Study of the β)lactamases involved in broad)spectrum cephalosporin resistance among Pseudomonas aeruginosa clinical isolates

O presente estudo teve como objetivo determinar as β)lactamases envolvidas na resistência às cefalosporinas de amplo espectro em uma coleção de Pseudomonas aeruginosa isoladas de hemoculturas de pacientes internados em um complexo hospitalar universitário na cidade de São Paulo durante o ano de 2005. No primeiro trabalho descrevemos a produção de CTX)M)2 em um isolado que apresentava o estranho fenótipo de sensibilidade à ceftazidima e resistência à cefepima. O gene que codificava esta enzima estava localizado no cromossomo bacteriano, em um contexto genético idêntico àquele encontrado em plasmídeos que carregam blaCTX)M)2, que encontram)se disseminados entre enterobactérias. No segundo trabalho, descrevemos as β)lactamases envolvidas na resistência à ceftazidima em 43 isolados de P. aeruginosa da referida coleção, assim como o contexto e suporte no qual estavam inseridos os genes que codificavam as enzimas identificadas. Além disso, realizamos a tipagem molecular dos isolados estudados e pesquisamos os prontuários médicos dos pacientes infectados pelas amostras estudadas. A hiperprodução de AmpC foi considerada a única β)lactamase relacionada à resistência a ceftazidima em quatro isolados (9,3 por cento). Nove isolados (20,9 por cento) apresentaram a produção de β)lactamase de espectro estendido (ESBL), sendo que sete (16,3 por cento) apresentavam a enzima GES)1 e dois isolados (4,6 por cento) apresentavam a enzima CTX)M)2. A atividade hidrolítica contra os carbapenens foi detectada em trinta isolados (69,7 por cento), nos quais as enzimas IMP)1, GES) 5 e SPM)1 foram identificadas em 1, 2 e 27 isolados, respectivamente. Nenhum isolado apresentou produção simultânea de metalo)β)lactamase e ESBL. Os genes blaSPM)1 e blaCTX)M)2 estavam associados às seqüências de inserção ISCR4 e ISCR1, respectivamente, enquanto que os genes blaGES)1, blaGES)5 e blaIMP)1 estavam localizados em integrons da classe 1. Todos os genes codificadores de β)lactamases identificados apresentavam localização cromossomal. A tipagem molecular dos isolados estudados evidenciou a existência de sete genótipos distintos; porém, isolados produtores de uma mesma enzima freqüentemente apresentavam relação clonal. A análise dos prontuários médicos revelou que metade dos pacientes que apresentaram infecção da corrente sanguínea pelos isolados de P. aeruginosa estudados receberam terapia inadequada. Este estudo permitiu identificar a diversidade de genes codificadores de β)lactamases de amplo espectro hidrolítico que foram adquiridos por isolados clínicos de P. aeruginosa. Estes genes foram inseridos no DNA cromossomal destes isolados e, posteriormente, disseminados por transmissão cruzada..The aim of this study was to identify the β-lactamases involved in broad-spectrum cephalosporin resistance in P. aeruginosa isolates recovered from blood culture of patients hospitalized at a Brazilian teaching hospital located in São Paulo, between January and December 2005. In the first manuscript we have described the production of CTX-M-2 causing ceftazidime susceptibility and cefepime resistance in a P. aeruginosa clinical isolate. The CTX-M-2-encoding gene was located at the bacterial chromosome, and its vicinities were identical to those observed in blaCTX-M-2-carrying plasmids from enterobacterial isolates. In the second manuscript we have evaluated 43 ceftazidime-resistant P. aeruginosa isolates from the referred collection. We have described the β-lactamases involved in ceftazdidme resistance, as well as the genetic context and support of β-lactamaseencoding genes and we have performed molecular typing of isolates. The medical records of patients infected with isolates studied were also analyzed. AmpC overproduction was found to be the only β-lactamase-mediated mechanism responsible for ceftazidime resistance in four isolates (9.3%). Nine isolates (20.9%) produced an extended-spectrum β-lactamase (ESBL), either GES-1 (n = 7, 16.3%) or CTX-M-2 (n = 2, 4.6%). Carbapenemase activity was detected in 30 (69,7%) isolates, in which two (4.6%) produced the ESBL GES-5, a single isolate (2.3%) produced the metallo-β-lactamase (MBL) IMP-1; and 27 isolates produced the MBL SPM-1 (62.8%). None of the isolates coproduced both ESBL and MBL. Insertion sequence elements ISCR4 and ISCR1 were associated with blaSPM-1 and blaCTX-M-2 genes, respectively, whereas the blaGES and blaIMP-1 genes were part of class 1 integron structures. All β- lactamase-encoding genes identified were chromosomally located. Molecular typing showed the existence of seven distinct genotypes, in which producers of the same β- lactamase often belonged to a single clone. Clinical data revealed that half of the patients infected with isolates studied have received inadequate therapy, suggesting that empirical treatment protocols should be updated in the hospital studied. In this study we have identified a variety of broad-spectrum β-lactamase-encoding genes that have been initially acquired by P. aeruginosa clinical isolates, inserted on its chromosomal DNA and then spread between patients by cross-transmition.Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)BV UNIFESP: Teses e dissertaçõe

