The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases, 2004
Staphylococcus aureus is a pathogen that has been associated with nosocomial infections since the... more Staphylococcus aureus is a pathogen that has been associated with nosocomial infections since the preantibiotic era. Since the introduction of antibiotics in medical practice in the 1940 s, methicillin-resistant S. aureus (MRSA) strains have been emerging in various parts of the world. In view of the important role of the phagocytic system in the defense against this bacteria, we decided to study phagocytosis by neutrophils and monocytes of an epidemic MRSA strain in São Paulo, Brazil, in comparison with methicillin-sensitive strains. Complement system opsonins are fundamental for efficient ingestion of the resistant and sensitive strains by both types of phagocytes. We found no association of the opsonic requirement of the MRSA strain with the multiresistance phenotype. On the other hand, the MRSA strain was found to be more resistant to the effector mechanisms of neutrophils than both sensitive strains when opsonized with fresh serum, despite the phagocytosis results. This fact su...
Graefes Archive for Clinical and Experimental Ophthalmology, 2006
Purpose To report the use of pulsed-field gel electrophoresis (PFGE) in the investigation of the... more Purpose To report the use of pulsed-field gel electrophoresis (PFGE) in the investigation of the origin of infectious keratitis. Methods A 19-year-old girl presented with infectious keratitis in the left eye. She was a soft contact lens wearer, and was noncompliant with the proper cleaning methods proposed by the manufacturer. Microbiological assessment was performed by means of culture and PFGE. Results The patient
... O Staphylococcus epidermidis é a espécie mais fre-qüente das BHs por ECN7-9. Os ECN estão ass... more ... O Staphylococcus epidermidis é a espécie mais fre-qüente das BHs por ECN7-9. Os ECN estão associados às BHs em diferentes situações: septicemias neo-natais10,11, pacientes imunodeprimidos12,13, uso de nutrição parenteral total14,15, pacientes pós-cirúrgi-cos16-18 ...
Diagnostic Microbiology and Infectious Disease, 2015
Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their ... more Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their impact over settings of different complexity are scarce. We performed a study aimed at identifying determinants of VRE emergence and spread in a public hospital consortium (comprising 2 hospitals, with 318 and 57 beds) in inner Brazil. Molecular typing and case-control studies (addressing predictors of acquisition or clonality) were performed. Among 122 authocthonous isolates, 106 were Enterococcus faecium (22 clones), and 16, Enterococcus faecalis (5 clones). Incidence was greater in the small-sized hospital, and a previous admission to this hospital was associated with greater risk of VRE colonization or infection during admission to the larger one. Overall risk factors included comorbidities, procedures, and antimicrobials (piperacillin-tazobactam, cefepime, and imipenem). Risk factors varied among different hospitals, species, and clones. Our findings demonstrate that VRE can spread within low-complexity facilities and from these to larger hospitals.
Nephrology nursing journal : journal of the American Nephrology Nurses' Association
This study evaluated the prevalence and risk factors for endocarditis in patients undergoing hemo... more This study evaluated the prevalence and risk factors for endocarditis in patients undergoing hemodialysis with central venous catheter (CVC) and to identify the microorganisms isolated from the bloodstream. This cohort study followed 94 patients with end stage renal disease (ESRD) who developed bacteremia after the insertion of a CVC for dialysis in the hospital São Paulo, UNIFESP, Brazil. They were divided into two groups: patients with endocarditis (E+) and patients without (E-). The prevalence of endocarditis was 29%. Among risk factors, the time of hospitalization and residence of the catheter were significantly higher (p < 0.001) in group E+. The mortality rate was 15%, and lethality of endocarditis was 55%. Of the 38 microorganisms isolated in group E+, 20 were S. aureus and 45% of those were MRSA. Group E+ with MRSA presented 100% mortality. High mortality and lethality in the E+ group was observed, and of the microorganisms isolated, MRSA was the most lethal. This article...
Resolution of Mycobacterium avium complex bacteremia following highly active antiretroviral thera... more Resolution of Mycobacterium avium complex bacteremia following highly active antiretroviral therapy. DJ Hadad, DS Lewi, ACC Pignatari, MC Martins, W Vitti Jr, RD Arbeit Clinical Infectious Diseases 26:33, 758-9, 3/1998. A ...
