Background:In Brazil, ventilator-associated pneumonia (VAP) caused by carbapenem resis- tant Acinetobacter baumanniiand Pseudomonas aeruginosaisolates are associated with significant mortality, morbidity and costs. Studies on the clonal relatedness of these isolates could lay the foundation for effective infection prevention and control programs.Objectives: We sought to study the epidemiological and molecular characteristics of A. baumannii vs. P. aeruginosaVAP in an adult intensive care unit (ICU).Methods: It was conducted a cohort study of patients with VAP caused by carbapenem resistant A. baumanniiand P'. aeruginosaduring 14 months in an adult ICU. Genomic studies were used to investigate the clonal relatedness of carbapenem resistant OXA-23-producing A. baumanniiand P. aeruginosaclinical isolates. The risk factors for acquisition of VAP were also evaluated. Clinical isolates were collected for analysis as were samples from the environment and were typed using pulsed field gel electrophoresis.Results: Multivariate logistic regression analysis identified trauma diagnosed at admission and inappropriate antimicrobial therapy as independent variables associated with the development of A. baumanniiVAP and hemodialysis as independent variable associated with P. aeruginosaVAP. All carbapenem resistant clinical and environmental isolates of A. baumanniiwere OXA-23 producers. No MBL-producer P. aeruginosawas detected. Molecular typing revealed a polyclonal pattern; however, clone A (clinical) and H (surface) were the most frequent among isolates of A. baumanniitested, with a greater pattern of resistance than other isolates. In P. aeruginosathe most frequent clone I was multi-sensitive.Conclusion: These findings suggest the requirement of constant monitoring of these microor- ganisms in order to control the spread of these clones in the hospital environment.

OBJECTIVE: The present studywas designed to evaluate the molecular epidemiology of CTX-M producing Klebsiella pneumoniae, Enterobacter cloacae and Escherichia coli isolated from bloodstream infections at tertiary care hospitals in the State of Rio de Janeiro, Brazil. MATERIAL AND METHODS: A total of 231 nonduplicate Enterobacteriaceae were isolated from five Brazilian hospitals between September 2007 and September 2008. The antimicrobial susceptibility testing was performed by disk diffusion method according to the Clinical Laboratory Standard Institute. Isolates showing resistance to third-generation cephalosporins were screened for ESBL activity by the double-disk synergy test. The presence of blaCTX-M , blaCTX-M-15 and blaKPC genes was determined by Polymerase Chain Reaction (PCR) amplification andDNA sequencing. The molecular typing of CTX-M producing isolateswas performed by pulsed-field gel electrophoresis (PFGE). RESULTS AND DISCUSSION: Ninety-three isolates were screened as ESBL positive and 85 (91%) were found to carry CTX-M-type, as follows: K. pneumoniae 59 (49%), E. cloacae 15 (42%), and E. coli 11 (15%). Ten isolates resistant for carbapenems in K. pneumoniae were blaKPC-2 gene positive. Among CTX-M type isolates, CTX-M-15 was predominant in more than 50% of isolates for K. pneumoniae, E. coli, and E. cloacae. PFGE analysis of CTX-M producing isolates showed the predominance of CTX-M-15 in 10 of 24 pulsotypes in K. pneumoniae, 6 of 13 in E. cloacae and 3 of 6 in E. coli. CTX-M-15 was also predominant among KPC producing isolates. In conclusion, this study showed that CTX-M-15 was circulating in Rio de Janeiro state in 2007-2008. This data reinforce the need for continuing surveillance because this scenario may have changed over the years.

OBJECTIVE: The present study was undertaken to characterize CTX-M ESBL-producing Klebsiella pneumoniae collected from hospitals in different cities of Brazil. MATERIAL AND METHODS: Eighty-five K. pneumoniae strains isolated from hospitalized patients in six different hospitals of three cities of Brazil were analyzed. ESBL production was confirmed by the standard double-disk synergy test and the Etest®. The MIC50 and MIC90 for ESBL-producing isolates were determined by the Etest® method. The antimicrobial susceptibilities of bacterial isolates were determined using the agar diffusion method according to the CLSI. Screening for blaTEM, blaSHV, blaCTX-M genes and class 1 integron was performed by PCR amplification. To determine the genomic diversity of CTX-M-producers, isolates were analyzed by macrorestriction profile analysis following PFGE. RESULTS AND DISCUSSION: Seventy-one K. pneumoniae isolates were ESBL-producing. PCR and sequencing experiments detected 38 CTX-M-producing K. pneumoniae belonged to groups CTX-M 1, CTX-M 2, CTX-M 8 and CTX-M 9. The association of different types ESBL (CTX-M, SHV and TEM) was frequent. All K. pneumoniae isolates carried class 1 integron. PFGE analysis revealed thirty-one clonal types among CTX-M-producing isolates. The data presented herein illustrate the diversity of genotypes of CTX-M producing K. pneumoniae among Brazilians hospitals.

