Phenotypic detection of metallo-β-lactamases in Pseudomonas aeruginosa and Acinetobacter baumannii isolated from hospitalized patients in São Luis, State of Maranhão, Brazil

Introduction Acquired metallo-β-lactamases (MβL) are emerging determinants of resistance in Pseudomonas aeruginosa and Acinetobacter baumannii. The objectives of this study were to phenotypically detect MβL in imipenem-resistant P. aeruginosa and A. baumannii, to investigate the association between MβL-positive strains and hospitals, and to compare the resistance profiles of MβL-producing and non-MβL-producing strains. Methods The approximation disk and combined disk assay methods were used in this study. Results A total of 18 (38.3%) P. aeruginosa isolates and 1 (5.6%) A. baumannii isolate tested positive for the presence of MβL. Conclusions These results demonstrate the need for strict surveillance and for the adoption of preventive measures to reduce the spread of infection and potential outbreaks of disease caused by MβL-producing microorganisms.

Detection of P. aeruginosa harboring bla(CTX-M-2), bla(GES-1) and bla(GES-5), bla(IMP-1) and bla(SPM-1) causing infections in Brazilian tertiary-care hospital

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Pseudomonas spp. ISOLATED FROM THE ORAL CAVITY OF HEALTHCARE WORKERS FROM AN ONCOLOGY HOSPITAL IN MIDWESTERN BRAZIL

This cross-sectional study, performed in an oncology hospital in Goiania, aimed to characterize the prevalence of oral colonization and antimicrobial susceptibility of Pseudomonas spp. isolated from the saliva of healthcare workers. Microorganisms were subjected to biochemical tests, susceptibility profile, and phenotypic detection. Of 76 participants colonized with Gram negative bacilli, 12 (15.8%) harbored Pseudomonas spp. Of all isolates, P. aeruginosa (75.0%), P. stutzeri (16.7%), and P. fluorescens (8.3%), were resistant to cefoxitin, and therefore likely to be AmpC producers. The results are clinically relevant and emphasize the importance of surveillance to minimize bacterial dissemination and multiresistance.

Nosocomial infection and characterization of extended-spectrum β-lactamases-producing Enterobacteriaceae in Northeast Brazil

INTRODUCTION: Extended spectrum β-lactamases (ESBLs) are enzymes that degrade β-lactam antibiotics and have been reported to be an important cause of nosocomial infection in worldwide. METHODS: During 2009, 659 enterobacteria strains were isolated from different clinical specimens and tested for ESBL production. The disk approximation test, combined disk method and addition of clavulanic acid were used for phenotypic detection of the ESBL-producing strains and PCR for detection of the blaTEM and blaCTX-M genes. RESULTS: Among the isolates, 125 were ESBL producers. The blaCTX-M and blaTEM genes were detected in 90.4% and 75% of the strains, respectively. Most strains were isolated from urine. Klebsiella pneumoniae was the most prevalent organism. Microorganisms presented high resistance to the antibiotics. CONCLUSIONS: These results support the need for extending ESBL detection methods to different pathogens of the Enterobacteriaceae family because these methods are only currently standardized by the CLSI for Escherichia coli, Klebsiella pneumoniae, Klebsiella oxytoca and Proteus mirabilis. Carbapenems were the antibiotic class of choice for the treatment of infections caused by ESBL-producing Enterobacteriaceae.

A rapid and simple method to detect ESBL in Enterobacter cloacae based on MIC of cefepime

INTRODUCTION: The aim of this study was to identify a rapid and simple phenotypic method for extended-spectrum β-lactamase (ESBL) detection in Enterobacter cloacae. METHODS: A total of 79 consecutive, non-repeated samples of E. cloacae were evaluated. Four phenotypic methods were applied for ESBL detection, results were compared to multiplex polymerase chain reaction (PCR) as the gold standard reference method: 1) ceftazidime and cefotaxime disks with and without clavulanate, both with boronic acid added; 2) disk approximation using cefepime and amoxicillin/clavulanate; 3) ESBL screening by minimum inhibitory concentration (MIC) ≥ 16µg/mL and 4) by MIC ≥ 2µg/mL for cefepime. RESULTS: Method 4 showed the best combination of sensitivity (100%) and specificity (94%). CONCLUSIONS: MIC ≥ 2µg/mL for cefepime would be very useful for the phenotypic detection of ESBL in samples of E. cloacae.