Revista Do Instituto De Medicina Tropical De Sao Paulo, 1996
Apart from cryptococcosis and histoplasmosis, which are mycoses contained by T cell-mediated mech... more Apart from cryptococcosis and histoplasmosis, which are mycoses contained by T cell-mediated mechanisms of host defense, fungemia is rarely found in AIDS patients. The frequency of fungemia due to Candida spp. has been reported to be as low as 1%. We report a non-neutropenic AIDS patient who presented a candidemia which probably arose from her gastrointestinal tract.
The alarming emergence and spread of antimicrobial resistance among common bacteria threatens the... more The alarming emergence and spread of antimicrobial resistance among common bacteria threatens the effectiveness of therapy for many infections. Surveillance of antimicrobial resistance is essential to identify the major problems and guide adequate control measures. Several resistance surveillance programs have been implemented in North America and Europe in the last decade; however, very few programs have assessed antimicrobial resistance in Latin American countries. The SENTRY Antimicrobial Surveillance Program was initiated in 1997 and represents the most comprehensive surveillance program in place at the present time worldwide. The SENTRY Program collects consecutive isolates from clinically documented infections in more than 80 medical centers worldwide (10 in Latin America). The isolates are collected according to the type of infection (objectives) and susceptibility tested in a central microbiology laboratory by reference broth microdilution methods according to NCCLS guidelines. The Program also incorporated molecular typing (ribotyping and PFGE) and resistance mechanism analysis of selected isolates. In this report we present a very broad analysis of the data generated by testing almost 20,000 bacterial isolates against more than 30 antimicrobial agents. The susceptibility results (MIC 50 , MIC 90 and % susceptible) are presented in 11 tables according to the organism and site of infection. The data from Brazil, as well as the data from isolates collected in 2001, are analyzed separately. This report allows the evaluation of the activities numerous antimicrobial agents against clinical isolates collected in Latin American countries.
We describe herein the microbiological characterization of what was, to our knowledge, the first ... more We describe herein the microbiological characterization of what was, to our knowledge, the first Cfr-producing MSSA strain (048-45547X) causing a fatal pneumonia in an oncology patient in Sã o Paulo, Brazil. The index Staphylococcus aureus 048-45547X was recovered from blood cultures and species identification and susceptibility testing were performed locally using the BD Phoenix TM Automated Microbiology System. S. aureus was submitted to a central monitoring laboratory (JMI Laboratories, North Liberty, IA, USA) as part of the 2012 SENTRY Antimicrobial Surveillance Program, where identification was confirmed by MALDI-TOF MS (Bruker Daltonics, Bremen, Germany). The index strain was further tested for susceptibility by CLSI broth microdilution (BMD) and also interpreted by the CLSI criteria, when available. 1 Strain 048-45547X was susceptible to oxacillin (MIC, 0.25 -0.5 mg/L) and linezolid (MIC, 2 -4 mg/L) by the BD system and BMD as shown in . The 048-45547X strain was screened for the presence of cfr, erm(A -C), mecA, mecC and mutations in the 23S rRNA and ribosomal proteins (L3 and L4). The cfr and erm(B) genes were detected in the 048-45547X strain. No mutations were observed in the domain V region of the 23S rRNA gene or L3, but a V142I amino acid substitution was detected in L4. The mecA and mecC genes were not detected, as expected.
