First national survey of antibiotic susceptibility of the Bacteroides fragilis group: emerging resistance to carbapenems in Argentina

The antibiotic susceptibility rates of 363 clinical Bacteroides fragilis group isolates collected from 17 centers in Argentina during the period from 2006 to 2009 were as follows: piperacillin-tazobactam, 99%; ampicillin-sulbactam, 92%; cefoxitin, 72%; tigecycline, 100%; moxifloxacin, 91%; and clindamycin, 52%. No metronidazole resistance was detected in these isolates during this time period. Resistance to imipenem, doripenem, and ertapenem was observed in 1.1%, 1.6%, and 2.3% of B. fragilis group strains, respectively. B. fragilis species showed a resistance profile of 1.5% to imipenem, 1.9% to doripenem, and 2.4% to ertapenem. This is the first report of carbapenem resistance in Argentina. The cfiA gene was present in 8 out of 23 isolates, all of them belonging to the B. fragilis species and displaying reduced susceptibility or resistance to carbapenems (MICs ≥ 4 μg/ml). Three out of eight cfiA-positive isolates were fully resistant to carbapenems, while 5 out of 8 isolates showed low-level resistance (MICs, 4 to 8 μg/ml). The inhibition by EDTA was a good predictor of the presence of metallo-β-lactamases in the fully resistant B. fragilis strains, but discrepant results were observed for low-level resistant isolates. B. fragilis was more susceptible to antimicrobial agents than other Bacteroides species. Bacteroides vulgatus species was the most resistant to ampicillin-sulbactam and piperacillin-tazobactam, and B. thetaiotaomicron/ovatus strains showed the highest level of resistance to carbapenems, with an unknown resistance mechanism. B. vulgatus and the uncommon non-Bacteroides fragilis species were the most resistant to moxifloxacin, showing an overall resistance rate of 15.1%.Fil: Fernández Canigia, Liliana. Asociación Argentina de Microbiología; ArgentinaFil: Litterio, Mirta. Asociación Argentina de Microbiología; ArgentinaFil: Legaria, María C.. Asociación Argentina de Microbiología; ArgentinaFil: Castello, Liliana. Asociación Argentina de Microbiología; ArgentinaFil: Predari, Silvia C.. Asociación Argentina de Microbiología; ArgentinaFil: Di Martino, Ana. Asociación Argentina de Microbiología; ArgentinaFil: Rossetti, Adelaida. Asociación Argentina de Microbiología; ArgentinaFil: Rollet, Raquel. Asociación Argentina de Microbiología; ArgentinaFil: Carloni, Graciela. Asociación Argentina de Microbiología; ArgentinaFil: Bianchini, Hebe. Asociación Argentina de Microbiología; ArgentinaFil: Cejas, Daniela. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Radice, Marcela Alejandra. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Gutkind, Gabriel Osvaldo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Anaerobe Surveillance Team

Changing Epidemiology of KPC Producing Klebsiella pneumoniae in Argentina: Emergence of Hypermucoviscous ST25 and High Risk Clone ST307

