Evolution of resistance of Klebsiella pneumoniae in Londrina University Hospital from 2000 to 2011

The present study aimed to evaluate the evolution of antibiotic resistance in clinical isolates of Klebsiella pneumoniae in the period of 2000 to 2011, at the University Hospital of Londrina (HU-UEL). A retrospective analysis of 2,318 antimicrobial susceptibility tests of K. pneumoniae was performed from a database of the Clinical Laboratory of Microbiology of the University Hospital. In the period of 2000 to 2009, the main mechanism of resistance observed to ?-lactam antimicrobials was due to the production of ESBL ?-lactamase type (?-lactamase wide spectrum), which can be verified by the increased resistance of K. pneumoniae to 3rd generation cephalosporins and cefepime. However, the first strains of K. pneumoniae carbapenemase-producing appeared in 2009, compromising the efficacy of carbapenems. The rates of resistance to ertapenem ranged from 16%, in 2005, to 40% in 2011. Another class of committed antibiotics was the fluoroquinolones; for ciprofloxacin, resistance rates ranged from 13% to 62%, in 2001 and 2011, respectively. Aminoglycosides exhibited oscillations of resistance during the period studied, reaching, in 2011, values of 56% and 30% for gentamicin and amikacin, respectively. Meanwhile, trimethoprim/ sulfamethoxazole and piperacillin/tazobactam reached about 60%, in the same period. Therefore, knowing the antimicrobial resistance of K. pneumoniae strains is essential for proper treatment of patients and adoption of appropriate measures that aims infection control, and proper use of these drugs

Vancomycin-resistant Enterococcus spp.: clinical characteristics and risk factors

Vancomycin-resistant Enterococci (VRE) have emerged as a relevant multidrug-resistant pathogen and potencially lethal etiology of healthcare associated infections worldwide. This study intends to show the epidemiology and clinical characteristics of patients with VRE in a Hospital in South Brazil. A retrospective study was conducted from January 2005 to November 2007. A total of 122 VRE were identified in this period at the University Hospital of Londrina. All patients with VRE clinical culture have identified and their medical records have reviewed. The presence of colonization was evaluated through rectal swab cultures, and the species identification of clinical samples was performed by automated method MicroScan®. The mean age of patients was 54 years. Urinary tract (68.0%) and blood (23.8%) were the most frequent sites, and ICU was the largest sector of occurrence (49.2%). E. faecium was the predominant species, in 82.8% of cases. The risk factors presents were length of hospitalization (mean 58.2 days), previous use of antimicrobials and invasive procedure, such as use of central venous catheter, urinary catheter and mechanical ventilation. Control barriers and surveillance cultures are essential to prevent the VRE spread. The results obtained in this study contribute to a better understanding of the epidemiological dynamics of infections and the spread of VRE in University Hospital of Londrina