Detecção de bactérias multirresistentes aos antimicrobianos em esgoto hospitalar no Rio de Janeiro

Submitted by Alessandra Portugal ([email protected]) on 2013-09-24T14:50:16Z No. of bitstreams: 1 Thiago Pavoni.pdf: 1955163 bytes, checksum: b15140ec10d9f1473101f075a2a57a86 (MD5)Made available in DSpace on 2013-09-24T14:50:16Z (GMT). No. of bitstreams: 1 Thiago Pavoni.pdf: 1955163 bytes, checksum: b15140ec10d9f1473101f075a2a57a86 (MD5) Previous issue date: 2011Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil.Drogas antimicrobianas e bactérias resistentes aos antimicrobianos estão disseminadas em grandes quantidades no ambiente, como resultado do aumento e freqüente uso indiscriminado dos antibióticos. Bactérias e seus genes de resistência têm sido detectados em diferentes ambientes, tais como esgoto hospitalar, esgoto doméstico e águas de rios contaminados. O esgoto hospitalar é um importante poluente, representando riscos para a saúde pública se chegar aos sistemas de distribuição. Ambientes fortemente seletivos, como os hospitais, permitem a geração bactérias resistentes, as quais podem ser lançadas no esgoto hospitalar. O presente trabalho tem como objetivo investigar a presença bactérias resistentes aos antimicrobianos em efluentes de uma estação de tratamento de esgoto hospitalar no Rio de Janeiro, avaliando o potencial do sistema de tratamento para a eliminação de micro-organismos. A estação de tratamento de esgoto fica localizada na região metropolitana. O sistema de lodo ativado por aeração prolongada é constituído por três partes básicas: o tanque de aeração, o decantador e o tanque de cloração. Vinte e quatro amostras de esgoto foram coletadas no período de Julho a Dezembro de 2008. Oito amostras (1000 mL) foram coletadas a partir de diferentes pontos: afluente, efluente do tanque decantador e efluente clorado. Micro-organismos indicadores também foram investigados. Os isolados bacterianos foram identificados a partir de provas bioquímicas convencionais. A sensibilidade aos antimicrobianos das bactérias isoladas foi determinada através do método fenotípico de difusão em ágar, de acordo com as orientações do Clinical and Laboratory Standards Institute (CLSI). A identificação da produção fenotípica de beta-lactamases de espectro estendido e de carbapenemases entre os isolados também seguiram as recomendações do CLSI. Ensaios de PCR foram processados para a identificação dos genes blaKPC, blaTEM, blaSHV e blaCTX-M. A genotipagem das amostras bacterianas foi realizada por eletroforese em gel de campo pulsado. Concentrações significativas de coliformes totais e fecais foram detectadas nos efluentes hospitalares. Um total de 226 isolados foi identificado, entre os quais 213 (94%) pertenciam à família Enterobacteriaceae. Outros grupos de micro-organismos, como Pseudomonas aeruginosa, Acinetobacter baumannii e Aeromonas spp., foram também observados. A maioria das cepas era sensível ao imipenem e ao meropenem; e resistente à cefalotina, à cefotaxima e ao sulfametoxazol-trimetoprim. O fenótipo de ESBL foi caracterizado em 97 (43%) isolados. Os produtores de ESBL mais comuns foram: Klebsiella pneumoniae, Enterobacter cloacae e Escherichia coli. Micro-organismos patogênicos e altas taxas de resistência ainda puderam ser observados nos efluentes clorados. Os genes blaTEM, blaSHV e blaCTX-M foram detectados em 82%, 48% e 67% dos isolados do efluente hospitalar, respectivamente. Em muitos isolados, a ocorrência de mais de um tipo de ESBL foi observada, sendo a associação dos tipos TEM e CTX-M a mais frequente. O gene blaKPC foi detectado em dois isolados do efluente. Foi possível observar isolados clínicos e do esgoto geneticamente relacionados. Concluímos que, apesar do tratamento, o esgoto hospitalar pode ser considerado um veículo ambiental de disseminação de bactérias