ABSTRACT Background: The spread of carbapenemase- and extended-spectrum β-lactamase (ESBL)-producing gram-negative bacilli (GNB) represent a global public health threat that limits therapeutic options for hospitalized patients. This study aimed to evaluate the in-vitro susceptibility of β-lactam-resistant GNB to ceftazidime-avibactam (C/A) and ceftolozane-tazobactam (C/T), and investigate the molecular determinants of resistance. Methods: Overall, 101 clinical isolates of Enterobacterales and Pseudomonas aeruginosa collected from a general hospital in Brazil were analyzed. Susceptibility to the antimicrobial agents was evaluated using an automated method, and the minimum inhibitory concentrations (MIC50/90) of C/A and C/T were determined using Etest®. The β-lactamase-encoding genes were investigated using polymerase chain reaction. Results: High susceptibility to C/A and C/T was observed among ESBL-producing Enterobacterales (100% and 97.3% for CLSI and 83.8% for BRCAST, respectively) and carbapenem-resistant P. aeruginosa (92.3% and 87.2%, respectively). Carbapenemase-producing Klebsiella pneumoniae exhibited high resistance to C/T (80%- CLSI or 100%- BRCAST) but high susceptibility to C/A (93.4%). All carbapenem-resistant K. pneumoniae isolates were susceptible to C/A, whereas only one isolate was susceptible to C/T. Both antimicrobials were inactive against metallo-β-lactamase-producing K. pneumoniae isolates. Resistance genes were concomitantly identified in 44 (44.9%) isolates, with bla CTX-M and bla SHV being the most common. Conclusions: C/A and C/T were active against microorganisms with β-lactam-resistant phenotypes, except when resistance was mediated by metallo-β-lactamases. Most C/A- and C/T-resistant isolates concomitantly carried two or more β-lactamase-encoding genes (62.5% and 77.4%, respectively).

Abstract We report the occurrence in Brazil of the bla NDM-1 gene in Acinetobacter pittii, prior to the previously described first reports regarding the species Providencia rettgeri and Enterobacter hormaechei. Clinical isolates were investigated by polymerase chain reaction followed by bidirectional sequencing, and species was confirmed by 16S rDNA sequencing and matrix-assisted laser desorption-ionization time-of-flight spectrometry. A. pittii carrying bla NDM-1 was confirmed in a patient with no national or international travel history, or transfer from another hospital. The findings warn of the possibility of silent spread of bla NDM-1 to the community.

Resumo Aves silvestres são importantes para a saúde pública devido ao seu potencial de transmissão de microrganismos patogênicos aos seres humanos. As aves aquáticas, como o guará (Eudocimus ruber), forrageiam e se reproduzem próximo de áreas antropizadas e estas, quando contaminadas, podem transmitir bactérias patogênicas às aves. O objetivo deste trabalho foi identificar o perfil de bactérias aeróbicas cloacais em filhotes de guará na colônia mista da Ilha Jarivatuba, em Joinville, Santa Catarina. Foram coletados swabs cloacais de filhotes de guará na estação reprodutiva de 2015/2016 (n=16) e 2016/2017 (n=34), todos de aves de aspecto clínico normal, e plaqueados em ágar sangue, MacConkey e Salmonella-Shigella em aerobiose. Foram isolados os seguintes microrganismos: Escherichia coli, Proteus vulgaris, Proteus spp., Klebsiella sp. Enterococcus spp. e Staphylococcus spp. A ocorrência de E. coli, Enterococcus spp. e P. vulgaris podem ser representantes da microbiota natural da espécie, uma informação desconhecida. Entretanto, a localização da colônia de aves aquáticas, na foz do rio Cachoeira, com o aporte de efluentes domésticos e industriais da cidade de Joinville sem tratamento adequado, pode indicar modificação dos perfis bacterianos. Torna-se evidente a necessidade de avançar com a sua tipificação fenotípica e genotípica dos isolados, para análises comparativas com estirpes presentes nos efluentes sanitários da região. Os resultados poderão contribuir para a conservação da espécie e outras aves aquáticas da área, permitindo a elaboração de projetos de conservação, gestão do ambiente costeiro e marinho, além de subsidiar medidas preventivas efetivas no combate as perdas de filhotes e potenciais epidemias zoonóticas.

