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ABSTRACT Background: Vaccines in development against Group B Streptococcus (GBS) should contain the most prevalent capsular genotypes screened in the target population. In low- and middle-income countries epidemiological data on GBS carriage among pregnant women, a prerequisite condition for GBS neonatal sepsis, is needed to inform vaccine strategies. Objective: To investigate the prevalence of different GBS capsular genotypes that colonizes at-risk pregnant women in a private maternity hospital in São Paulo, Brazil. Methods: GBS strains isolated in routine maternity procedures from at-risk pregnant women from 2014 to 2018 were confirmed by mass spectrometry (MALDI-TOF) with subsequent DNA extraction for identification of capsular genotype through polymerase chain reaction (PCR). Demographic and gestational data were analyzed. Results: A total of 820 Todd-Hewitt broths positive for GBS were selected for streptococcal growth. Recovery and confirmation of GBS by MALDI-TOF were possible in 352. Strains were processed for determination of capsular genotype by PCR. From the total of 352 GBS isolates, 125 strains (35.5%) were genotyped as Ia; 23 (6.5%) as Ib; 41 (11.6%) as II; 36 (10.2%) as III; 4 (1.1%) as IV; 120 (34.1%) as V and 1 strain (0.3%) as VIII. Two isolates (0.7%) were not genotyped by used methodology. No statistically significant correlation between gestational risk factors, demographic data and distribution of capsular genotypes were found. Conclusions: GBS capsular genotypes Ia, Ib, II, III, and V were the most prevalent isolates colonizing at risk pregnant women in the present study. The inclusion of capsular genotypes Ia and V in the composition of future vaccines would cover 69.6% of capsular genotypes in the studied population. No statistically significant differences were observed between capsular genotype and gestational and demographic data and risk factors.

https://doi.org/10.1016/j.bjid.2021.101586 42 downloads

Invasive pneumococcal disease in children with cancer: Incidence density, risk factors and isolated serotypes
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Lages, Pedro Mendes

; Carlesse, Fabianne

; Boettger, Bruno Cruz

; Pignatari, Antônio Carlos Campos

; Petrilli, Antônio Sérgio

; Moraes-Pinto, Maria Isabel de

Brazilian Journal of Infectious Diseases

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Dez 2020, Volume 24 Nº 6 Páginas 489 - 496

Resumo: En | Texto: En | PDF: En

ABSTRACT Background: Pediatric oncology patients (POP) have a high risk of infections due to impaired immunity. Invasive pneumococcal disease (IPD) is an important cause of severe infection in these patients and it is associated with high mortality. This study aimed to evaluate the incidence and risk factors associated with IPD at a Pediatric Oncology Center in Brazil. Methods: This was a retrospective case-control study. All IPD cases in children with cancer from 2005 through 2016 were reviewed. Each case of IPD was matched with two controls from a cohort of patients matched for year of IPD, age and disease in order to assess risk factors. The incidence density was calculated as the number of IPD per 100,000 patients-year. Results: A total of 51 episodes of IPD in 49 patients was identified. All pneumococci were isolated from blood cultures. The median age was five years and 67% were male; mortality rate was 7.8%. The IPD incidence density rate in POP was 311.21 per 100,000 patients-year, significantly higher than the rate in the general pediatric population. Severe neutropenia was the only risk factor associated with IPD, after multivariate conditional logistic regression analysis. Conclusion: Although pneumococcal disease decreased after the introduction of 10-valent pneumococcal vaccine in the Brazilian national immunization schedule in 2010, there was no decrease in the IPD incidence rate in our cohort. A higher coverage rate of pneumococcal vaccination in children in the general population might be necessary to reduce the incidence rate in this high-risk population.

https://doi.org/10.1016/j.bjid.2020.09.003 296 downloads

Case report of a child with influenza and fatal community-associated methicillin-resistant Staphylococcus aureus sepsis
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Boettger, Bruno Cruz