Untersuchungen zum Vorkommen und molekularen Mechanismus der Biofilm-Bildung bei Enterokokken aus verschiedenen klinischen Bereichen

Im Rahmen der vorliegenden Arbeit wurde eine größere Anzahl an E. faecalis Isolaten aus Vaginalabstrichen, erstmals insbesondere von Patientinnen, die an Bakterieller Vaginose litten, untersucht und mit E. faecalis Stämme aus verschiedenen anderen klinischen Bereichen auf das Vorkommen von Virulenzfaktoren verglichen. Weiterhin wurden Korrelationen zwischen bestimmten Faktoren und der Menge an produziertem Biofilm erstellt, um mögliche Zusammenhänge zum Mechanismus der Biofilm-Bildung zu erfassen. Mittels statistischer Analysen konnte hinsichtlich der 150 untersuchten E. faecalis Isolate nachgewiesen werden, dass keine signifikanten Unterschiede der Inzidenzen von Virulenzfaktoren (esp, asa1, gelE, GelE, cylA, β-Hämolyse) zwischen den Stämmen der verschiedenen Herkunftsbereiche bestanden. In Bezug auf das Auftreten von Biofilm-Bildung zeigte sich ein erhöhtes Vorkommen bei Stämmen aus Urin sowie invasiver Herkunft (insgesamt jeweils ca. 70 % mäßige und starke Biofilm-Bildner) im Vergleich zu E. faecalis Isolaten aus Wunden oder Faeces (je ca. 40 %). Statistische Auswertungen bzgl. des Zusammenhangs eines oder einer Kombination von Virulenzfaktoren mit der Menge an gebildetem Biofilm wiesen darauf hin, dass Isolate, die das esp Gen besaßen, in erhöhtem Maße zur Biofilm-Bildung befähigt waren. Dies zeigte einen gewissen Einfluss des Zellwandproteins auf die Fähigkeit zur Biofilm-Bildung bei E. faecalis. Allerdings wurden stets auch Stämme identifiziert, die die Fähigkeit zur Biofilm-Bildung trotz des Fehlens der jeweils untersuchten genetischen Determinante bzw. der Determinanten aufwiesen, so dass auf das Vorhandensein weiterer, unbekannter Einflussfaktoren auf den Mechanismus der Biofilm-Bildung bei E. faecalis geschlossen werden konnte. Unter 78 untersuchten E. faecium Isolaten aus verschiedenen klinischen Bereichen konnte lediglich ein Stamm (1,3 %) als mäßiger Biofilm-Bildner charakterisiert werden, so dass die Fähigkeit bei dieser Spezies in der hier untersuchten Region unter diesen Bedingungen kaum nachgewiesen werden konnte. Einen Schwerpunkt dieser Arbeit bildete die Untersuchung zum Vorkommen von Virulenzfaktoren und Biofilm-Bildung bei E. faecalis Isolaten aus Vaginalabstrichen. Bzgl. des Auftretens