Enterococcus faecalis resistant to vancomycin and teicoplanin (VanA phenotype) isolated from a bone marrow transplanted patient in Brazil

We report for the first time in Brazil, a patient from whom an Enterococcus faecalis VanA phenotype was isolated. Glycopeptide resistance is not commonly observed in Enterococcus faecalis, so this finding is of great concern since this species is responsible for 90% of enterococcal infections in Brazil. The isolate was recovered from a surveillance rectal swab culture from a patient with acute lymphocytic leukemia (ALL). Identification to the species level was performed by conventional biochemical tests and Vitek GPI cards. Antimicrobial susceptibility testing was evaluated by use of broth microdilution and Etest (AB BIODISK, Solna, Sweden) methods. The isolate was identified as E. faecalis and was considered resistant to both vancomycin (MIC, > 256 mug/mL) and teicoplanin (MIC, 256 mug/mL). The isolate also showed high level resistance to gentamicin and streptomycin (MICs, > 1024 mug/mL), but was considered susceptible to ampicillin (MIC, 4 mug/mL). Although the frequency of enterococcal infections is very low in most Latin America countries, the finding of glycopeptide (VanA) resistance in E. faecalis increases concern about apreading antimicrobial resistance in this region.Federal University of São Paulo Infectious Disease Division Special Clinical Microbiology LaboratoryFederal University of São Paulo Infectious Disease Division Nosocomial Infection Control CommitteeUniversity of Iowa College of Medicine Department of PathologySão Paulo Hospital Central LaboratoryUNIFESP, Infectious Disease Division Special Clinical Microbiology LaboratoryUNIFESP, Infectious Disease Division Nosocomial Infection Control CommitteeSciEL

Avaliação da qualidade dos discos com antimicrobianos para testes de disco-difusão disponíveis comercialmente no Brasil

Introdução: O teste de suscetibilidade a antimicrobianos representa um dos testes de maior importância clínica realizados pelo laboratório de microbiologia. Devido ao grande número de antimicrobianos e à complexidade dos mecanismos de resistência desenvolvidos pelas bactérias, fica muito difícil hoje a detecção de problemas nos testes de suscetibilidade pela simples avaliação dos resultados obtidos. Sendo assim, é extremamente importante que haja uma avaliação constante da qualidade destes testes. Objetivo: O objetivo do presente estudo foi avaliar a qualidade dos discos de antimicrobianos comercializados no Brasil. Material e métodos: Foram avaliados discos de 18 antimicrobianos obtidos de cinco diferentes fontes comerciais, os quais foram testados frente a quatro cepas bacterianas oriundas da ATCC, pelo método de difusão em ágar, seguindo as recomendações do National Committee for Clinical Laboratory Standards (NCCLS). Cada teste foi repetido 20 vezes. Resultados: Nenhuma das marcas apresentou desempenho satisfatório para o uso na rotina de um laboratório de microbiologia. O melhor desempenho foi apresentado pela marca Cecon®, com 89,6% de concordância. A marca Sensifar® apresentou taxa de concordância geral semelhante (90,8%). A marca com o pior desempenho foi a Pimenta Abreu®, com apenas 58,6% de concordância. Conclusão: Os resultados do presente estudo indicam que os discos de antimicrobianos comercializados no Brasil são de baixa qualidade, possivelmente refletindo a falta de controle de qualidade na produção e/ou estocagem dos produtos antes da sua distribuição. Esses dados chamam a atenção para a necessidade de implantação de sistemas efetivos de fiscalização da comercialização desses produtos e de programas criteriosos de controle de qualidade por parte dos laboratórios que os utilizam

Enterococcus faecalis resistant to vancomycin and teicoplanin (VanA phenotype) isolated from a bone marrow transplanted patient in Brazil

We report for the first time in Brazil, a patient from whom an Enterococcus faecalis VanA phenotype was isolated. Glycopeptide resistance is not commonly observed in Enterococcus faecalis, so this finding is of great concern since this species is responsible for 90% of enterococcal infections in Brazil. The isolate was recovered from a surveillance rectal swab culture from a patient with acute lymphocytic leukemia (ALL). Identification to the species level was performed by conventional biochemical tests and Vitek GPI cards. Antimicrobial susceptibility testing was evaluated by use of broth microdilution and Etest (AB BIODISK, Solna, Sweden) methods. The isolate was identified as E. faecalis and was considered resistant to both vancomycin (MIC, > 256 mug/mL) and teicoplanin (MIC, 256 mug/mL). The isolate also showed high level resistance to gentamicin and streptomycin (MICs, > 1024 mug/mL), but was considered susceptible to ampicillin (MIC, 4 mug/mL). Although the frequency of enterococcal infections is very low in most Latin America countries, the finding of glycopeptide (VanA) resistance in E. faecalis increases concern about apreading antimicrobial resistance in this region