Determinação da resistência antimicrobiana associada em isolados clínicos de Staphylococcus aureus e Pseudomonas aeruginosa em um hospital público de Goiânia, Estado de Goiás

Este estudo avaliou a resistência antimicrobiana associada de Pseudomonas aeruginosa e Staphylococcus aureus a um agente antimicrobiano com outras drogas. A resistência antimicrobiana associada foi calculada através do risco relativo. Houve uma relação óbvia entre resistência à oxacilina e a outros agentes antimicrobianos entre os isolados de Staphylococcus aureus resistentes à oxacilina (68,5%) superior a 32%, com exceção da linezolida (6,7%). Resistência associada pronunciada entre drogas foi observada para isolados de Pseudomonas aeruginosa, particularmente entre ciprofloxacina e os carbapenens (59,6% a 60,7%), entre aminoglicosídeos e carbapenens (66,3% a 67,7%) e os demais β-lactâmicos (52,3% a 85,8%). O presente trabalho enfatiza a importância da cultura diagnóstica e do teste de suscetibilidade na seleção de um correto agente antimicrobiano com relação ao impacto clínico no aumento da multirresistência e na seleção de resistência antimicrobiana associada.

Prevalence and clinical outcomes of episodes of ventilator-associated pneumonia caused by SPM-1-producing and non-producing imipenem-resistant Pseudomonas aeruginosa

INTRODUCTION: Pseudomonas aeruginosa is a leading cause of ventilator-associated pneumonia (VAP) and exhibits high rates of resistance to several antimicrobial drugs. The carbapenens are usually the drugs of choice against this microorganism. However, the carbapenem resistance has increased among these strains worldwide. The presence of metallo-β-lactamases (MBL) has been pointed out as a major mechanism of resistance among these strains. No previous study addressed outcomes of respiratory infections caused by these strains. METHODS: Our group sought to analyze the epidemiology and clinical outcomes of patients with VAP caused by imipenem-resistant P. aeruginosa. A total of 29 clinical isolates of carbapenem-resistant Pseudomonas aeruginosa were screened for metallo-β-lactamase (MBL) genes. RESULTS: Demographic and clinical variables were similar between the SPM-1-producing and non-SPM-1-producing group. Five (17.2%) isolates were positive for blaSPM-1. No other MBL gene was found. All patients were treated with polymyxin B. The infection-related mortality was 40% and 54.2% for SPM-1-producing and -non-producing isolates, respectively. CONCLUSIONS: There were no differences in epidemiological and clinical outcomes between the two groups.

Detecção de genes de beta-lactamases de amplo espectro em Pseudomonas aeruginosa resistentes aos carbapenêmicos isoladas em São José do Rio Preto - SP

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Avaliação de métodos de triagem e de detecção fenotípica de ß-lactamase de espectro ampliado (ESBL)

The catalytic function of extended-spectrum β-lactamases can result in high degrees of bacterial resistance to β-lactamic antimicrobials and in the emergence of ESBL among the members of Enterobacteriaceae family, especially Klebsiella pneumoniae and Escherichia coli. This occurs due to the dissemination and emergence of new variants of these enzymes caused by the high utilization of antibiotics like broad-spectrum cephalosporins. The ESBL are β-lactamases capable of conferring bacterial resistance to the penicillins, 1st, 2nd and 3rd generation cephalosporins, and aztreonam (but not cephamycins and carbapenems) through the hydrolysis of these antibiotics. In view of this phenomenon, the exact screening and detection of the producers of ESBL are essential for the appropriate selection of the antimicrobial therapy. The purposes of this study were to evaluate the best antimicrobial for the selection of ESBL producers and to determine the best method for the detection of such microorganisms. We evaluated 200 sequential bacterial samples including the species Klebsiella pneumoniae (56.5%), Escherichia coli (34%), Proteus mirabilis (8.5%) and Klebsiella oxytoca (1%), previously characterized as ESBL producers between February and September 2008 in the Laboratory of Microbiology, Botucatu Medical School - UNESP, Botucatu, São Paulo State, Brazil. To select the ESBL-producer bacteria, we used the disks recommended by CLSI 2008, aztreonam (ATM), cefpodoxime (CPD), ceftriaxone (CRO), cefotaxime (CTX) and ceftazidime (CAZ), besides cefepime (FEP). ESBL production was confirmed by three methods: double disk screening, ESBL Etest®, and Vitek® automated system. The disks employed in the double disk screening were: penicillin associated with β-lactamase inhibitor, amoxicillin-clavulanic acid, and two β-lactamic antibiotics, ceftazidime and cefotaxime...(Complete abstract click electronic access below)