von Virulenzfaktoren und Biofilm-Produktion konnte kein Unterschied zwischen Stämmen assoziiert mit Bakterieller Vaginose und Isolaten einer Vergleichsgruppe festgestellt werden. Allerdings zeigte eine Gegenüberstellung mit den untersuchten E. faecalis Stämmen aus anderen klinischen Bereichen, dass die 80 Isolate aus Vaginalabstrichen eine ähnlich hohe Inzidenz bestimmter Virulenzfaktoren wie Stämme aus Faeces, Urin, Wunden oder invasiver Herkunft sowie eine mit den Isolaten aus Urin und invasiver Herkunft vergleichbar hohe Fähigkeit zur Biofilm-Bildung aufwiesen (ca. 75 % mäßige und starke Biofilm-Bildner). Dies deutete auf eine Verbreitung der Biofilm-Bildungsfähigkeit bei E. faecalis Stämmen der Vaginalflora und somit auf eine große Bedeutung der Eigenschaft für Isolate dieser Herkunft hin. Die statistische Auswertung der Korrelationen von Virulenzfaktoren mit der Menge an gebildetem Biofilm lieferte ähnliche Ergebnisse wie die Analysen bzgl. der 150 E. faecalis Isolate aus anderen klinischen Bereichen und untermauerte die Annahme, dass zusätzliche Faktoren zu den hier untersuchten Determinanten bei E. faecalis vorhanden sein müssen, die Einfluss auf den Mechanismus der Biofilm-Bildung nehmen. Deshalb konzentrierte sich ein weiterer Teil der vorliegenden Arbeit auf die Herstellung und Charakterisierung von E. faecalis Biofilm-Spontanmutanten, um bisher noch ungeklärte Mechanismen oder neue Faktoren zu erkennen, die Einfluss auf die Biofilm-Bildung bei E. faecalis nehmen. Die Untersuchung einer Mutante (1.10.16) und ihres Wildtypstamms lieferte erstmals den phänotypischen Nachweis des HMW-Komplexes der drei Bee-Proteine sowie die Identifizierung konservierter Pili-Motive dieser Proteine. Des Weiteren schien die in diesem Cluster ebenfalls codierte Sortase-1 dasjenige Enzym zu sein, das höchstwahrscheinlich die Bindung des Proteins Bee-2 innerhalb dieses HMW-Komplexes katalysiert. Insofern lieferten diese Untersuchungen neue, konkrete Hinweise zur Rolle des bee Genclusters bei der Pili-Biogenese und Biofilm-Bildung von E. faecalis. Darüber hinaus stellen Erkenntnisse aus der Charakterisierung von zwei weiteren hergestellten Biofilm-Spontanmutanten viel versprechende Ausgangspunkte für zukünftige Untersuchungen dar, die ein weitergehendes Verständnis der molekularen Mechanismen der Biofilm-Bildung bei E. faecalis erzielen könnten.