Inappropriate antibiotic use in normally self-limiting acute respiratory tract infections (RTIs),... more Inappropriate antibiotic use in normally self-limiting acute respiratory tract infections (RTIs), such as sore throat and the common cold, is a global problem and an important factor for increasing levels of antibiotic resistance. A new group of international experts-the Global Respiratory Infection Partnership (GRIP)-is committed to addressing
Endoftalmites bacterianas com culturas positivas: uma revisão de 6 anos Descritores: Infecções oc... more Endoftalmites bacterianas com culturas positivas: uma revisão de 6 anos Descritores: Infecções oculares bacterianas; Endoftalmite/etiologia; Endoftalmite/cirurgia; Humor aquoso/microbiologia; Resistência microbiana a medicamentos; Testes de sensibilidade microbiana Objetivo: Determinar a distribuição dos microrganismos isolados de pacientes com endoftalmite bacteriana e sua sensibilidade a antimicrobianos. Métodos: Foram analisados retrospectivamente os dados clínicos e microbiológicos dos pacientes com hipótese diagnóstica de endoftalmite e cultura bacteriana positiva, atendidos no Departamento de Oftalmologia da UNIFESP de 1º de janeiro de 2000 a 31 de dezembro de 2005. Resultados: De 451 pacientes, 153 (33,9%) apresentaram cultura bacteriana positiva. Foram isolados 155 microrganismos, sendo 79,35% gram-positivos e 20,65% gram-negativos. Os Staphylococcus coagulase-negativos (SCoN) (41,94%) foram os mais freqüentemente isolados. A sensibilidade aos antimicrobianos entre os gram-negativos foi: amicacina 87,10%, tobramicina 80,65%, ciprofloxacina 96,67%, levofloxacina, gatifloxacina e moxifloxacina 100%, ceftazidima 85%, e gentamicina 80,65%. A sensibilidade à vancomicina entre os gram-positivos foi de 100%. S. aureus e SCoN apresentaram 83,33% de sensibilidade à oxacilina, 89,61% à ciprofloxacina e 100% à gatifloxacina e moxifloxacina. A forma de aquisição predominante foi a pós-operatória (60,65%). Conclusão: Observamos baixa sensibilidade da cultura para o diagnóstico etiológico das endoftalmites. Uma terapia antimicrobiana ou profilaxia empírica deve ser ativa contra os microrganismos gram-positivos, particularmente contra estafilococos. Estudos de vigilância de resistência bacteriana são importantes para adequação desses esquemas. RESUMO INTRODUÇÃO
We evaluated the antimicrobial resistance patterns and molecular characteristics of 11 extraintes... more We evaluated the antimicrobial resistance patterns and molecular characteristics of 11 extraintestinal Escherichia coli strains and 1 intestinal E. coli from human infections collected in Brazil. Two E. coli strains were nonsusceptible to extended spectrum cephalosporins (cefotaxime, ceftazidime, and cefepime); one isolated from diarrhea carried bla CTX-M-14 and bla TEM-1 , whereas the other, isolated from tracheal secretion, carried bla CTX-M-15 and bla OXA-1 . Five E. coli strains showed resistance to quinolones. Integrase associated with class 1 integron (intl1) was detected in 8 of the 12 E. coli strains belonging to various serotypes and this gene was carried by plasmids showing similar size. Pulsed-field gel electrophoresis showed that E. coli strains were genetically diverse, and phylogenetic grouping showed that the E. coli strains belonged to groups A, B2, and D (33.3%), respectively. This is the first report of E. coli isolates carrying bla CTX-M-14 and bla CTX-M-15 in Brazil. The presence of mobile elements containing antimicrobial resistance genes is worrisome since it could promote the dissemination of resistance and lead to the acquisition of resistance to other antimicrobials agents such as the carbapenems.
Revista do Instituto de Medicina Tropical de São Paulo, 1995
Yeasts of the genus Candida have been recognized as important microorganisms responsible for noso... more Yeasts of the genus Candida have been recognized as important microorganisms responsible for nosocomial fungemia. Six blood-stream and two intravenous central catheter C. albicans strains were isolated from eight patients and studied by electrophoretic karyotyping of chromosomal DNA by pulsed-field gel electrophoresis. Seven chromosomal DNA profiles were identified. Two patients showed isolates with the same profile, suggesting nosocomial transmission. Karyotyping of C. albicans revealed an excellent discriminatory power among the isolates and may therefore be useful in the study of nosocomial candidemia.
This study evaluated the breath CH4 excretion and concentration of M. smithii in intestinal micro... more This study evaluated the breath CH4 excretion and concentration of M. smithii in intestinal microbiota of schoolchildren from 2 slums. One hundred and eleven children from a slum near a sanitary landfill, 35 children of a slum located away from the sanitary landfill, and 32 children from a high socioeconomic level school were included in the study. Real-time PCR was performed to quantify the M. smithii nifH gene and it was present in the microbiota of all the participating children, with higher (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) concentrations in those who lived in the slum near the landfill (3.16 × 10(7) CFU/g of feces), comparing with the children from the slum away from the landfill (2.05 × 10(6) CFU/g of feces) and those from the high socioeconomic level group (3.93 × 10(5) CFU/g of feces). The prevalence of children who present breath methane was 53% in the slum near the landfill, 31% in the slum further away from the landfill and, 22% in the high socioeconomic level group. To live near a landfill is associated with higher concentrations of M. smithii in intestinal microbiota, comparing with those who live away from the landfill, regardless of their socioeconomics conditions.