; Rezende, Thais Freitas Teles

; Teixeira, Nathalia Bibiana

; Pignatari, Antonio Carlos Campos

; Kiffer, Carlos Roberto Veiga

Revista da Sociedade Brasileira de Medicina Tropical

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2020, Volume 53 elocation e20200050

Resumo: En | Texto: En | PDF: En

Abstract In the present study, we report the incidence of septic shock syndrome associated with methicillin-resistant Staphylococcus aureus in a child who initially presented influenza-like illness and developed septic shock shortly after 48 h of hospitalization, and eventually died within a few hours of the onset of sepsis. S. aureus isolated from the blood culture was characterized as the community-associated strain carrying the staphylococcal cassette chromosome mec (SCCmec) type IV element. Therefore, it is important to better understand the community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections and their potential association with influenza for early diagnosis and successful treatment of this fatal disease.

https://doi.org/10.1590/0037-8682-0050-2020 515 downloads

Direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry and real-time PCR in a combined protocol for diagnosis of bloodstream infections: a turnaround time approach
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Quiles, Milene Gonçalves

; Boettger, Bruno Cruz

; Inoue, Fernanda Matsiko

; Monteiro, Jussimara

; Santos, Daniel Wagner

; Ponzio, Vinicius

; Carlesse, Fabianne

; Cappellano, Paola

; Carvalhaes, Cecilia Godoy

; Pignatari, Antonio Carlos Campos

Brazilian Journal of Infectious Diseases

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Jun 2019, Volume 23 Nº 3 Páginas 164 - 172

Resumo: En | Texto: En | PDF: En

ABSTRACT Bloodstream infections (BSIs) are serious infections associated with high rates of morbidity and mortality. Every hour delay in initiation of an effective antibiotic increases mortality due to sepsis by 7%. Turnaround time (TAT) for conventional blood cultures takes 48 h, forcing physicians to streamline therapy by exposing patients to broad-spectrum antimicrobials. Our objective was (1) to evaluate the accuracy and TAT of an optimized workflow combining direct matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) and in-house real-time polymerase chain reaction (PCR) for bacterial identification and antimicrobial resistance profiling directly from positive blood bottles for diagnosing bloodstream infections and (2) to verify the effect of reporting results to medical staff. A total of 103 BSI episodes from 91 patients admitted to three hospitals in São Paulo, Brazil were included. TAT from molecular versus conventional methods was measured and compared. Our protocol showed an overall agreement of 93.5% for genus and 78.5% for species identification; 74.2% for methicillin resistance detection, 89.2% for extended-spectrum β-lactamase profiling, 77.8% for metallo-β-lactamase profiling, and 100% for carbapenemase profile and vancomycin-resistance detection when compared with conventional testing. TAT of molecular sample processing according to our protocol was 38 h shorter than conventional methods. Antimicrobial interventions were possible in 27 BSI episodes. Antimicrobial discontinuation was achieved in 12 BSI episodes while escalation of therapy occurred in 15 episodes. Antimicrobial therapy was inadequate in three (12%) BSI episodes diagnosed using results of molecular testing. Our in-house rapid protocol for identifying both bacteria and antimicrobial resistance provided rapid and accurate results, having good agreement with conventional testing results. These results could contribute to faster antimicrobial therapy interventions in BSI episodes.

https://doi.org/10.1016/j.bjid.2019.05.005 402 downloads

Temporal evolution of antimicrobial resistance among Neisseria gonorrhoeae clinical isolates in the most populated South American Metropolitan Region
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Martins, Rafael Affini

; Cassu-Corsi, Dandara

; Nodari, Carolina Silva

; Cayô, Rodrigo

; Natsumeda, Larissa

; Streling, Ana Paula

; Doi, André Mario

; da Silva, Roberto José Carvalho

; Bocalon, Roberta Alessandra Lima

; Gales, Ana Cristina

; Pignatari, Antonio Carlos Campos

Memórias do Instituto Oswaldo Cruz

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2019, Volume 114 elocation e190079