Salmonella Typhimurium é considerada uma das principais bactérias causadoras de salmonelose nos animais e no homem em todo o mundo. No Brasil, Salmonella Typhimurium é um dos mais prevalentes sorovares isolados de alimentos para consumo humano. O uso indiscriminado de antibióticos em produtos agrícolas e no tratamento de pacientes humanos tem contribuído para aumentar a multirresistência desse sorovar a diversos antimicrobianos. No presente estudo, 278 cepas de STM foram selecionadas de diferentes fontes e regiões do Brasil, no período de 1999 a 2004 e realizadas a fagotipagem e análise do perfil de resistência antimicrobiana no Laboratório de Enterobactérias, Instituto Oswaldo Cruz, FIOCRUZ. Os principais fagotipos isolados foram DT 193 (64,3%), DT 19 (17,4%) e DT 18 (4%). Os fagotipos DT 10 (2%), DT 27 (3,24%), DT 13 (0,36%), DT 22 (0,36%), DT 28 (0,36%), DT 29 (0,36%) e DT 149 (0,36%) foram isolados em menores percentuais. Um total de 54% das cepas de STM foi resistente a três ou mais classes de antimicrobianos e não foi observada resistência a cefalosporinas de terceira geração ou ciprofloxacina. Esses resultados indicam os principais lisotipos de Salmonella Typhimurium circulantes entre os animais, alimentos de consumo humano e seres humanos no Brasil, bem como o aumento da multirresistência antimicrobiana. O monitoramento de cepas de Salmonella Typhimurium baseado na fagotipagem e no padrão de resistência antimicrobiana são ferramentas úteis para detectar surtos, identificar a fonte de infecção e implementar programas de prevenção e controle de salmonelose.

Salmonella Typhimurium has become a widespread cause of salmonellosis among humans and animals worldwide. In Brazil, Salmonella Typhimurium (STM) is one of the most prevalent serovars isolated from food for human consumption. The uncontrolled sale and use of antimicrobials in agriculture and for treating human patients contributes to increase multidrug resistance of this serovar. In the present study, a total of 278 STM isolates from different sources and regions of Brazil over the period 1999 to 2004 were phage typed and analyzed for their antimicrobial resistance profile at Laboratory of Enterobacteria, Oswaldo Cruz Institute, FIOCRUZ. The main STM phage types isolated were DT 193 (64.3%), DT 19 (17.4%) and DT 18 (4%). Others phage types as DT 10 (2%), DT 27 (3.24%), DT 13 (0.36%), DT 22 (0.36%), DT 28 (0.36%), DT 29 (0.36%) and DT 149 (0.36%) were obtained in low percentages. A total of 54% STM strains were resistant to three or more antimicrobial classes, while no resistance to third generation cephalosporin or ciprofloxacin was identified in these strains. Those results show the STM phage types circulating among animals, food for human consumption and humans in Brazil as well as the increasing of multidrug resistance. The surveillance of STM strains based on phage typing and antimicrobial resistance profile are useful for detecting outbreaks, identifying sources of infection and implementing prevention and control measures.

Neste trabalho utilizou-se 272 isolados de Salmonella Enteritidis, dos quais 111 foram isolados de carcaças de frango congeladas, 126 de alimentos e material biológico de humanos envolvidos em episódios de toxinfecções alimentares e 35 de diferentes materiais de origem avícola Destas amostras, 111 foram fagotipadas, sendo 57,65% classificadas como fagotipo 4, 32,43% como fagotipo 4a, 3,60% como fagotipo 6a e 0,90% como fagotipo 7, enquanto 5,40% das amostras não foram fagotipáveis A predominância do fagotipo 4 está em concordância com os resultados publicados ao redor do mundo, e reforça a necessidade de estudos relacionados ao significado epidemiológico destes achados.

272 isolates of Salmonella Enteritidis (111 isolated from frozen broiler chicken carcasses, 126 from human food and other biological materials involved in food poisoning outbreaks and 35 from different poultry materials) were selected for phage typing. From these, 111 were phage typed, 57.65% being classified as phage type 4, 32.43% as phage type 4a, 3.60% as phage type 6a and 0.90% as phage type 7, whereas 5.40% samples were not phage typeable. The predominance of phage type 4 is in agreement with the results published worldwide, and reinforces the need for studies related to the epidemiological meaning of these findings.

Das 7058 amostras de Vibrio cholerae isoladas de pacientes com suspeita de síndrome coleriforme, no período de 1991 a 1993, no Estado do Ceará, foram detectadas duas com as características de múltipla resistência aos antimicrobianos (tetraciclina, ampicilina, eritromicina, sulfametoxazol-trimetoprima) e ao composto vibriostático O/129 (2,4-diamino-6,7-diisopropilpteridina). Do ponto de vista bacteriológico uma amostra foi identificada como V. cholerae sorogrupo O:1, biotipo El Tor e sorovar Inaba e a outra, caracterizada como V. cholerae sorogrupo O:22, classificada bioquimicamente no tipo II de Heiberg. Foi demonstrado que apenas na amostra do sorogrupo O:1, a multirresistência era codificada por um plasmídio, transferível por conjugação para Escherichia coli K12 e amostras sensíveis de V. cholerae O1 e não O1, numa freqüência entre 8x10-2 a 5x10-6. O plasmídio responsável pela multirresistência apresentou um peso molecular de 147 Kb, compatível com as descrições em outras partes do mundo.

Of 7058 Vibrio cholerae strains recovered from patients suspected of cholera in the State of Ceará between December 1991 and September 1993, two were resistant to antimicrobials (Ampicillin, erythromycin, trimethoprim-sulfamethoxazole, tetracycline) and to vibriostatic agent O/129 (2,4-diamino-6,7-diisopropylpteridine). From the bacteriological standpoint, one strain was identified as V. cholerae serogroup O:1, biotype El Tor, serovar Inaba, and another as V. cholerae serogroup O:22, biochemically classified as Heiberg type II. It was shown that only in the serogroup O:1 strain, multiple resistance was encoded by a plasmid transferrable by conjugation to Escherichia coli K12 and a sensitive strains of V. cholerae O1 and non-O1, with at a frequency between 8x10-2 and 5x10-6. The plasmid, with a molecular weight of 147 Kb, encoded both multiple resistance to antimicrobials and the vibriostatic compound (O/129), compatible with descriptions reported in other parts of world.