SUMMARY - Traditionally the Laboratory of Clinical Microbiology uses the susceptibility test to t... more SUMMARY - Traditionally the Laboratory of Clinical Microbiology uses the susceptibility test to the novobiocin to distinguish the cli- nically significant species from SCoN, between them the Staphylococcus saprophyticus. Due to the increase of these microorganisms in the infections related to the health assistance, this study had as objective to relate two cases of bacteremia for SCoN novobiocin re- sistant
Revista Do Instituto De Medicina Tropical De Sao Paulo, 2003
Background: The integrin CD103 is preferentially expressed on intraepithelial T lymphocytes, and ... more Background: The integrin CD103 is preferentially expressed on intraepithelial T lymphocytes, and cells expressing this integrin may play a regulatory role in the microenvironment of the epithelial cell layer. Methods: The relative number of CD103 ؉ /CD4 ؉ T cells in the bronchoalveolar lavage was significantly elevated in all patients diagnosed with interstitial lung diseases compared with patients with other non-fibrotic disorders of the lung. Results: Analysis by flow cytometry showed that the CD103 ؉ and the CD103 ؊ subpopulations were memory T cells based on the high expression of CD45RO ؉ . However, the CD103 ؉ /CD4 ؉ T cells were CD25 low , CD27 ؊ , CD28 low , and CD62L ؊ , whereas the CD103 ؊ /CD4 ؉ T cells expressed CD25 and CD62L and were CD27 high and CD28 high . In addition, the CD103 ؉ /CD4 ؉ T cells expressed significantly higher quantities of VLA-1 and CD101 than did CD103 ؊ /CD4 ؉ T cells. Reverse transcriptase polymerase chain reaction analysis of purified CD103 ؉ and CD103 ؊ CD4 ؉ T cells showed production of tumor necrosis factor (TNF) ␣-R-1 (p55), TNF-␣-R-2 (p75), interferon ␥, interleukin-10, and TNF-␣ mRNA in both subpopulations. No interleukin-4 mRNA was detected in either subpopulation. Conclusions: CD103 ؉ /CD4 ؉ T cells represent a T-helper 1-like subpopulation in human lungs with a distinct effector phenotype. Despite the lack of CD27 and the low CD25 and CD28 expression, these cells show a high degree of activation. These results suggest that CD103 expressing CD4 T cells in the lung are continuously activated, long-living cells. Cytometry Part B (Clin. Cytometry) 54B:19 -27, 2003.
The reduction in time required to identify vancomycin-resistant enterococci (VRE) has gained incr... more The reduction in time required to identify vancomycin-resistant enterococci (VRE) has gained increased importance during hospital outbreaks. In the present study, we implemented a laboratory protocol to speed up the VRE screening from rectal samples. The protocol combines a medium for selective VRE isolation (VREBAC ® , Probac, São Paulo) and a multiplex PCR for detection and identification of vanA and vanB resistance genes. The screening performance was analyzed in 114 specimens collected from four intensive care units. The swabs were collected at two periods: (1) during a VRE outbreak (February 2006, n=83 patients) and (2) at the post-outbreak period, after adoption of infection control measures . Forty-one/83 VRE (49.4%) and 3/31(9.7%) VRE were found at the first and second period, respectively. All isolates harbored the vanA gene. In both periods, detection of the gene vanA parallels to the minimum inhibitory concentration values of >256 µ µ µ µ µg/mL and >48 µ µ µ µ µg/mL for vancomycin and teicoplanin, respectively. Multiplex PCR and conventional methods agreed in 90.2% for enterococci identification. Besides this accuracy, we also found a remarkable reduction in time to obtain results. Detection of enterococcal species and identification of vancomycin resistance genes were ready in 29.5 hours, in comparison to 72 hours needed by the conventional methods. In conclusion, our protocol identified properly and rapidly enterococci species and vancomycin-resistance genes. The results strongly encourage its adoption by microbiology laboratories for VRE screenning in rectal samples.