Resumo: En | Texto: En | PDF: En

A total of 124 Neisseria gonorrhoeae isolates recovered during a 12-year period (2003-2015) from outpatients assisted at Centro de Referência e Treinamento DST/AIDS-CRT of São Paulo city, Brazil, were analysed. The following resistance rates were observed: penicillin-59.6%, ciprofloxacin-15.3%, and azithromycin-6.7%. Although reduced susceptibility to these drugs was observed since 2003, no ceftriaxone-resistant isolates were detected. Ciprofloxacin- and azithromycin non-susceptible isolates were grouped in 11 clusters. Mutations were detected in GyrA and ParC of isolates 124 and 260, and a C2611T substitution on 23S rRNA alleles was also observed in isolate 260. Both isolates belonged to ST1901/ST6210 (MSLT/NG-MAST schemes).

https://doi.org/10.1590/0074-02760190079 734 downloads

Anatomical terminology of the internal nose and paranasal sinuses: cross-cultural adaptation to Portuguese
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Bezerra, Thiago Freire Pinto

; Stamm, Aldo

; Anselmo-Lima, Wilma Teresinha

; Fornazieri, Marco Aurélio

; Melo, Nelson D’Ávila

; Balsalobre, Leonardo

; Jotz, Geraldo Pereira

; Leão, Henrique Zaquia

; Nunes, André Alencar Araripe

; Felippu, Alexandre

; Cedin, Antonio Carlos

; Pinheiro-Neto, Carlos D.

; Oliveira, Diego Lima

; Sakano, Eulalia

; Kosugi, Eduardo Macoto

; Araújo, Elizabeth

; Valera, Fabiana Cardoso Pereira

; Pinna, Fábio de Rezende

; Romano, Fabrizio Ricci

; Pádua, Francine Grecco de Melo

; Ramos, Henrique Faria

; Telles Jr., João

; Sá, Leonardo Conrado Barbosa de

; D'Assunção Filho, Leopoldo Marques

; Sennes, Luiz Ubirajara

; Gregório, Luis Carlos

; Sampaio, Marcelo H.

; Santos, Marco César Jorge dos

; Franca, Marco

; Mocellin, Marcos

; Lessa, Marcus Miranda

; Avelino, Melissa Ameloti G.

; Tepedino, Miguel

; Andrade, Nilvano Alves de

; Piltcher, Otavio B.

; Roithmann, Renato

; Pilan, Renata Mendonça

; Meireles, Roberto Campos

; Guimarães, Roberto Eustáquio

; Santos, Rodrigo de Paula

; Pezato, Rogério

; Pignatari, Shirley

; Abdo, Tatiana Telles

; Nakajima, Victor

; Almeida, Washington

; Nakanishi, Marcio

; Voegels, Richard L.

Brazilian Journal of Otorhinolaryngology

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Dez 2018, Volume 84 Nº 6 Páginas 677 - 686

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo: Introdução: A cirurgia endoscópica funcional endonasal é um procedimento cirúrgico frequente entre os otorrinolaringologistas. Em 2014, a Sociedade Europeia de Rinologia publicou o "Documento Europeu para Posicionamento sobre a Terminologia Anatômica Interna do Nariz e das Cavidades Paranasais" com o objetivo de unificar os termos na língua inglesa. Ainda não dispomos de uma terminologia unificada na língua portuguesa. Objetivo: Adaptação transcultural dos termos anatômicos do nariz e das cavidades paranasais para o português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses". Método: Um grupo de rinologistas de todo o Brasil, com experiência em cirurgia endoscópica endonasal, foi convidado a participar da elaboração desse posicionamento sobre os termos anatômicos do nariz e das cavidades paranasais para o português conforme metodologia adaptada da previamente descrita por Rudmik e Smith. Resultados: Os resultados desse documento foram gerados a partir da concordância da maioria dos participantes conforme as sugestões mais populares entre os rinologistas. Uma adaptação transcultural da terminologia anatômica nasossinusal foi consolidada. Sugerimos que se busque uniformizar termos como "concha inferior", "septo nasal", "porção (óssea/cartilaginosa) do septo nasal", "meato (médio/ inferior) nasal", "via da drenagem do seio frontal", "recesso frontal" e "processo uncinado". Conclusão: Consolidamos uma versão adaptada em português da "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" que auxiliará a publicação de comunicados técnicos, publicações científicas e o ensino dos termos anatômicos internos do nariz e das cavidades paranasais no Brasil.