Objectives: To assess the epidemiological features of 76 Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae (KPC-Kp) isolates recovered from three hospitals in Buenos Aires, Argentina, during 2015–2017. Methods: Antimicrobial susceptibilities were determined according to CLSI Clinical and Laboratoy Standards guidelines. Molecular typing of KPC-Kp was performed by pulsed-field gel electrophoresis (PFGE)-Xbal and multilocus sequence typing. Plasmid encoded genes involved in carbapenem, fosfomycin and colistin resistance were detected by polymerase chain reaction (PCR) and sequencing. Also, mgrB inactivation was investigated in those colistin-resistant isolates. Genetic platforms involved in horizontal spread of blaKPC were investigated by PCR mapping. Results: Besides β-lactams, high resistance rates were observed for gentamycin, quinolones and trimethoprim-sulfamethoxazole. KPC-Kp sequence type (ST)258 corresponded to 26% of the isolates, while 42% corresponded to ST25. The other isolates were distributed in a diversity of lineages such as ST11 (10.5%), ST392 (10.5%), ST307, ST13, ST101, ST15 and ST551. blaKPC-2 was detected in 75 of 76 isolates, and one ST307 isolate harboured blaKPC-3. Tn4401 was identified as the genetic platform for blaKPC in epidemic lineages such as ST258 and ST307. However, in ST25 and ST392, which are usually not related to blaKPC, a blaKPC-bearing non-Tn4401 element was identified. Alterations in mgrB were detected in seven of 11 colistin-resistant isolates. Conclusions: Despite previous reports in Argentina, ST258 is no longer the absolute clone among KPC-Kp isolates. In the present study, dissemination of more virulent lineages such as the hypermucoviscous ST25 was detected. The emergence of the high-risk clone ST307 and occurrence of blaKPC-3 was noticed for the first time in this region.Fil: Cejas, Daniela. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Elena, Alan Xavier. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Nuñez, Daiana Guevara. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Platero, Priscila Sevillano. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentina. Universidad del Salvador; ArgentinaFil: De Paulis, Adriana. Universidad de Buenos Aires. Facultad de Medicina. Instituto de Investigaciones Médicas; ArgentinaFil: Magariños, Francisco. Gobierno de la Ciudad de Buenos Aires. Hospital de Agudos "D. F. Santojanni"; ArgentinaFil: Alfonso, Claudia. Gobierno de la Ciudad de Buenos Aires. Hospital de Agudos "D. F. Santojanni"; ArgentinaFil: Berger, María Alejandra. Hospital Aleman; ArgentinaFil: Fernández Canigia, Liliana. Hospital Aleman; ArgentinaFil: Gutkind, Gabriel Osvaldo. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Radice, Marcela Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica. Departamento de Microbiología, Inmunología y Biotecnología. Cátedra de Microbiología; Argentin

Mucoidy, Quorum Sensing, Mismatch Repair and Antibiotic Resistance in Pseudomonas aeruginosa from Cystic Fibrosis Chronic Airways Infections

Survival of Pseudomonas aeruginosa in cystic fibrosis (CF) chronic infections is based on a genetic adaptation process consisting of mutations in specific genes, which can produce advantageous phenotypic switches and ensure its persistence in the lung. Among these, mutations inactivating the regulators MucA (alginate biosynthesis), LasR (quorum sensing) and MexZ (multidrug-efflux pump MexXY) are the most frequently observed, with those inactivating the DNA mismatch repair system (MRS) being also highly prevalent in P. aeruginosa CF isolates, leading to hypermutator phenotypes that could contribute to this adaptive mutagenesis by virtue of an increased mutation rate. Here, we characterized the mutations found in the mucA, lasR, mexZ and MRS genes in P. aeruginosa isolates obtained from Argentinean CF patients, and analyzed the potential association of mucA, lasR and mexZ mutagenesis with MRS-deficiency and antibiotic resistance. Thus, 38 isolates from 26 chronically infected CF patients were characterized for their phenotypic traits, PFGE genotypic patterns, mutations in the mucA, lasR, mexZ, mutS and mutL gene coding sequences and antibiotic resistance profiles. The most frequently mutated gene was mexZ (79%), followed by mucA (63%) and lasR (39%) as well as a high prevalence (42%) of hypermutators being observed due to loss-of-function mutations in mutL (60%) followed by mutS (40%). Interestingly, mutational spectra were particular to each gene, suggesting that several mechanisms are responsible for mutations during chronic infection. However, no link could be established between hypermutability and mutagenesis in mucA, lasR and mexZ, indicating that MRS-deficiency was not involved in the acquisition of these mutations. Finally, although inactivation of mucA, lasR and mexZ has been previously shown to confer resistance/tolerance to antibiotics, only mutations in MRS genes could be related to an antibiotic resistance increase. These results help to unravel the mutational dynamics that lead to the adaptation of P. aeruginosa to the CF lung

Neumonía necrotizante adquirida en la comunidad causada por Staphylococcusaureus resistente a meticilina ST30-SCCmecIVc-spat019-LPV positivo en San Antoniode Areco, Argentin