Perfil molecular e pesquisa de beta-lactamases de espectro ampliado de isolados de Klebsiella pneumoniase em rebanhos bovinos leiteiros no Estado de São Paulo

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

A three-hybrid system to detect RNA-protein interactions in vivo.

RNA-protein interactions are pivotal in fundamental cellular processes such as translation, mRNA processing, early development, and infection by RNA viruses. However, in spite of the central importance of these interactions, few approaches are available to analyze them rapidly in vivo. We describe a yeast genetic method to detect and analyze RNA-protein interactions in which the binding of a bifunctional RNA to each of two hybrid proteins activates transcription of a reporter gene in vivo. We demonstrate that this three-hybrid system enables the rapid, phenotypic detection of specific RNA-protein interactions. As examples, we use the binding of the iron regulatory protein 1 (IRP1) to the iron response element (IRE), and of HIV trans-activator protein (Tat) to the HIV trans-activation response element (TAR) RNA sequence. The three-hybrid assay we describe relies only on the physical properties of the RNA and protein, and not on their natural biological activities; as a result, it may have broad application in the identification of RNA-binding proteins and RNAs, as well as in the detailed analysis of their interactions.

Accuracy of phenotypic methicillin susceptibility methods in the detection of Staphylococcus aureus isolates carrying different SCCmec types

A total of 138 isolates, 118 methicillin-resistant Staphylococcus aureus (MRSA) isolates (staphylococcal cassette chromosome type II, 20 isolates, type III, 39 isolates and type IV, 59 isolates) and 20 methicillin-sensitive S. aureus isolates were evaluated by phenotypic methods: cefoxitin and oxacillin disk diffusion (DD), agar dilution (AD), latex agglutination (LA), oxacillin agar screening (OAS) and chromogenic agar detection. All methods showed 100% specificity, but only the DD tests presented 100% sensitivity. The sensitivity of the other tests ranged from 82.2% (OAS)-98.3% (AD). The LA test showed the second lowest sensitivity (86.4%). The DD test showed high accuracy in the detection of MRSA isolates, but there was low precision in the detection of type IV isolates by the other tests, indicating that the genotypic characteristics of the isolates should be considered.

DETECTION OF VIRULENCE GENES IN ENVIRONMENTAL STRAINS OF Vibrio cholerae FROM ESTUARIES IN NORTHEASTERN BRAZIL

The objectives of this study were to detect the presence of Vibrio cholerae in tropical estuaries (Northeastern Brazil) and to search for virulence factors in the environmental isolates. Water and sediment samples were inoculated onto a vibrio-selective medium (TCBS), and colonies with morphological resemblance to V. cholerae were isolated. The cultures were identified phenotypically using a dichotomous key based on biochemical characteristics. The total DNA extracted was amplified by PCR to detect ompW and by multiplex PCR to detect the virulence genes ctx, tcp, zot and rfbO1. The results of the phenotypic and genotypic identification were compared. Nine strains of V. cholerae were identified phenotypically, five of which were confirmed by detection of the species-specific gene ompW. The dichotomous key was efficient at differentiating environmental strains of V. cholerae. Strains of V. cholerae were found in all four estuaries, but none possessed virulence genes.

Evaluation of bacterial growth inhibition by mercaptopropionic acid in metallo-β-lactamase detection on multidrug-resistant Acinetobacter baumannii

INTRODUCTION: Metallo-β-lactamase (MBL) has been reported all over the world. METHODS: The inhibitory effect of mercaptopropionic acid (MPA) on bacterial growth was evaluated by comparison between disk diffusion and broth dilution methodology with determination of the minimum inhibitory concentration (MIC) for multidrug-resistant Acinetobacter baumanni strains. RESULTS: MPA significantly inhibited growth of the strains. CONCLUSIONS: The use of MPA can affect the results in phenotypic methods of MBL detection.

Rapid detection and differentiation of mycobacterial species using a multiplex PCR system

Introduction The early diagnosis of mycobacterial infections is a critical step for initiating treatment and curing the patient. Molecular analytical methods have led to considerable improvements in the speed and accuracy of mycobacteria detection. Methods The purpose of this study was to evaluate a multiplex polymerase chain reaction system using mycobacterial strains as an auxiliary tool in the differential diagnosis of tuberculosis and diseases caused by nontuberculous mycobacteria (NTM) Results Forty mycobacterial strains isolated from pulmonary and extrapulmonary origin specimens from 37 patients diagnosed with tuberculosis were processed. Using phenotypic and biochemical characteristics of the 40 mycobacteria isolated in LJ medium, 57.5% (n=23) were characterized as the Mycobacterium tuberculosis complex (MTBC) and 20% (n=8) as nontuberculous mycobacteria (NTM), with 22.5% (n=9) of the results being inconclusive. When the results of the phenotypic and biochemical tests in 30 strains of mycobacteria were compared with the results of the multiplex PCR, there was 100% concordance in the identification of the MTBC and NTM species, respectively. A total of 32.5% (n=13) of the samples in multiplex PCR exhibited a molecular pattern consistent with NTM, thus disagreeing with the final diagnosis from the attending physician. Conclusions Multiplex PCR can be used as a differential method for determining TB infections caused by NTM a valuable tool in reducing the time necessary to make clinical diagnoses and begin treatment. It is also useful for identifying species that were previously not identifiable using conventional biochemical and phenotypic techniques.

Effects of long-term averaging of quantitative blood pressure traits on the detection of genetic associations.