Abstract Introduction: Functional endonasal endoscopic surgery is a frequent surgical procedure among otorhinolaryngologists. In 2014, the European Society of Rhinology published the "European Position Paper on the Anatomical Terminology of the Internal Nose and Paranasal Sinuses", aiming to unify the terms in the English language. We do not yet have a unified terminology in the Portuguese language. Objective: Transcultural adaptation of the anatomical terms of the nose and paranasal cavities of the "European Anatomical Terminology of the Internal Nose and Paranasal Sinuses" to Portuguese. Methods: A group of rhinologists from diverse parts of Brazil, all experienced in endoscopic endonasal surgery, was invited to participate in the creation of this position paper on the anatomical terms of the nose and paranasal sinuses in the Portuguese language according to the methodology adapted from that previously described by Rudmik and Smith. Results: The results of this document were generated based on the agreement of the majority of the participants according to the most popular suggestions among the rhinologists. A cross-cultural adaptation of the sinonasal anatomical terminology was consolidated. We suggest the terms "inferior turbinate", "nasal septum", "(bone/cartilaginous) part of the nasal septum", "(middle/inferior) nasal meatus", "frontal sinus drainage pathway", "frontal recess" and "uncinate process" be standardized. Conclusion: We have consolidated a Portuguese version of the European Anatomical Terminology of the Internal Nose and Paranasal Sinuses, which will help in the publication of technical announcements, scientific publications and the teaching of the internal anatomical terms of the nose and paranasal sinuses in Brazil.

https://doi.org/10.1016/j.bjorl.2018.08.003 1085 downloads

Fecal microbiota analysis of children with small intestinal bacterial overgrowth among residents of an urban slum in Brazil
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Mello, Carolina Santos

; Rodrigues, Mirian Silva do Carmo

; Araújo Filho, Humberto Bezerra de

; Melli, Lígia Cristina Fonseca Lahoz

; Tahan, Soraia

; Pignatari, Antônio Carlos Campos

; Morais, Mauro Batista de

Jornal de Pediatria

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Out 2018, Volume 94 Nº 5 Páginas 483 - 490

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: Analisar a composição da microbiota fecal de crianças moradoras de uma favela urbana no Brasil, com e sem sobrecrescimento bacteriano no intestino delgado, e investigar a ocorrência de déficit de crescimento e anemia. Métodos: Foram estudadas 100 crianças, com idade entre 5 e 11 anos, na cidade de Osasco, São Paulo. Sobrecrescimento bacteriano no intestino delgado foi pesquisado por teste respiratório do hidrogênio e metano no ar expirado com lactulose. Foram mensurados peso, estatura e calculados os índices antropométricos estatura para idade e índice de massa corporal para idade. Foi investigada a ocorrência de anemia, pela avaliação da hemoglobina capilar. A análise dos filos, gêneros e espécies bacterianas em amostras de fezes foi realizada por polymerase chain reaction em tempo real. Resultados: Sobrecrescimento bacteriano no intestino delgado foi diagnosticado em 61,0% das crianças avaliadas. Foi verificada menor média do escore Z do índice estatura para idade (-0,48±0,90 vs.-0,11±0,97 DP) e de hemoglobina capilar (12,61±1,03 vs. 13,44±1,19 g/dL) no grupo de crianças com sobrecrescimento bacteriano no intestino delgado, quando comparadas àquelas sem sobrecrescimento bacteriano no intestino delgado (p < 0,05). Nas crianças com sobrecrescimento bacteriano no intestino delgado foi observada maior frequência de Salmonella spp., quando comparadas àquelas sem sobrecrescimento bacteriano no intestino delgado (37,7% vs. 10,3%; p = 0,002). Maior contagem de Eubactérias totais (p = 0,014) e Firmicutes (p = 0,038) foi observada nas crianças sem sobrecrescimento bacteriano no intestino delgado, enquanto que as crianças com sobrecrescimento bacteriano no intestino delgado apresentaram maior contagem de Salmonella (p = 0,002). Conclusão: Nas crianças com diagnóstico de sobrecrescimento bacteriano no intestino delgado verificaram-se menores valores de estatura para idade e de hemoglobina. Foram constatadas diferenças na microbiota fecal das crianças com sobrecrescimento bacteriano no intestino delgado, especificamente, maior frequência e contagem de Salmonella spp. e menores contagens de Firmicutes e Eubactérias totais.

