The investigations of the antibacterial actions, observed in ternary associations involving silver nanoparticles (AgNPs), chitosan and the antibiotics azithromycin (AZ), levofloxacin (LE) or tetracycline (TE), against Gram-negative and Gram-positive bacterial strains, were performed by in vitro antimicrobial susceptibility testing and checkerboard assays. The pH impact in the culture medium was carefully discarded, but preserving the best conditions for solubilizing chitosan. The synergistic antibacterial effects were observed in the most combinations of AgNPs, chitosan and antibiotic, leading to a reduction from 37 to 97% in the minimum inhibitory concentration of the drugs. The mechanisms for the enhanced antimicrobial effects were proposed based on the investigations of the adsorptions of the drugs on the silver surfaces through surface-enhanced Raman scattering (SERS) spectroscopy.

ABSTRACT To characterize methicillin-resistant Staphylococcus aureus isolates from an intensive care unit of a tertiary-care teaching hospital, between 2005 and 2010. A total of 45 isolates were recovered from patients admitted to the intensive care unit in the study period. Resistance rates higher than 80% were found for clindamycin (100%), erythromycin (100%), levofloxacin (100%), azithromycin (97.7%), rifampin (88.8%), and gentamycin (86.6%). The SCCmec typing revealed that the isolates harbored the types III (66.7%), II (17.8%), IV (4.4%), and I (2.2%). Four (8.9%) isolates carried non-typeable cassettes. Most (66.7%) of the isolates were related to the Brazilian endemic clone from CC8/SCCmec III, which was prevalent (89.3%) between 2005 and 2007, while the USA100/CC5/SCCmec II lineage emerged in 2007 and was more frequent in the last few years. The study showed high rates of antimicrobial resistance among methicillin-resistant S. aureus isolates and the replacement of Brazilian clone, a well-established hospital lineage, by the USA100 in the late 2000s, at the intensive care unit under study.