality rate by 32.27%. UI caused an average additional length of stay of 19.66 days and risk of death of 12.85%. HAP resulted in an extra Hospital stay of 25.06 days and mortality rate of 24.71%. This study confirms the results of the previous literature that patients experiencing HAIs incur in an excess of mortality rates and Hospital stay, and, overall, it presents worse results comparing with other countries.

Oropharyngeal colonization by Haemophilus influenzae in healthy children from Taubaté (São Paulo), prior to the Haemophilus influenzae type b vaccination program in Brazil

Haemophilus influenzae is one of the most important bacterial agents of otitis and sinusitis. H. influenzae type b (Hib) is one of the main causes of meningitis, pneumonia, and septicemia in nonvaccinated children under 6 years of age. The aims of this study were to determine the prevalence of H. influenzae and Hib oropharyngeal colonization prior to the onset of the Hib vaccination program in Brazil in previously healthy children and to assess the susceptibility profile of this microorganism to a selected group of antimicrobials that are used to treat acute respiratory infections. METHOD: Cultures of Haemophilus influenzae were made from oropharynx swabs from 987 children under 6 years of age who were enrolled in 29 day-care centers in Taubaté (a city of São Paulo state, Brazil) between July and December 1998. RESULTS: The prevalence of H. influenzae carriers was 17.4%, and only 5.5% of the strains were beta-lactamase producers. The prevalence of Hib carriers was high, 7.3% on average (range, 0.0 - 33.3%). CONCLUSIONS: The low prevalence of colonization by penicillin-resistant strains indicates that it is not necessary to substitute ampicilin or amoxicilin to effectively treat otitis and sinusitis caused by H. influenzae in Taubaté.

Influence of nephrotic state on the infectious profile in childhood idiopathic nephrotic syndrome

Patients with idiopathic nephrotic syndrome present alterations in their cellular and humoral immune reactions that predispose them to the development of infectious processes. PURPOSE: To characterize the infectious processes in patients with idiopathic nephrotic syndrome. PATIENTS AND METHODS: Ninety-two children and adolescents with idiopathic nephrotic syndrome were assessed retrospectively. The types of infection were grouped as follows: upper respiratory tract infections; pneumonia; skin infections; peritonitis; diarrhea; urinary tract infection ; herpes virus; and others. The patients were divided into 2 groups: Group I (steroid-responsive) n = 75, with 4 subgroups-IA (single episode) n = 10, IB (infrequent relapsers) n = 5, IC (frequent relapsers) n = 14, and ID (steroid-dependent) n = 46; and Group II (steroid-resistant) n = 17. The incidence-density of infection among the patients was assessed throughout the follow-up period. Comparisons for each group and subgroup were done during the periods of negative and nephrotic proteinuria. RESULTS: The analysis revealed a greater incidence-density of infections during the period of nephrotic proteinuria in all the groups and subgroups, with the exception of subgroup IA. During the period of nephrotic proteinuria, subgroups IC, ID, and Group II presented a greater incidence-density of infections as compared to subgroup IA. For the period of negative proteinuria, there was no difference in the incidence-density of infections between the groups and subgroups. Upper respiratory tract infections were the most frequent infectious processes. CONCLUSION: The nephrotic condition, whether as part of a course of frequent relapses, steroid dependence, or steroid resistance, conferred greater susceptibility to infection among the patients with idiopathic nephrotic syndrome. The results of this study suggest that the best preventive action against infection in this disease is to control the nephrotic state.

Terapia celular com células mesenquimais por via intracoronária: contributos do estudo invasivo da microcirculação coronária