Abstract Objective: To analyze the fecal microbiota composition of children living in an urban slum in Brazil, with or without small intestinal bacterial overgrowth, and to investigate the occurrence of stunting and anemia. Methods: A total of 100 children were studied, aged 5-11 years, from the municipality of Osasco, São Paulo. Small intestinal bacterial overgrowth was screened through hydrogen and methane breath test with lactulose. Weight and height were measured, and the height-for-age and body mass-for-age anthropometric indexes were calculated. The occurrence of anemia was investigated by capillary hemoglobin. Analysis of bacterial phylum, genus, and species was performed by real-time polymerase chain reaction in fecal samples. Results: Small intestinal bacterial overgrowth was identified in 61.0% of the children. A lower mean of height-for-age Z-score ([−0.48 ± 0.90] vs. [−0.11 ± 0.97]; p = 0.027), as well as capillary hemoglobin ([12.61 ± 1.03 g/dL] vs. [13.44 ± 1.19 g/dL]; p < 0.001) was demonstrated in children with SIBO when compared with children without small intestinal bacterial overgrowth. Children with small intestinal bacterial overgrowth presented a higher frequency of Salmonella spp., when compared to those without small intestinal bacterial overgrowth (37.7% vs. 10.3%; p = 0.002). Higher counts of total Eubacteria (p = 0.014) and Firmicutes (p = 0.038) were observed in children without small intestinal bacterial overgrowth; however, a higher count of Salmonella (p = 0.002) was found in children with small intestinal bacterial overgrowth. Conclusion: Children who lived in a slum and were diagnosed with small intestinal bacterial overgrowth showed lower H/A Z-scores and hemoglobin levels. Furthermore, differences were observed in the fecal microbiota of children with small intestinal bacterial overgrowth, when compared to those without it; specifically, a higher frequency and count of Salmonella, and lower counts of Firmicutes and total Eubacteria.

https://doi.org/10.1016/j.jped.2017.09.003 2096 downloads

Tailoring antimicrobials in febrile neutropenia: using faster diagnostic and communication tools to improve treatment in the era of extensively resistant pathogens
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Souza, Ingvar Ludwig Augusto de

; Quiles, Milene Gonçalves

; Boettger, Bruno Cruz

; Pignatari, Antonio Carlos Campos

; Cappellano, Paola

Brazilian Journal of Infectious Diseases

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Jun 2018, Volume 22 Nº 3 Páginas 239 - 242