multirresistentes. A ocorrência destes micro-organismos nos efluentes é preocupante e tem impacto sobre a saúde pública. Medidas urgentes são necessárias para enfrentar este problema. Vale ressaltar que, em muitos países em desenvolvimento, os efluentes hospitalares não recebem tratamento adequado.Antimicrobial drugs and antimicrobial - resistant bacteria are discharged in large quantities in the environment as a result of increasing ly frequent and indiscriminate use of antibiotics . Antimicrobial - resistant bacteri a and antimicrobial - resistant genes have been detected in different environments, such as domestic sewage, hospital sewage and sewage - contaminated river waters. Hospital sewage is an important pollutant , representing risks to public health if it reaches th e distribution system. The occurrence of strongly selective environments, such as hospitals, leads to an incre ase of multiresistant bacteria, which can be released in hospital sewage. The aim of this study was to investigate the antimicrobial - resistant bac teria isolated from a hospital sewage treatment plant in Rio de Janeiro city, evaluating the treatment plant’s potential to remove these microorganisms. The sewage treatment plant serve a hospital located in the metropolitan area of the Rio de Janeiro city (RJ), Brazil. The extended aeration activated sludge plant is divided into three parts, an aeration tank, a clarifier tank and a chlorine contact tank. During the study, twenty - four sewage samples were collected in the period from July to December 2008. E ight samples (1000 ml) were collected on each day from the following: influent; clarifier tank effluent; and chlorine contact tank effluent. Total and faecal coliforms concentrations were also determined . Isolates were identified using established biochemi cal procedures. The antimicrobial susceptibilities of bacterial isolates were determined using the agar diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Isolates were screened for the KPC - and ESBL - producing phen otype according to the CLSI. PCR experiments were used for the molecular detection of bla KPC , bla TEM , bla SHV and bla CTX - M genes. The genetic relat ionships of isolates were determined by PFGE. High concentrations of total and faecal coliforms were detected in the influent , clarifier tank and chlorine contact tank effluent. A total of 226 isolates were identified, among which 213 (94%) were Enterobacteriaceae . In addition , Pseudomonas aeruginosa , Acinetobacter baumannii and Aeromonas spp . in hospital effluent were observed . The majority of the strai ns were susceptible to imipenem and meropenem and resistant to cefalothin, cefotaxime and trimethoprim - sulphametoxazole. ESBL phenotype was characterized in 97 (43%) isolates. The most common ESBL - producing isolates were: Klebsiella pneumoniae , Enterobacter cloacae , and Escherichia coli . Pathogenic microorganisms and higher antimicrobial resistance rates were detected in chlorine contact tank effluent. The bla TEM , bla SHV and bla CTX - M genes were detected in 82%, 48% a nd 67% of isolates respectively. Many of the isolates harboured other β - lactam resistance enzymes and the a ssociation of types TEM and CTX - M was more frequent. The bla KPC was detected in isolates from effluents. PFGE analysis revealed clonal types among cl inical isolates and isolates from effluents. Despite the treatment of the wastewater, hospital effluent may be considered as a potential environmental vehicle of multiresi s tant microorganisms. The occurrence of multiresistant bacteria isolates in hospital effluents is worrisome and has a real impact on public health. Urgent measures are necessary in order to counteract this problem. It should be noted that effluents from hospitals in developing countries do not receive adequate treatmen