Plasmid-mediated quinolone resistance in Aeromonas allosaccharophila recovered from a Swiss lake

Objectives To search for plasmid-mediated qnr genes among waterborne environmental Aeromonas spp. recovered from Switzerland. Methods Isolates presenting MICs of nalidixic acid or ciprofloxacin ≥1 mg/L were screened for qnr genes by a multiplex PCR approach followed by sequencing. Plasmids were transferred by transformation, and further analysis of the genetic structures surrounding the qnrS2 gene was carried out by PCR and sequencing. Results A qnrS2 gene was identified from a single Aeromonas allosaccharophila isolate (Lugano lake, Lugano), as part of a mobile insertion cassette located on a broad host range IncU-type plasmid. This plasmid co-harboured a class 1 integron containing the aac(6′)-Ib-cr, blaOXA-1, catB3 and arr-3 gene cassettes. Conclusions These findings strengthen further the role of Aeromonas spp. as a reservoir of antimicrobial resistance determinants in the environmen

CRONOLOGIA DA EMERGÊNCIA GLOBAL DE CARBAPENEMASES EM BACILOS GRAM-NEGATIVOS

A resistência aos antimicrobianos, principalmente aos de última geração, como os carbapenemas, é um dos maiores problemas de saúde pública do século XXI, e nos últimos anos tem aumentado consideravelmente a morbi-letalidade em infecções associadas à assistência à saúde. O presente trabalho visa fazer um levantamento das carbapenemases já descritas em diversas espécies de bacilos gram-negativos com ênfase em suas primeiras descrições. As carbapenemases podem ser divididas em: serina carbapenemases da classe A de Ambler, metalo carbapenemases e serina carbapenemases da classe D de Ambler (oxacilinases). As enzimas da classe A, são capazes de causar resistência a todos os betalactâmicos, dentre as enzimas dessa classe, a mais disseminada é a KPC que inicialmente foi descrita em Klebsiella pneumoniae, entretanto, posteriormente já foi descrita em diversos outros gêneros bacterianos em todo o mundo; as metalo carbapenemases possuem ação contra todos os betalactâmicos, exceto os monobactâmicos, onde as enzimas IMP, VIM, e NDM são as mais disseminadas mundialmente; as serina carbapenemase da classe D, chamadas oxacilinases, são capazes de conferir resistência a todos os betalactâmicos, e são comumente descritas em enterobactérias, Acinetobacter spp., e Pseudomonas spp. Essas enzimas, que já foram descritas em diversos gêneros de bacilos gram-negativos têm impossibilitado o tratamento de diversas infecções pelos betalactâmicos e sua disseminação já tomou dimensões globais

The route of antimicrobial resistance from the hospital effluent to the environment: focus on the occurrence of KPC-producing Aeromonas spp. and Enterobacteriaceae in sewage

We investigated the antimicrobial resistance profile and the occurrence of Klebsiella pneumoniae carbapenemase (KPC)-producing Gram-negative rods in sewage samples obtained from a Brazilian teaching hospital and from the wastewater treatment plant (WWTP) that receives it for treatment. We identified multidrug-resistant bacteria as well as KPC-2-producing Aeromonas spp. and several Enterobacteriaceae species, including Kluyvera spp., in the hospital effluent and in different sites of the WWTP. Most isolates showed the bla(KPC-2) gene harbored on a transposon that was carried by conjugative plasmids. the presence of KPC production among Aeromonas spp., Kluyvera spp., and other Enterobacteriaceae indicates the adaptability of such isolates to aquatic environments, not only in the hospital effluent but also throughout the WWTP. Although secondary treatment seems to decrease the amount of KPC producers in sewage, multidrug-resistant isolates are continually disposed in the urban river. Thus, sewage treatment regulations are urgently needed to decelerate the evolution of antimicrobial resistance beyond hospitals. (C) 2013 Elsevier Inc. All rights reserved.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)Sanofi-AventisThermo FisherbioMerieuxUniversidade Federal de São Paulo, Dept Med, Div Infectol, Lab ALERTA, São Paulo, BrazilUniv Fed Rio de Janeiro, Inst Microbiol Paulo de Goes, Rio de Janeiro, BrazilUniversidade Federal de São Paulo, Dept Biofis, São Paulo, BrazilFundacao Parque Zool São Paulo, Lab Microbiol Aplicada, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Med, Div Infectol, Lab ALERTA, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Biofis, São Paulo, BrazilFAPESP: 2009/11051-0CNPq: 307816/2009-5CNPq: 302981/2011-0Web of Scienc

Staphylococcus saprophyticus Recovered from Humans, Food, and Recreational Waters in Rio de Janeiro, Brazil.