Community-acquired methicillin-resistant Staphylococcus aureus is the first causeof skin and soft tissue infections, but can also produce severe diseases such as bacteremia,osteomyelitis and necrotizing pneumonia. Some S. aureus lineages have been described in casesof necrotizing pneumonia worldwide, usually in young, previously healthy patients. In this work,we describe a fatal case of necrotizing pneumonia due to community-acquired methicillin-resistant S. aureus clone ST30-SCCmecIVc-spat019-PVL positive in an immunocompetent adultpatientFil: Fernández, Silvina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Murzicato, Sofía. Hospital Municipal Emilio Zerboni; ArgentinaFil: Sandoval, Orlando. Hospital Municipal Emilio Zerboni; ArgentinaFil: Fernández Canigia, Liliana. Hospital Aleman; ArgentinaFil: Mollerach, Marta Eugenia. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; Argentin

Vaginal Microflora Associated With Bacterial Vaginosis in Nonpregnant Women: Reliability of Sialidase Detection

Objective: To determine the prevalence of Gardnerella vaginalis, anaerobic bacteria and Mycoplasma hominis in vaginal specimens of women with and without bacterial vaginosis (BV) as well as to determine the sensitivity and specificity of the direct sialidase assay of vaginal fluid as a rapid test for diagnosing this syndrome

Detection and genetic characterization of β-lactamases in Prevotella intermedia and Prevotella nigrescens isolated from oral cavity infections and peritonsillar abscesses

A prospective analysis on β-lactam resistance mechanisms and β-lactamase prevalence was conducted on Prevotella intermedia and Prevotella nigrescens recovered from patients with chronic periodontitis and peritonsillar abscesses. Both phenotypic and genotypic methods were performed to characterize the β-lactamases, their coding genes and their genetic contexts. Overall, β-lactamase production was observed in 64% (16/25) P.intermedia and 23.8% (5/21) P.nigrescens (p<0.01). Besides higher β-lactamase production rates were observed in P.intermedia (8/16) than in P.nigrescens (2/16) recovered from chronic periodontitis, almost all isolates from peritonsillar abscesses were producers (8/9 and 3/3, respectively). cfxA, but not cepA and cblA, was detected in those isolates, which were previously categorized as β-lactamase producers. CfxA producing isolates displayed higher β-lactam MICs than non-producers in both species. The most frequent allele was cfxA2, followed by cfxA3 and a new allelic variant named cfxA6. The analysis of the downstream flanking region in the three cfxA variants revealed the association with mobA of Tn. 4555, suggesting their localization in a mobilizable element. β-lactam resistance and cfxA carriage prevalence seems to be not only related to the bacterial species but also to the infection site.Fil: Fernández Canigia, Liliana. Hospital Alemán; ArgentinaFil: Cejas, Daniela. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; ArgentinaFil: Gutkind, Gabriel Osvaldo. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; ArgentinaFil: Radice, Marcela Alejandra. Consejo Nacional de Investigaciones Científicas y Técnicas. Oficina de Coordinación Administrativa Houssay; Argentina. Universidad de Buenos Aires. Facultad de Farmacia y Bioquímica; Argentin

Evaluation of three methods for in vitro detection of antifungal susceptibility of Candida species