The Brazilian journal of infectious diseases : an official publication of the Brazilian Society of Infectious Diseases, 2004
Staphylococcus aureus is a pathogen that has been associated with nosocomial infections since the... more Staphylococcus aureus is a pathogen that has been associated with nosocomial infections since the preantibiotic era. Since the introduction of antibiotics in medical practice in the 1940 s, methicillin-resistant S. aureus (MRSA) strains have been emerging in various parts of the world. In view of the important role of the phagocytic system in the defense against this bacteria, we decided to study phagocytosis by neutrophils and monocytes of an epidemic MRSA strain in São Paulo, Brazil, in comparison with methicillin-sensitive strains. Complement system opsonins are fundamental for efficient ingestion of the resistant and sensitive strains by both types of phagocytes. We found no association of the opsonic requirement of the MRSA strain with the multiresistance phenotype. On the other hand, the MRSA strain was found to be more resistant to the effector mechanisms of neutrophils than both sensitive strains when opsonized with fresh serum, despite the phagocytosis results. This fact su...
Graefes Archive for Clinical and Experimental Ophthalmology, 2006
Purpose To report the use of pulsed-field gel electrophoresis (PFGE) in the investigation of the... more Purpose To report the use of pulsed-field gel electrophoresis (PFGE) in the investigation of the origin of infectious keratitis. Methods A 19-year-old girl presented with infectious keratitis in the left eye. She was a soft contact lens wearer, and was noncompliant with the proper cleaning methods proposed by the manufacturer. Microbiological assessment was performed by means of culture and PFGE. Results The patient
... O Staphylococcus epidermidis é a espécie mais fre-qüente das BHs por ECN7-9. Os ECN estão ass... more ... O Staphylococcus epidermidis é a espécie mais fre-qüente das BHs por ECN7-9. Os ECN estão associados às BHs em diferentes situações: septicemias neo-natais10,11, pacientes imunodeprimidos12,13, uso de nutrição parenteral total14,15, pacientes pós-cirúrgi-cos16-18 ...
Diagnostic Microbiology and Infectious Disease, 2015
Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their ... more Although vancomycin-resistant enterococci (VRE) are reported in Brazil since 1996, data on their impact over settings of different complexity are scarce. We performed a study aimed at identifying determinants of VRE emergence and spread in a public hospital consortium (comprising 2 hospitals, with 318 and 57 beds) in inner Brazil. Molecular typing and case-control studies (addressing predictors of acquisition or clonality) were performed. Among 122 authocthonous isolates, 106 were Enterococcus faecium (22 clones), and 16, Enterococcus faecalis (5 clones). Incidence was greater in the small-sized hospital, and a previous admission to this hospital was associated with greater risk of VRE colonization or infection during admission to the larger one. Overall risk factors included comorbidities, procedures, and antimicrobials (piperacillin-tazobactam, cefepime, and imipenem). Risk factors varied among different hospitals, species, and clones. Our findings demonstrate that VRE can spread within low-complexity facilities and from these to larger hospitals.
Nephrology nursing journal : journal of the American Nephrology Nurses' Association
This study evaluated the prevalence and risk factors for endocarditis in patients undergoing hemo... more This study evaluated the prevalence and risk factors for endocarditis in patients undergoing hemodialysis with central venous catheter (CVC) and to identify the microorganisms isolated from the bloodstream. This cohort study followed 94 patients with end stage renal disease (ESRD) who developed bacteremia after the insertion of a CVC for dialysis in the hospital São Paulo, UNIFESP, Brazil. They were divided into two groups: patients with endocarditis (E+) and patients without (E-). The prevalence of endocarditis was 29%. Among risk factors, the time of hospitalization and residence of the catheter were significantly higher (p < 0.001) in group E+. The mortality rate was 15%, and lethality of endocarditis was 55%. Of the 38 microorganisms isolated in group E+, 20 were S. aureus and 45% of those were MRSA. Group E+ with MRSA presented 100% mortality. High mortality and lethality in the E+ group was observed, and of the microorganisms isolated, MRSA was the most lethal. This article...