RESUMO: Introdução - A utilização de células e das suas propriedades para o tratamento das doenças cardiovasculares, é uma promessa para o futuro e talvez a única forma de ultrapassar algumas das insuficiências das terapêuticas atuais. A via de entrega das células mais utilizada na investigação tem sido a intracoronária, ganhando a microcirculação especial relevância, por ser onde ocorre a primeira interação com o tecido nativo. As células estaminais mesenquimais (CEM) têm propriedades que as tornam particularmente aptas para a Terapia Celular, mas as suas dimensões, superiores ao diâmetro dos capilares, tem motivado controvérsia quanto à sua entrega intracoronária. A cardiologia de intervenção tem atualmente técnicas que permitem a avaliação em tempo real e in vivo do estado da microcirculação coronária. A determinação do índice da resistência da microcirculação (IRM) fornece informação sobre a circulação dos pequenos vasos, de forma independente da circulação coronária e do estado hemodinâmico, mas a aplicabilidade clínica deste conhecimento encontra-se ainda por definir. Objectivos Esclarecer o potencial do IRM no estudo dos efeitos do transplante de CEM por via intracoronária. População e Métodos . Estudo pré-clínico com modelo animal (suíno) desenvolvido em 3 fases. Na Primeira Fase foram utilizados 8 animais saudáveis para estudar e validar a técnica de determinação de estudo da microcirculação. Efetuou-se a determinação do IRM com duas doses diferentes de papaverina para a indução da resposta hiperémica máxima (5 e 10 mg) e após a disfunção da microcirculação com injeção intracoronária de microesferas de embozene com 40 μm de diâmetro. Na Segunda Fase foram utilizados 18 animais saudáveis, randomizados em grupo controlo e grupo recetor de 30 x 106 CEM por via intracoronária. Foram avaliados de forma cega o IRM, a pressão aórtica, o fluxo coronário epicárdico e a ocorrência de alterações electrocardiográficas. Na Terceira Fase foram utilizados 18 animais, com enfarte agudo do miocárdio provocado (EAM), randomizados em grupo controlo, grupo recetor de CEM expandidas de forma convencional e grupo recetor de CEM expandidas com metodologia inovadora e de menores dimensões. Foi realizada uma exploração da dose/efeito com infusão faseada de 10 x 106, 15 x 106 e 20 x 106 CEM, com determinação do IRM, da pressão aórtica, do fluxo coronário epicárdico e da ocorrência de alterações eletrocardiográficas. Quatro semanas após a entrega das células foi novamente avaliado o IRM e foi efetuado o estudo anatomopatológico dos animais na procura de evidência de neoangiogénese e de regeneração miocárdica, ou de um efeito positivo da resposta reparadora após o enfarte. Resultados Nas 3 fases todos os animais mantiveram estabilidade hemodinâmica e eletrocardiográfica, com exceção da elevação de ST de V1-V3 verificada após a injeção das microesferas. Na Primeira Fase as duas doses de papaverina induziram uma resposta hiperémica eficaz, sem tradução com significado na determinação do IRM (variação da pressão distal de - 11,4 ± 5 e de - 10,6± 5 mmHg com as doses de 5 e 10 mg respetivamente (p=0,5). Com a injeção das microesferas o IRM teve uma elevação média de 310 ± 190 %, para um valor médio de 41,3 ± 16 U (p = 0,001). Na Segunda Fase não houve diferenças significativas dos parâmetros hemodinâmicos, do fluxo epicárdico e da avaliação eletrocardiográfica entre os dois grupos. O IRM de base foi semelhante e após a infusão intracoronária observou-se uma elevação expressiva do IRM nos animais que receberam células em comparação com o grupo controlo (8,8 U ± 1 vs. 14,2 U ± 1,8, P=0,02) e quanto ao seu valor de base (aumento de 112%, p=0,008). Na terceira Fase não houve novamente diferenças significativas dos parâmetros hemodinâmicos, do fluxo epicárdico e da avaliação eletrocardiográfica entre os três grupos. Houve uma elevação do IRM nos animais que receberam células a partir da 2ª dose (72% nas células convencionai e 108% nas células inovadoras) e que se manteve com a 3ª dose (100% nas células convencionais e 88% nas inovadoras) com significado estatístico em comparação com o grupo controlo (p=0,034 com a 2ªdose e p=0,024 com a 3ª dose). Quatro semanas após a entrega das CEM observou-se a descida do IRM nos dois grupos que receberam células, para valores sobreponíveis aos do grupo controlo e aos valores pós-EAM. Na avaliação anatomopatológica e histológica dos corações explantados não houve diferenças entre os três grupos. Conclusões O IRM permite distinguir alterações da microcirculação coronária motivadas pela entrega intracoronária de CEM, na ausência de alterações de outros parâmetros clínicos da circulação coronária utilizados em tempo real. As alterações do IRM são progressivas e passíveis de avaliar o efeito/dose, embora não tenha sido possível determinar diferenças com os dois tipos de CEM. No nosso modelo a injeção intracoronária não se associou a evidência de efeito benéfico na reparação ou regeneração miocárdica após o EAM.---------------------------- ABSTRACT: ABSTRACT Introduction The use of cells for the treatment of cardiovascular disease is a promise for the future and perhaps the only option to overcome some of the shortcomings of current therapies. The strategy for the delivery of cells most often used in current research has been the intracoronary route and due to this microcirculation gains special relevance, mainly because it is the first interaction site of transplanted cells with the native tissue. Mesenchymal stem cells (MSC) have properties that make them suitable for Cell Therapy, but its dimensions, larger than the diameter of capillaries, have prompted controversy about the safety of intracoronary delivery. The interventional cardiology currently has techniques that allow for real-time and in vivo assessment of coronary microcirculation state. The determination of the index of microcirculatory resistance index (IMR) provides information about small vessels, independently of the coronary circulation and hemodynamic status, but the clinical applicability of this knowledge is yet to be defined. Objectives To clarify the potential use of IMR in the study of the effects of MSC through intracoronary transplantation. Population and Methods Preclinical study with swine model developed in three phases. In Phase One 8 healthy animals were used to study and validate the IMR assessment in our animal model. IMR was assessed with two different doses of papaverine for inducing the maximal hyperaemic response (5 and 10 mg) and microcirculation dysfunction was achieved after intracoronary injection with embozene microspheres with 40 μm in diameter. In Phase Two we randomized 18 healthy animals divided between the control group and the one receiving 30 x 106 MSC through an intracoronary infusion. There we blindly evaluated IMR, the aortic pressure, the epicardial coronary flow and the occurrence of ECG changes. In Phase Three we used 18 animals with a provoked acute myocardial infarction (AMI), randomized into a control group, a MSC expanded conventionally receiver group and a MSC expanded with an innovative methodology receiver group. There was a stepwise infusion with doses of 10 x 106, 15 x 106 and 20 x 106 MSC with determination of IMR, the aortic pressure, the epicardial coronary flow and occurrence of electrocardiographic abnormalities. Four weeks after cell delivery we again measured the IMR and proceeded with the pathological study of animals in the search for evidence of neoangiogenesis and myocardial regeneration, or a positive effect in the reparative response following the infarction. Results All animals remained hemodynamically stable and with no electrocardiographic abnormalities, except for the ST elevation in V1-V3 observed after injection of the microspheres. In Phase One the two doses of papaverine achieved an hyperemic and effective response without significant differences in IMR (variation of the distal pressure -11.4 ± 5 and -10.6 ± 5 mmHg with the doses of 5 and 10 mg respectively (p = 0.5). With the injection of the microspheres the IMR had an average increase of 310 ± 190% for an average value of 41.3 ± 16 U (p = 0.001). In the second phase there were no significant differences in hemodynamic parameters, epicardial flow and electrocardiographic assessment between the two groups. The baseline IMR was similar and after intracoronary infusion there was a significant increase in animals receiving cells compared with the control group (8.8 ± U 1 vs. 14.2 ± 1.8, p = 0.02) and with their baseline (112% increase, p = 0.008). In the third phase again there were no significant differences in hemodynamic parameters, the epicardial flow and electrocardiographic evaluation between the three groups. There was a significant increase in IMR in animals that received cells from the 2nd dose (72% in conventional cells and 108% in the innovative cells) that remained with the 3rd dose (100% in conventional cells and 88% in the innovative) with statistical significance compared with the control group (p = 0.034 with 2nd dose, p = 0.024 with 3rd dose). Four weeks after delivery of the MSC we observed the fall of the IMR in the two groups that received cells with values overlapping those of the control group. In pathological and histological evaluation of removed hearts there were no differences among the three groups. Conclusions The IMR allows for the differentiation of changes in coronary microcirculation motivated by intracoronary delivery of MSC in the absence of modification in other clinical parameters. IMR changes are progressive and enable the evaluation of the effect / dose, though it has not been possible to determine differences in the two types of MSC. In our model, intracoronary injection of MSC was not associated with evidence of repair or myocardial regeneration after AMI.