Los métodos de referencia E. Def 7.1 y M27-A3, que detectan resistencia in vitro a los antifúngicos, son onerosos y muy laboriosos, por lo que su implementación en los laboratorios hospitalarios es limitada. Existen técnicas comerciales de simple realización, que permitirían obtener resultados comparables a los que se obtienen con los métodos estándares. Los objetivos de esta investigación fueron: a) comparar los resultados de concentración inhibitoria mínima obtenidos según el método de referencia E.Def 7.1 con los obtenidos mediante el empleo del equipo comercial ATB® Fungus 3 en un conjunto de 82 aislamientos clínicos de Candida spp. frente a los siguientes antifúngicos: anfotericina B, 5-fluorocitosina, fluconazol e itraconazol; b) comparar en ese mismo conjunto de aislamientos los resultados del estudio de sensibilidad al fluconazol por difusión en agar empleando tabletas Neo-SensitabsTM o discos Malbrán con los que se obtienen por el método de referencia. La concordancia general entre el método de referencia y el ATB® Fungus 3 fue del 90,2 %, mientras que la concordancia del método de referencia con los métodos por difusión con discos y con tabletas alcanzó el 96,3% y el 92,7 %, respectivamente. El ATB® Fungus 3 fue eficaz para determinar la sensibilidad a la anfotericina B y a la 5-fluorocitosina, pero se observaron discrepancias al evaluar la sensibilidad a los azoles. Los métodos por difusión resultaron útiles para determinar la sensibilidad al fluconazol; sin embargo, observamos 3 discrepancias muy mayores, 1 mayor y 2 menores con el método de difusión con tabletas, mientras que con los discos solo se produjeron 3 discrepancias menores.Reference methods E.Def 7.1 and M27-A3 detect in vitro resistance; however, they are expensive and very laborious. Thus, their actual use in hospital laboratories is limited. There are commercial techniques available, having easier accessibility and development, which would yield results comparable to those of the reference methods. The objectives of this study were: a) to compare the results of minimal inhibitory concentration of 82 Candida spp. clinic isolates according to reference method E.Def 7.1 and ATB® Fungus 3; b) to compare the results of fluconazole susceptibility testing by disk diffusion in agar with Neo-SensitabsTM tablets and Malbrán disks with those of the reference methods. Minimal inhibitory concentration for amphotericin B, 5-flucytosine, fluconazole and itraconazole was performed according to the E.Def 7.1 and the ATB Fungus 3 methods and diffusion was carried out with fluconazole disks and tablets. General concordance between the reference method and ATB Fungus 3 was 90.2 % and 96.3 and 92.7% for diffusion with disks and tablets. The ATB Fungus 3 method was effective to determine susceptibility against amphotericin B and 5-flucytosine; however, discrepancies were observed with azole drugs. Disk diffusion methods are useful to determine susceptibility to fluconazole; however, 3 very major, 1 major and 2 minor errors were observed with the tablets, whereas only 3 minor errors were observed with the disks.Fil: Maldonado, I. Sección Microbiología. Laboratorio Central, Hospital Alemán; Argentina.Fil: Fernández, Canigia, Liliana. Sección Microbiología. Laboratorio Central, Hospital Alemán; Argentina.Fil: Vivot, W. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Micología; Argentina.Fil: Domecq, P. Sección Microbiología. Laboratorio Central, Hospital Alemán; Argentina.Fil: Davel, Graciela Odelsia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Micología; Argentina.Fil: Córdoba, Susana. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Departamento de Micología; Argentina

New Mutation in 23S rRNA Gene Associated with High Level of Azithromycin Resistance in Neisseria gonorrhoeae▿

Fil: Galarza, Patricia G. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Centro Nacional de Referencia en Enfermedades de Transmisión Sexual; Argentina.Fil: Abad, Raquel. Instituto de Salud Carlos III. Reference Laboratory for Neisseria; España.Fil: Fernández, Canigia, Liliana. Hospital Alemán. Laboratorio de Microbiología; Argentina.Fil: Buscemi, Luis. Hospital Muñiz. Laboratorio de Microbiología; Argentina.Fil: Pagano, Irene. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Centro Nacional de Referencia en Enfermedades de Transmisión Sexual; Argentina.Fil: Oviedo, Claudia. ANLIS Dr.C.G.Malbrán. Instituto Nacional de Enfermedades Infecciosas. Centro Nacional de Referencia en Enfermedades de Transmisión Sexual; Argentina.Fil: Vazquez, Julio A. Instituto de Salud Carlos III. Reference Laboratory for Neisseria; España.Although azithromycin (1 g orally in a single dose) is not recommended for treating gonorrhea, it is still used in some parts of the world, and it is widely used either to treat Chlamydia trachomatis infections or, in combination withexpanded-spectrum cephalosporins, to treat simultaneous infections with both chlamydia and gonococci (7). A higher dose of 2 g of new formulations of azithromycin with a lower incidence of gastrointestinal intolerance may be more effective (9), but recent descriptions of gonococcal strains showing azithromycin resistance or high-level azithromycin resistance (AzHLR; MIC of azithromycin, 256 mg/liter) would make that treatment untenable if strains of this type were to emerge elsewhere and spread (1, 2, 6)