Staphylococcus saprophyticus is an important agent of urinary tract infection (UTI) in young women, but information about this pathogen in human microbiota and in common environment is lacking. The aim of this study was to characterize S. saprophyticus isolates from genitoanal microbiota of 621 pregnant women, 10 minas cheese packs, and five beaches in Rio de Janeiro city and compare PFGE profiles of these isolates with five UTI PFGE clusters described in this city. We investigated 65 S. saprophyticus isolates from microbiota, 13 from minas cheese, and 30 from beaches and 32 UTI isolates. Antimicrobial resistance was determined by disk diffusion, MIC by agar dilution, and PCR. Erythromycin-resistance genes erm(C), msr(A), msr(B), mph(C), and lin(A) were found in 93% of isolates. Trimethoprim-sulfamethoxazole resistance correlated with dfrG or dfrA genes. Three cefoxitin-resistant isolates carried the mecA gene. All isolates obtained from cheese were susceptible to all antimicrobial agents. Six of 10 pregnant women with >1 isolate had monoclonal colonization. Isolates from pregnant women shared 100% similarity with UTI PFGE cluster types A and E obtained almost 10 years previously, suggesting temporal persistence of S. saprophyticus. Antimicrobial resistance of beach isolates reflected the profiles of human isolates. Taken together, results indicate a shared source for human and environmental isolates

Pyrosequencing-based analysis reveals a novel capsular gene cluster in a KPC-producing Klebsiella pneumoniae clinical isolate identified in Brazil

Background: An important virulence factor of Klebsiella pneumoniae is the production of capsular polysaccharide (CPS), a thick mucus layer that allows for evasion of the host's defense and creates a barrier against antibacterial peptides. CPS production is driven mostly by the expression of genes located in a locus called cps, and the resulting structure is used to distinguish between different serotypes (K types). in this study, we report the unique genetic organization of the cps cluster from K. pneumoniae Kp13, a clinical isolate recovered during a large outbreak of nosocomial infections that occurred in a Brazilian teaching hospital.Results: A pyrosequencing-based approach showed that the cps region of Kp13 (cps(Kp13)) is 26.4 kbp in length and contains genes common, although not universal, to other strains, such as the rm/BADC operon that codes for L-rhamnose synthesis. cpsKp13 also presents some unique features, like the inversion of the wzy gene and a unique repertoire of glycosyltransferases. in silico comparison of cps(Kp13) RFLP pattern with 102 previously published cps PCR-RFLP patterns showed that cpsKp13 is distinct from the C patterns of all other K serotypes. Furthermore, in vitro serotyping showed only a weak reaction with capsular types K9 and K34. We confirm that K9 cps shares common genes with cps(Kp13) such as the rm/BADC operon, but lacks features like uge and Kp13-specific glycosyltransferases, while K34 capsules contain three of the five sugars that potentially form the Kp13 CPS.Conclusions: We report the first description of a cps cluster from a Brazilian clinical isolate of a KPC-producing K. pneumoniae. the gathered data including K-serotyping support that Kp13's K-antigen belongs to a novel capsular serotype. the CPS of Kp13 probably includes L-rhamnose and D-galacturonate in its structure, among other residues. Because genes involved in L-rhamnose biosynthesis are absent in humans, this pathway may represent potential targets for the development of antimicrobial agents. Studying the capsular serotypes of clinical isolates is of great importance for further development of vaccines and/or novel therapeutic agents. the distribution of K-types among multidrug-resistant isolates is unknown, but our findings may encourage scientists to perform K-antigen typing of KPC-producing strains worldwide.LNCC, Rio de Janeiro, BrazilUniv Fed Rio de Janeiro, Inst Microbiol Paulo de Goes, Rio de Janeiro, BrazilUniv Estadual Londrina, Dept Patol Clin Anal Clin & Toxicol, Londrina, BrazilUniversidade Federal de São Paulo, Lab ALERTA, Div Doencas Infecciosas, São Paulo, BrazilUniversidade Federal de São Paulo, Lab ALERTA, Div Doencas Infecciosas, São Paulo, BrazilWeb of Scienc