Resumo: En | Texto: En | PDF: En

ABSTRACT Febrile Neutropenia represents a medical emergency and the use of appropriate antimicrobial therapy is essential for a better outcome. Although being time-consuming, conventional cultures and antimicrobial susceptibility tests remain the golden standard practices for microbiology identification. Final reports are typically available within several days. Faster diagnostic tools, such as species identification trough Matrix Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) and molecular techniques might help to shorten time to diagnostic and also guide definitive therapy in this scenario. Here we present a case in which the use of a diagnostic molecular workflow combining MALDI-TOF and real-time PCR for relevant genes codifying antibiotic resistant integrated with instant communication report, led to a tailored and more appropriate treatment in a patient presenting with febrile neutropenia.

https://doi.org/10.1016/j.bjid.2018.05.009 417 downloads

High mortality outbreak of carbapenem-resistant Pseudomonas aeruginosa infection in a Brazilian pediatric oncology hospital
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Quiles, Milene Gonçalves

; Carlesse, Fabianne

; Silva, Maria Aparecida Aguiar da

; Mingrone, Roberta Cabral

; Fonseca, Juliane Melo

; Silva, Dafne Cardoso

; Pignatari, Antonio Carlos Campos

Brazilian Journal of Infectious Diseases

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Mar 2017, Volume 21 Nº 2 Páginas 205 - 206

Resumo: En | Texto: En | PDF: En

https://doi.org/10.1016/j.bjid.2016.10.012 826 downloads

10.

The inappropriate use of antibiotics in upper respiratory tract infections: it is time for action
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Pignatari, Antonio Carlos Campos

; Myake, Monica Menon

Brazilian Journal of Otorhinolaryngology

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Abr 2016, Volume 82 Nº 2 Páginas 121 - 122

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

https://doi.org/10.1016/j.bjorl.2015.12.003 1418 downloads

11.

Trends of 9,416 multidrug-resistant Gram-negative bacteria
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Oliveira, Viviane Decicera Colombo

; Rubio, Fernando Góngora

; Almeida, Margarete Teresa Gottardo

; Nogueira, Mara Corrêa Lelles

; Pignatari, Antonio Carlos Campos

Revista da Associação Médica Brasileira

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Jun 2015, Volume 61 Nº 3 Páginas 244 - 249

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

Resumo Objetivo: a resistência bacteriana hospitalar a múltiplos antibióticos é uma grande preocupação mundial. O objetivo deste estudo foi conhecer os agentes multidroga-resistentes (MDR), materiais clínicos, origem e evolução, e correlaciona-los à sensibilidade bacteriana e ao consumo de antimicrobianos. Métodos: foram avaliadas 9.416 bactérias de origem nosocomial, em um hospital terciário, durante o período de 1999 a 2008. Foram definidas como MDR as bactérias Gram-negativas (BGN) que apresentaram resistência a duas ou mais classes/grupos de antibióticos. Resultados: as BGN MDR tiveram um aumento global de 3,7 vezes no final do período (p<0,001). O Acinetobacter baumannii foi o mais prevalente (36,2%). Durante o período do estudo, houve um aumento significativo de 4,8 e 14,6 para A. baumannii e K. pneumoniae (p<0,001), respectivamente. Sessenta e sete por cento das BGN MDR foram isoladas em unidade de terapia intensiva. A resistência do A. baumannii aos carbapenêmicos aumentou de 7,4 para 57,5% durante o período, concomitante ao aumento do consumo. Conclusão: durante essa década, houve uma prevalência de BGN e um aumento gradual das BGN MDR. Houve um aumento da resistência aos carbapenêmicos de 50,1% durante o estudo.

Summary Objective: a resistance of hospital-acquired bacteria to multiple antibiotics is a major concern worldwide. The objective of this study was to investigate multidrugresistant (MDR) bacteria, clinical specimens, origin of specimen and trends, and correlate these with bacterial sensitivity and consumption of antimicrobials. Methods: 9,416 bacteria of nosocomial origin were evaluated in a tertiary hospital, from 1999 to 2008. MDR was defined for Gram-negative bacteria (GNB) as resistance to two or more classes/groups of antibiotics. Results: GNB MDR increased by 3.7 times over the study period (p<0.001). Acinetobacter baumannii was the most prevalent (36.2%). Over the study period, there were significant 4.8-fold and 14.6-fold increases for A. baumannii and K. pneumoniae (p<0.001), respectively. Sixty-seven percent of isolates of MDR GNB were isolated in intensive care units. The resistance of A. baumannii to carbapenems increased from 7.4 to 57.5% during the study period and concomitant with an increased consumption. Conclusion: that decade showed prevalence of GNB and a gradual increase in MDR GNB. There was an increase in carbapenem resistance of 50.1% during the study.