Resolution of Mycobacterium avium complex bacteremia following highly active antiretroviral thera... more Resolution of Mycobacterium avium complex bacteremia following highly active antiretroviral therapy. DJ Hadad, DS Lewi, ACC Pignatari, MC Martins, W Vitti Jr, RD Arbeit Clinical Infectious Diseases 26:33, 758-9, 3/1998. A ...
Revista Do Instituto De Medicina Tropical De Sao Paulo, 1996
Apart from cryptococcosis and histoplasmosis, which are mycoses contained by T cell-mediated mech... more Apart from cryptococcosis and histoplasmosis, which are mycoses contained by T cell-mediated mechanisms of host defense, fungemia is rarely found in AIDS patients. The frequency of fungemia due to Candida spp. has been reported to be as low as 1%. We report a non-neutropenic AIDS patient who presented a candidemia which probably arose from her gastrointestinal tract.
The alarming emergence and spread of antimicrobial resistance among common bacteria threatens the... more The alarming emergence and spread of antimicrobial resistance among common bacteria threatens the effectiveness of therapy for many infections. Surveillance of antimicrobial resistance is essential to identify the major problems and guide adequate control measures. Several resistance surveillance programs have been implemented in North America and Europe in the last decade; however, very few programs have assessed antimicrobial resistance in Latin American countries. The SENTRY Antimicrobial Surveillance Program was initiated in 1997 and represents the most comprehensive surveillance program in place at the present time worldwide. The SENTRY Program collects consecutive isolates from clinically documented infections in more than 80 medical centers worldwide (10 in Latin America). The isolates are collected according to the type of infection (objectives) and susceptibility tested in a central microbiology laboratory by reference broth microdilution methods according to NCCLS guidelines. The Program also incorporated molecular typing (ribotyping and PFGE) and resistance mechanism analysis of selected isolates. In this report we present a very broad analysis of the data generated by testing almost 20,000 bacterial isolates against more than 30 antimicrobial agents. The susceptibility results (MIC 50 , MIC 90 and % susceptible) are presented in 11 tables according to the organism and site of infection. The data from Brazil, as well as the data from isolates collected in 2001, are analyzed separately. This report allows the evaluation of the activities numerous antimicrobial agents against clinical isolates collected in Latin American countries.
We describe herein the microbiological characterization of what was, to our knowledge, the first ... more We describe herein the microbiological characterization of what was, to our knowledge, the first Cfr-producing MSSA strain (048-45547X) causing a fatal pneumonia in an oncology patient in Sã o Paulo, Brazil. The index Staphylococcus aureus 048-45547X was recovered from blood cultures and species identification and susceptibility testing were performed locally using the BD Phoenix TM Automated Microbiology System. S. aureus was submitted to a central monitoring laboratory (JMI Laboratories, North Liberty, IA, USA) as part of the 2012 SENTRY Antimicrobial Surveillance Program, where identification was confirmed by MALDI-TOF MS (Bruker Daltonics, Bremen, Germany). The index strain was further tested for susceptibility by CLSI broth microdilution (BMD) and also interpreted by the CLSI criteria, when available. 1 Strain 048-45547X was susceptible to oxacillin (MIC, 0.25 -0.5 mg/L) and linezolid (MIC, 2 -4 mg/L) by the BD system and BMD as shown in . The 048-45547X strain was screened for the presence of cfr, erm(A -C), mecA, mecC and mutations in the 23S rRNA and ribosomal proteins (L3 and L4). The cfr and erm(B) genes were detected in the 048-45547X strain. No mutations were observed in the domain V region of the 23S rRNA gene or L3, but a V142I amino acid substitution was detected in L4. The mecA and mecC genes were not detected, as expected.