Blood pressure (BP) is a heritable, quantitative trait with intraindividual variability and susceptibility to measurement error. Genetic studies of BP generally use single-visit measurements and thus cannot remove variability occurring over months or years. We leveraged the idea that averaging BP measured across time would improve phenotypic accuracy and thereby increase statistical power to detect genetic associations. We studied systolic BP (SBP), diastolic BP (DBP), mean arterial pressure (MAP), and pulse pressure (PP) averaged over multiple years in 46,629 individuals of European ancestry. We identified 39 trait-variant associations across 19 independent loci (p < 5 × 10(-8)); five associations (in four loci) uniquely identified by our LTA analyses included those of SBP and MAP at 2p23 (rs1275988, near KCNK3), DBP at 2q11.2 (rs7599598, in FER1L5), and PP at 6p21 (rs10948071, near CRIP3) and 7p13 (rs2949837, near IGFBP3). Replication analyses conducted in cohorts with single-visit BP data showed positive replication of associations and a nominal association (p < 0.05). We estimated a 20% gain in statistical power with long-term average (LTA) as compared to single-visit BP association studies. Using LTA analysis, we identified genetic loci influencing BP. LTA might be one way of increasing the power of genetic associations for continuous traits in extant samples for other phenotypes that are measured serially over time.

Population-based registration of phenotypic anatomic and familial data for melanoma: results from a Swiss multicentric study

CONTEXT AND OBJECTIVES: A multicentric study was set up to assess the feasibility for Swiss cancer registries of actively retrieving 3 additional variables of epidemiological and a etiological relevance for melanoma, and of potential use for the evaluation of prevention campaigns. MATERIAL AND METHODS: The skin type, family history of melanoma and precise anatomical site were retrieved for melanoma cases registered in 5 Swiss cantons (Neuchâtel, St-Gall and Appenzell, Vaud and Wallis) over 3 to 6 consecutive years (1995-2002). Data were obtained via a short questionnaire administered by the physicians - mostly dermatologists - who originally excised the lesions. As the detailed body site was routinely collected in Ticino, data from this Cancer Registry were included in the body site analysis. Relative melanoma density (RMD) was computed by the ratio of observed to expected numbers of melanomas allowing for body site surface areas, and further adjusted for site-specific melanocyte density. RESULTS: Of the 1,645 questionnaires sent, 1,420 (86.3%) were returned. The detailed cutaneous site and skin type were reliably obtained for 84.7% and 78.7% of questionnaires, and family history was known in 76% of instances. Prevalence of sun-sensitive subjects and patients with melanoma affected first-degree relatives, two target groups for early detection and surveillance campaigns were 54.1% and 3.4%, respectively. After translation into the 4th digit of the International Classification of Diseases for Oncology, the anatomical site codes from printed (original information) and pictorial support (body chart from the questionnaire) concurred for 94.6% of lesions. Discrepancies occurred mostly for lesions on the upper, outer part of the shoulder for which the clinician's textual description was "shoulder blade". This differential misclassification suggests under-estimation by about 10% of melanomas of the upper limbs and an over-estimation of 5% for truncal melanomas. Sites of highest melanoma risk were the face, the shoulder and the upper arm for sexes, the back for men and the leg for women. Three major features of this series were: (1) an unexpectedly high RMD for the face in women (6.2 vs 4.2 in men), (2) the absence of a male predominance for melanomas on the ears, and (3) for the upper limbs, a steady gradient of increasing melanoma density with increasing proximity to the trunk, regardless of sex. DISCUSSION AND CONCLUSION: The feasibility of retrieving the skin type, the precise anatomical location and family history of melanoma in a reliable manner was demonstrated thanks to the collaboration of Swiss dermatologists. Use of a schematic body drawing improves the quality of the anatomical site data and facilitate the reporting task of doctors. Age and sex patterns of RMD paralleled general indicators of sun exposure and behaviour, except for the hand (RMD=0.2). These Swiss results support some site or sun exposure specificity in the aetiology of melanoma.