A data-driven analytics approach in the study of pneumonia’s fatalities

As huge amounts of data become available in organizations and society, specific data analytics skills and techniques are needed to explore this data and extract from it useful patterns, tendencies, models or other useful knowledge, which could be used to support the decision-making process, to define new strategies or to understand what is happening in a specific field. Only with a deep understanding of a phenomenon it is possible to fight it. In this paper, a data-driven analytics approach is used for the analysis of the increasing incidence of fatalities by pneumonia in the Portuguese population, characterizing the disease and its incidence in terms of fatalities, knowledge that can be used to define appropriate strategies that can aim to reduce this phenomenon, which has increased more than 65% in a decade.

Strategies to combat infections of Acinetobacter baumannii biofilms

Dissertação de mestrado integrado em Engenharia Biomédica (área de especialização em Engenharia Clínica)

Development of elastin-like recombinamer films with antimicrobial activity

In the present work we explored the ABP-CM4 peptide properties from Bombyx mori for the creation of biopolymers with broad antimicrobial activity. An antimicrobial recombinant protein-based polymer (rPBP) was designed by cloning the DNA sequence coding for ABP-CM4 in frame with the N-terminus of the elastin-like recombinamer consisting of 200 repetitions of the pentamer VPAVG, here named A200. The new rPBP, named CM4-A200, was purified via a simplified nonchromatographic method, making use of the thermoresponsive behavior of the A200 polymer. ABP-CM4 peptide was also purified through the incorporation of a formic acid cleavage site between the peptide and the A200 sequence. In soluble state the antimicrobial activity of both CM4-A200 polymer and ABP-CM4 peptide was poorly effective. However, when the CM4-A200 polymer was processed into free-standing films high antimicrobial activity against Gram-positive and Gram-negative bacteria, yeasts and filamentous fungi was observed. The antimicrobial activity of CM4-A200 was dependent on the physical contact of cells with the film surface. Furthermore, CM4-A200 films did not reveal a cytotoxic effect against both normal human skin fibroblasts and human keratinocytes. Finally, we have developed an optimized ex vivo assay with pig skin demonstrating the antimicrobial properties of the CM4-A200 cast films for skin applications.