Abstract Wild birds are important for public health because of their potential to transmit pathogenic microorganisms to humans. The waterbird scarlet ibis (Eudocimus ruber) forages and breeds near urban areas and if they settle near polluted waters, the viability of adults and their young can be negatively affected. Hence, the aim of this study was to evaluate the cloacal aerobic bacteria profile of nestling scarlet ibis in a mixed colony in Jarivatuba Island, in Joinville, Santa Catarina, Brazil. Cloacal swab samples were collected from clinically normal scarlet ibis nestlings during the breeding season of 2015/2016 (n=16) and 2016/2017 (n=34), and plated onto blood, MacConkey, and Salmonella-Shigella agar plates. Escherichia coli, Proteus vulgaris, Proteus spp., Klebsiella sp., Enterococcus spp. and Staphylococcus spp. were isolated and may be representative of the normal microbiota of E. ruber, although the normal profile is unknown for the species. However, the location of this colony in an area without adequate sewage treatment, which receives domestic effluents, may indicate a modified bacterial profile. Further studies are needed, to better understand the host's natural microbiome, as well as on the bacterial isolates, in order to characterize any association with the contaminated water. These results lay the foundation for successful species conservation projects in the area by providing insights that will help improve the viability of nestlings in each reproductive season.

Abstract: INTRODUCTION: Members of the Acinetobacter genus are key pathogens that cause healthcare-associated infections, and they tend to spread and develop new antibiotic resistance mechanisms. Oxacillinases are primarily responsible for resistance to carbapenem antibiotics. Higher rates of carbapenem hydrolysis might be ascribed to insertion sequences, such as the ISAba1 sequence, near bla OXA genes. The present study examined the occurrence of the genetic elements bla OXA and ISAba1 and their relationship with susceptibility to carbapenems in clinical isolates of the Acinetobacter calcoaceticus-Acinetobacter baumannii complex. METHODS: Isolates identified over 6 consecutive years in a general hospital in Joinville, Southern Brazil, were evaluated. The investigation of 5 families of genes encoding oxacillinases and the ISAba1 sequence location relative to bla OXA genes was conducted using polymerase chain reaction. RESULTS: All isolates presented the bla OXA-51-like gene (n = 78), and 91% tested positive for the bla OXA-23-like gene (n = 71). The presence of ISAba1 was exclusively detected in isolates carrying the bla OXA-23-like gene. All isolates in which ISAba1 was found upstream of the bla OXA-23-like gene (n = 69) showed resistance to carbapenems, whereas the only isolate in which ISAba1 was not located near the bla OXA-23-like gene was susceptible to carbapenems. The ISAba1 sequence position of another bla OXA-23-like-positive isolate was inconclusive. The isolates exclusively carrying the bla OXA-51-like gene (n = 7) showed susceptibility to carbapenems. CONCLUSIONS: The presence of the ISAba1 sequence upstream of the bla OXA-23-like gene was strongly associated with carbapenem resistance in isolates of the A. calcoaceticus-A. baumannii complex in the hospital center studied.

Abstract: INTRODUCTION: Carbapenems are the therapy of choice for treating severe infections caused by the Acinetobacter calcoaceticus-Acinetobacter baumannii complex. We aimed to assess the prevalence and antimicrobial susceptibility profiles of producers of distinct oxacillinases among nosocomial isolates of the A. calcoaceticus-A. baumannii complex in a 249-bed general hospital located in Joinville, Southern Brazil. METHODS: Of the 139 A. baumannii clinical isolates with reduced susceptibility to carbapenems between 2010 and 2013, 118 isolates from varying anatomical sites and hospital sectors were selected for genotypic analysis. Five families of genes encoding oxacillinases, namely blaOXA-23-like, blaOXA-24-like, blaOXA-51-like, blaOXA-58-like, and blaOXA-143-like, wereinvestigated by multiplex polymerase chain reaction (PCR). RESULTS: Most (87.3%) isolates simultaneously carried the blaOXA-23-likeand blaOXA-51-likegenes, whereas three (2.5%) isolates harbored only blaOXA-51-likeones. The circulation of carbapenem-resistant isolates increased during the study period: from none in 2010, to 22 in 2011, 64 in 2012, and 53 in 2013. CONCLUSIONS: Isolates carrying the blaOXA-23-likeand blaOXA-51-likegenes were widely distributed in the hospital investigated. Because of the worsening scenario, the implementation of preventive measures and effective barriers is needed.