Draft genome sequence of a multidrug-resistant Acinetobacter baumannii ST15 (CC15) isolated from Brazil

Acinetobacter baumannii is an important pathogen frequently associated with nosocomial outbreaks around the world. In Brazil, A. baumannii has become particularly problematic because of its prevalence and the carbapenems resistance. Here, we report the draft genome sequence of a multidrug-resistant A. baumannii (ST15/CC15) isolated in 2009 from the state of Espírito Santo (Southeast Brazil). We observed important resistance determinant genes in an estimated genome size of 4,102,788 bp with 3,862 predicted coding regions. A detailed report of the genomic data analysis might help to understand the specific features of highly successful strains belonged to a relevant complex clonal in different Brazilian geographical regions

Diversity of genotypes in CTX-M-producing Klebsiella pneumoniae isolated in different hospitals in Brazil

Submitted by Ana Maria Fiscina Sampaio ([email protected]) on 2017-05-31T13:39:37Z No. of bitstreams: 1 Chagas TPG Diversity of genotypes....pdf: 375018 bytes, checksum: b38408ee64835a41251fd3b32e96340b (MD5)Approved for entry into archive by Ana Maria Fiscina Sampaio ([email protected]) on 2017-05-31T18:49:22Z (GMT) No. of bitstreams: 1 Chagas TPG Diversity of genotypes....pdf: 375018 bytes, checksum: b38408ee64835a41251fd3b32e96340b (MD5)Made available in DSpace on 2017-05-31T18:49:22Z (GMT). No. of bitstreams: 1 Chagas TPG Diversity of genotypes....pdf: 375018 bytes, checksum: b38408ee64835a41251fd3b32e96340b (MD5) Previous issue date: 2011FAPERJ e CNPq.Universidade do Estado do Rio de Janeiro. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilUniversidade Federal do Rio de Janeiro. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilUniversidade Rural do Rio de Janeiro. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilFundação Oswaldo Cruz. Centro de Pesquisas Gonçalo Moniz. Salvador, BA, BrasilHospital Infection Research Laboratory. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, BrasilObjective: 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

Diversity of genotypes in CTX-M-producing Klebsiella pneumoniae isolated in different hospitals in Brazil

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

First Report of NDM-1-Producing Acinetobacter baumannii Sequence Type 25 in Brazil

Submitted by sandra infurna ([email protected]) on 2015-10-12T23:19:18Z No. of bitstreams: 1 thiago_chagas_etal_IOC_2014.pdf: 134628 bytes, checksum: 4abd12234d4983ddb4c1d980540e5337 (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2015-10-12T23:19:49Z (GMT) No. of bitstreams: 1 thiago_chagas_etal_IOC_2014.pdf: 134628 bytes, checksum: 4abd12234d4983ddb4c1d980540e5337 (MD5)Approved for entry into archive by sandra infurna ([email protected]) on 2015-10-12T23:20:10Z (GMT) No. of bitstreams: 1 thiago_chagas_etal_IOC_2014.pdf: 134628 bytes, checksum: 4abd12234d4983ddb4c1d980540e5337 (MD5)Made available in DSpace on 2015-10-12T23:36:56Z (GMT). No. of bitstreams: 1 thiago_chagas_etal_IOC_2014.pdf: 134628 bytes, checksum: 4abd12234d4983ddb4c1d980540e5337 (MD5) Previous issue date: 2014Pontifical Catholic University.School of Health and Biosciences. Curitiba, PR, Brasil / State Central Public Health Laboratory. São José dos Pinhais, PR, Brasil.State Central Public Health Laboratory. São José dos Pinhais, PR, Brasil.University Hospital of Londrina. Londrina, PR, Brasil.University Hospital of Londrina. Londrina, PR, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil.New Delhi metallo-β-lactamase 1 (NDM-1) was first identified in Brazil in Enterobacter hormaechei and Providencia rettgeri in 2013. Here, we describe the first case of NDM-1-producing Acinetobacter baumannii sequence type 25 isolated from the urinary tract of a 71-year-old man who died of multiple complications, including A. baumannii infection. The NDM-1 gene was detected by quantitative PCR, and its sequence confirmed its presence in an ∼100-kb plasmid

Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) Applications in Bacteriology: brazilian contributions

Among its innumerous applications in Bacteriology, the Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) technique is evolving as a powerful tool for bacterial identification and antimicrobial resistance investigation. Publications have evaluated the MALDI-TOF MS performance in the identification of a series of bacterial pathogens, including the most common severe infectious agents, emergent pathogens involved with outbreaks of healthcare-associated infections, rare pathogens, and those whose isolation in culture media is difficult. As compared to conventional methods of bacterial identification, MALDI-TOF MS has proven to be a fast, accurate and cost-effective technique. Currently, MALDI-TOF MS has been used in antimicrobial resistance studies, since it has shown to be an efficient tool in detecting specific resistance mechanisms in bacteria, such as beta-lactamases production, for example. Here, we describe the advances in this growing field of mass spectrometry applied to Bacteriology, including Brazilian contributions.Among its innumerous applications in Bacteriology, the Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry (MALDI-TOF MS) technique is evolving as a powerful tool for bacterial identification and antimicrobial resistance investigation. Publications have evaluated the MALDI-TOF MS performance in the identification of a series of bacterial pathogens, including the most common severe infectious agents, emergent pathogens involved with outbreaks of healthcare-associated infections, rare pathogens, and those whose isolation in culture media is difficult. As compared to conventional methods of bacterial identification, MALDI-TOF MS has proven to be a fast, accurate and cost-effective technique. Currently, MALDI-TOF MS has been used in antimicrobial resistance studies, since it has shown to be an efficient tool in detecting specific resistance mechanisms in bacteria, such as beta-lactamases production, for example. Here, we describe the advances in this growing field of mass spectrometry applied to Bacteriology, including Brazilian contributions