https://doi.org/10.1590/1806-9282.61.03.244 3350 downloads

12.

Pharmacodynamic profiling of commonly prescribed antimicrobial drugs against Escherichia coli isolates from urinary tract
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Cuba, Gabriel Trova

; Pignatari, Antonio Carlos Campos

; Patekoski, Katya Silva

; Luchesi, Lucimila Jorge

; Kiffer, Carlos Roberto Veiga

Brazilian Journal of Infectious Diseases

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Out 2014, Volume 18 Nº 5 Páginas 512 - 517

Resumo: En | Texto: En | PDF: En

Since antimicrobial resistance among uropathogens against current first line agents has affected the management of severe urinary tract infection, we determined the likelihood that antibiotic regimens achieve bactericidal pharmacodynamic exposures using Monte Carlo simulation for five antimicrobials (ciprofloxacin, ceftriaxone, piperacillin/tazobactam, ertapenem, and meropenem) commonly prescribed as initial empirical treatment of inpatients with severe community acquired urinary tract infections. Minimum inhibitory concentration determination by Etest was performed for 205 Brazilian community urinary tract infection Escherichia coli strains from 2008 to 2012 and 74 E. coli bloodstream strains recovered from a surveillance study. Pharmacodynamic exposure was modeled via a 5000 subject Monte Carlo simulation. All isolates were susceptible to ertapenem and meropenem. Piperacillin/tazobactam, ceftriaxone and ciprofloxacin showed 100%, 97.5% and 83.3% susceptibility among outpatient isolates and 98.6%, 75.7% and 64.3% among inpatient isolates, respectively. Against outpatient isolates, all drugs except ciprofloxacin (82.7% in aggressive and 77.6% in conservative scenarios) achieved high cumulative fraction of response: car-bapenems and piperacillin/tazobactam cumulative fraction of responses were close to 100%, and ceftriaxone cumulative fraction of response was 97.5%. Similar results were observed against inpatients isolates for carbapenems (100%) and piperacillin/tazobactam (98.4%), whereas ceftriaxone achieved only 76.9% bactericidal cumulative fraction of response and ciprofloxacin 61.9% (aggressive scenario) and 56.7% (conservative scenario) respectively. Based on this model, standard doses of beta-lactams were predicted to deliver sufficient pharmacodynamic exposure for outpatients. However, ceftriaxone should be avoided for inpatients and ciprofloxacin empirical prescription should be avoided in both inpatients and outpatients with complicated urinary tract infection.

https://doi.org/10.1016/j.bjid.2014.01.008 2155 downloads

13.

Community-acquired methicillin-resistant Staphylococcus aureus carrying SCCmec type IV in southern Brazil
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Gelatti, Luciane Cristina

; Bonamigo, Renan Rangel

; Inoue, Fernanda Matsiko

; Carmo, Mirian Silva do

; Becker, Ana Paula

; Castrucci, Fernanda Marques da Silva

; Pignatari, Antônio Carlos Campos

; d' Azevedo, Pedro Alves

Revista da Sociedade Brasileira de Medicina Tropical

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Fev 2013, Volume 46 Nº 1 Páginas 34 - 38

