RESUMO
In this study, we investigated the frequency of isolates included in the susceptible-dose dependent (SDD) category, according to the Clinical and Laboratory Standards Institute guidelines, carrying blaTEM, blaSHV and blaCTX genes among 92 Klebsiella pneumoniae and 80 Enterobacter cloacae clinical isolates. The presence of one or more extended-spectrum ß-lactamases (ESBLs) genes was observed in 64% K. pneumoniae and 69% E. cloacae isolates. Nineteen isolates were included in SDD interpretive category criteria, of which 15 carried ESBL genes (seven K. pneumoniae and eight E. cloacae). Considering the high proportion of ESBL gene-containing isolates included in the SDD category (79%), we recommend that physicians exercise caution in the use of cefepime for treatment of infections caused by these isolates, reducing possible therapeutic failure, particularly in cases of ESBL-producing bacterial strains.
Assuntos
Antibacterianos/farmacologia , Proteínas de Bactérias/metabolismo , Cefalosporinas/farmacologia , Enterobacter cloacae/efeitos dos fármacos , Klebsiella pneumoniae/efeitos dos fármacos , beta-Lactamases/metabolismo , Antibacterianos/efeitos adversos , Antibacterianos/metabolismo , Antibacterianos/uso terapêutico , Proteínas de Bactérias/genética , Brasil , Cefepima , Cefalosporinas/efeitos adversos , Cefalosporinas/metabolismo , Cefalosporinas/uso terapêutico , Farmacorresistência Bacteriana , Farmacorresistência Bacteriana Múltipla , Enterobacter cloacae/classificação , Enterobacter cloacae/enzimologia , Enterobacter cloacae/crescimento & desenvolvimento , Infecções por Enterobacteriaceae/tratamento farmacológico , Infecções por Enterobacteriaceae/microbiologia , Genes Bacterianos , Humanos , Inativação Metabólica , Unidades de Terapia Intensiva , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/classificação , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/crescimento & desenvolvimento , Testes de Sensibilidade Microbiana , Tipagem Molecular , Guias de Prática Clínica como Assunto , beta-Lactamases/genéticaRESUMO
This study demonstrated a direct correlation between Acinetobacter baumannii clusters carrying the ISAba1/blaOXA-23 gene and increased minimal inhibitory concentrations for carbapenems and greater clonal diversity. Our findings showed that clusters carrying ISAba1 are widely distributed in our hospital, further complicating the treatment and control of infections caused by A baumannii.
Assuntos
Infecções por Acinetobacter/epidemiologia , Acinetobacter baumannii/enzimologia , Acinetobacter baumannii/genética , Proteínas de Bactérias/genética , Infecção Hospitalar/epidemiologia , Genótipo , beta-Lactamases/genética , Infecções por Acinetobacter/microbiologia , Antibacterianos/farmacologia , Carbapenêmicos/farmacologia , Infecção Hospitalar/microbiologia , Variação Genética , Hospitais , Humanos , Testes de Sensibilidade MicrobianaRESUMO
INTRODUCTION: The aim of this study was to identify a rapid and simple phenotypic method for extended-spectrum ß-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.
Assuntos
Enterobacter cloacae/enzimologia , beta-Lactamases/análise , Adulto , Antibacterianos/farmacologia , Cefepima , Cefalosporinas/farmacologia , Enterobacter cloacae/efeitos dos fármacos , Humanos , Unidades de Terapia Intensiva , Testes de Sensibilidade Microbiana/métodos , Fenótipo , Estudos Prospectivos , Sensibilidade e Especificidade , beta-Lactamases/metabolismoRESUMO
The objective of this study was to compare the performance of disk diffusion and agar dilution for the determination of susceptibility to ampicillin/sulbactam (SAM), ceftazidime, cefepime, imipenem, meropenem, polymyxin B and tigecycline of 121 Acinetobacter baumannii clinical isolates. The antimicrobial susceptibility testing methods were performed as recommended by the Clinical and Laboratory Standards Institute (CLSI). For SAM, in addition the Etest method was performed according to the manufacturer's instructions. The error rates for the antimicrobial agents for 121 isolates tested were within the acceptable ranges established by the CLSI, with the exception of SAM and polymyxin B. For polymyxin B, there were 1.7% very major errors and for SAM there were 15% comparing disk diffusion with agar dilution. The very major error rate of SAM comparing the Etest with agar dilution was 10%. These high observed rates of very major error cast doubt on the disk diffusion and Etest techniques as appropriate methods for detecting resistance to SAM.
RESUMO
Patients with chronic renal failure who are undergoing dialysis and kidney transplant recipients are susceptible to infection for several reasons. In this study, the profile of infections in patients with chronic renal failure and kidney transplant recipients treated at a hospital in northern Paraná, Brazil, from 2007 to 2009 was examined. The study involved 187 patients: 59 kidney transplant recipients and 128 patients undergoing dialysis. The frequency of infection was 25% (32/128) in dialysis patients and 8% (5/59) in transplant recipients (P = .008). Staphylococcus aureus was the most prevalent infectious agent, cultured from 27% (13/48) of samples, followed by Escherichia coli at 17% (8/48). All isolates of S aureus were sensitive to vancomycin and resistant to penicillin, and 43% were resistant to oxacillin. Most S aureus samples (43%) were isolated from cultures of blood samples. As for the E coli, 75% were resistant to cephalothin and 38% were resistant to sulfamethoxazole/trimethoprim. Most isolates of E coli (62%) were cultured from specimens of patients with suspected urinary tract infection.