Spread of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clones in patients with ventilator-associated pneumonia in an adult intensive care unit at a university hospital

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

Isolation of NDM-producing Providencia rettgeri in Brazil

Made available in DSpace on 2015-10-07T18:53:16Z (GMT). No. of bitstreams: 2 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) anapaula_assef_etal_IOC_2013.pdf: 76205 bytes, checksum: 4451c324cce222929e213c59f9c4805e (MD5) Previous issue date: 2013Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro. Instituto de Biologia Roberto Alcântara Gomes. Departamento de Bioquímica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil.Fundação Estadual de Produção e Pesquisa em Saúde (FEPPS IPB-LACEN-RS). Porto Alegre, RS, Brasil.Hospital Nossa Senhora da Conceição. Porto Alegre, RS, Brasil.Hospital Nossa Senhora da Conceição. Porto Alegre, RS, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH), Rio de Janeiro, RJ, Brasil

Multiclonal Expansion of Klebsiella pneumoniae Isolates Producing NDM-1 in Rio de Janeiro, Brazil

Submitted by Sandra Infurna ([email protected]) on 2018-02-22T11:44:03Z No. of bitstreams: 1 marise_asensi_etal_IOC_2017.pdf: 497018 bytes, checksum: dc58d964828de09e36dd354edb80c9a0 (MD5)Approved for entry into archive by Sandra Infurna ([email protected]) on 2018-02-22T11:56:02Z (GMT) No. of bitstreams: 1 marise_asensi_etal_IOC_2017.pdf: 497018 bytes, checksum: dc58d964828de09e36dd354edb80c9a0 (MD5)Made available in DSpace on 2018-02-22T11:56:03Z (GMT). No. of bitstreams: 1 marise_asensi_etal_IOC_2017.pdf: 497018 bytes, checksum: dc58d964828de09e36dd354edb80c9a0 (MD5) Previous issue date: 2017Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ. Brasil.Laboratório Central de Saúde Pública Noel Nutels. Rio de Janeiro, RJ, Brasil.Secretaria Estadual de Saúde. Coordenação Estadual de Controle de Infecção Hospitalar. Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro. Departamento de Bioquímica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ. Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ. Brasil.We characterized NDM-1-producingKlebsiellaisolates from Rio de Janeiro, Brazil. PCR was applied for resistance and virulence determinants. The genetic context ofblaNDMwas determined by S1 nuclease pulsed-field gel electrophoresis (PFGE) and hybridization. Genotyping was performed by PFGE and multilocus sequence typing (MLST). Most isolates carried multiple resistance genes and remained susceptible to amikacin, fosfomycin-trometamol, polymyxin B, and tigecycline. The spread of NDM-1-producingKlebsiella pneumoniaewas not associated with clonal expansion and appears to be associated with Tn3000

Detection of NDM-1, CTX-M-15 and qnrB4-producing Enterobacter 2 hormaechei isolates in Brazil

Made available in DSpace on 2015-06-01T19:34:19Z (GMT). No. of bitstreams: 2 license.txt: 1914 bytes, checksum: 7d48279ffeed55da8dfe2f8e81f3b81f (MD5) polyana_pereiraetal_IOC_2014.pdf: 463789 bytes, checksum: 9029bb00e92e127aff841d59588f718c (MD5) Previous issue date: 2014Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH). Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH). Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro. Instituto de Biologia Roberto Alcântara Gomes. Departamento de Bioquímica. Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH). Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH). Rio de Janeiro, RJ, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH). Rio de Janeiro, RJ, Brasil.Universidade do Estado do Rio de Janeiro, Rio de Janeiro. Faculdade de Ciências Médicas. Departamento de Microbiologia, Imunologia e Parasitologia. Rio de Janeiro, RJ, Brasil.Fundação Estadual de Produção e Pesquisa em Saúde (FEPPS IPB-LACEN-RS)., Porto Alegre, RS, Brasil.Hospital Nossa Senhora da Conceição. Porto Alegre, RS, Brasil.Hospital Nossa Senhora da Conceição. Porto Alegre, RS, Brasil.Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Pesquisa em Infecção Hospitalar (LAPIH). Rio de Janeiro, RJ, Brasil