Resumo: En | Texto: En | PDF: En

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen commonly associated with nosocomial infections. However, it has also been associated with community-acquired skin and soft tissue infections (CA-MRSA). There are few data on the identification and prevalence of CA-MRSA infections in Brazil. METHODS: This is a cross-sectional study of 104 patients with community-acquired skin infections attending two health care centers in Porto Alegre, southern Brazil. MRSA isolates were characterized by molecular methods, including detection of the mecA gene by PCR, gene SCCmec typing, Panton-Valentine leukocidin (PVL) detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). RESULTS: From the 104 samples, 58 Staphylococcus aureus isolates were obtained, of which five (8.6%) had a CA-MRSA-resistant profile. All five isolates had the mecA gene and amplified to SCCmec type IV. Analysis of chromosomal DNA by PFGE revealed the presence of two clusters related to international clones (OSPC and USA 300), with a Dice similarity coefficient >80%. The study was complemented by MLST, which detected three different strains: ST30, ST8, and ST45, the latter not presenting any relation with the clones compared in PFGE. CONCLUSIONS: The presence of CA-MRSA reveals an important change in the epidemiology of this pathogen and adds new elements to the knowledge of the molecular biology of infections by MRSA with SCCmec type IV in southern Brazil.

https://doi.org/10.1590/0037-868213022013 3752 downloads

14.

The first report of infection with Klebsiella pneumoniae carrying the bla kpc gene in State of Mato Grosso do Sul, Brazil
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Chang, Marilene Rodrigues

; Biberg, Camila Arguelo

; Lopes, Fernando Aguilar

; Tetila, Andyane Freitas

; Pignatari, Antonio Carlos Campos

Revista da Sociedade Brasileira de Medicina Tropical

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Fev 2013, Volume 46 Nº 1 Páginas 114 - 115

Resumo: En | Texto: En | PDF: En

The increased frequency and dissemination of enterobacteria resistant to various antimicrobials is currently worldwide concern. In January 2010, a 94-year-old patient with chronic lymphocytic leukemia was admitted to the University Hospital. This patient died 21 days after hospitalization due to the clinical worsening. Klebsiella pneumoniae producing of extended-spectrum β-lactamases (ESBLs) was isolated of urine culture. This bacterium demonstrated resistance to ceftazidime, ciprofloxacin, levofloxacin, ertapenem and imipenem. Susceptibility to cefoxitin, cefepime, meropenem, colistin and tigecycline. This study reports the first case of infection by Klebsiella pneumoniae carrying the bla kpc gene in the State of Mato Grosso do Sul, Brazil.

https://doi.org/10.1590/0037-868215502013 4741 downloads

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Proposta sobre uso de dados de receitas de antimicrobianos retidas: a experiência EUREQA
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Camargo, Eduardo Celso Gerbi

; Kiffer, Carlos Roberto Veiga

; Pignatari, Antonio Carlos Campos

; Shimakura, Silvia Emiko

; Ribeiro Jr, Paulo Justiniano

; Monteiro, Antonio Miguel Vieira

Cadernos de Saúde Pública

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Mai 2012, Volume 28 Nº 5 Páginas 985 - 990

Resumo: Pt En | Texto: Pt En | PDF: Pt | PDF: En

A presente nota pesquisa demonstra que o uso das informações de receituário ou prescrição médica tem fundamental valor para a compreensão das correlações da dinâmica da resistência bacteriana comunitária. Além disso, a análise dos dados gerada pode ajudar a estabelecer medidas e políticas de saúde pública mais adequadas para o controle e a otimização do consumo de antimicrobianos. Para isso, o artigo usa como base o modelo lógico desenvolvido pelo Projeto EUREQA voltado para aquisição, classificação, interpretação e análise das informações relacionadas à prescrição dos antimicrobianos de uso oral.

This study demonstrates that the use of information from medical prescriptions is essential for understanding the dynamics of community bacterial resistance. The resulting analysis can also influence and help establish more adequate public health policies on the control and optimization of antimicrobial use. The article demonstrates the use of a logical model developed by the EUREQA project for acquisition, classification, interpretation, and analysis of data from prescriptions for oral antimicrobial use.

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