Inappropriate antibiotic use in normally self-limiting acute respiratory tract infections (RTIs),... more Inappropriate antibiotic use in normally self-limiting acute respiratory tract infections (RTIs), such as sore throat and the common cold, is a global problem and an important factor for increasing levels of antibiotic resistance. A new group of international experts-the Global Respiratory Infection Partnership (GRIP)-is committed to addressing
Endoftalmites bacterianas com culturas positivas: uma revisão de 6 anos Descritores: Infecções oc... more Endoftalmites bacterianas com culturas positivas: uma revisão de 6 anos Descritores: Infecções oculares bacterianas; Endoftalmite/etiologia; Endoftalmite/cirurgia; Humor aquoso/microbiologia; Resistência microbiana a medicamentos; Testes de sensibilidade microbiana Objetivo: Determinar a distribuição dos microrganismos isolados de pacientes com endoftalmite bacteriana e sua sensibilidade a antimicrobianos. Métodos: Foram analisados retrospectivamente os dados clínicos e microbiológicos dos pacientes com hipótese diagnóstica de endoftalmite e cultura bacteriana positiva, atendidos no Departamento de Oftalmologia da UNIFESP de 1º de janeiro de 2000 a 31 de dezembro de 2005. Resultados: De 451 pacientes, 153 (33,9%) apresentaram cultura bacteriana positiva. Foram isolados 155 microrganismos, sendo 79,35% gram-positivos e 20,65% gram-negativos. Os Staphylococcus coagulase-negativos (SCoN) (41,94%) foram os mais freqüentemente isolados. A sensibilidade aos antimicrobianos entre os gram-negativos foi: amicacina 87,10%, tobramicina 80,65%, ciprofloxacina 96,67%, levofloxacina, gatifloxacina e moxifloxacina 100%, ceftazidima 85%, e gentamicina 80,65%. A sensibilidade à vancomicina entre os gram-positivos foi de 100%. S. aureus e SCoN apresentaram 83,33% de sensibilidade à oxacilina, 89,61% à ciprofloxacina e 100% à gatifloxacina e moxifloxacina. A forma de aquisição predominante foi a pós-operatória (60,65%). Conclusão: Observamos baixa sensibilidade da cultura para o diagnóstico etiológico das endoftalmites. Uma terapia antimicrobiana ou profilaxia empírica deve ser ativa contra os microrganismos gram-positivos, particularmente contra estafilococos. Estudos de vigilância de resistência bacteriana são importantes para adequação desses esquemas. RESUMO INTRODUÇÃO
We evaluated the antimicrobial resistance patterns and molecular characteristics of 11 extraintes... more We evaluated the antimicrobial resistance patterns and molecular characteristics of 11 extraintestinal Escherichia coli strains and 1 intestinal E. coli from human infections collected in Brazil. Two E. coli strains were nonsusceptible to extended spectrum cephalosporins (cefotaxime, ceftazidime, and cefepime); one isolated from diarrhea carried bla CTX-M-14 and bla TEM-1 , whereas the other, isolated from tracheal secretion, carried bla CTX-M-15 and bla OXA-1 . Five E. coli strains showed resistance to quinolones. Integrase associated with class 1 integron (intl1) was detected in 8 of the 12 E. coli strains belonging to various serotypes and this gene was carried by plasmids showing similar size. Pulsed-field gel electrophoresis showed that E. coli strains were genetically diverse, and phylogenetic grouping showed that the E. coli strains belonged to groups A, B2, and D (33.3%), respectively. This is the first report of E. coli isolates carrying bla CTX-M-14 and bla CTX-M-15 in Brazil. The presence of mobile elements containing antimicrobial resistance genes is worrisome since it could promote the dissemination of resistance and lead to the acquisition of resistance to other antimicrobials agents such as the carbapenems.
Revista do Instituto de Medicina Tropical de São Paulo, 1995
Yeasts of the genus Candida have been recognized as important microorganisms responsible for noso... more Yeasts of the genus Candida have been recognized as important microorganisms responsible for nosocomial fungemia. Six blood-stream and two intravenous central catheter C. albicans strains were isolated from eight patients and studied by electrophoretic karyotyping of chromosomal DNA by pulsed-field gel electrophoresis. Seven chromosomal DNA profiles were identified. Two patients showed isolates with the same profile, suggesting nosocomial transmission. Karyotyping of C. albicans revealed an excellent discriminatory power among the isolates and may therefore be useful in the study of nosocomial candidemia.
This study evaluated the breath CH4 excretion and concentration of M. smithii in intestinal micro... more This study evaluated the breath CH4 excretion and concentration of M. smithii in intestinal microbiota of schoolchildren from 2 slums. One hundred and eleven children from a slum near a sanitary landfill, 35 children of a slum located away from the sanitary landfill, and 32 children from a high socioeconomic level school were included in the study. Real-time PCR was performed to quantify the M. smithii nifH gene and it was present in the microbiota of all the participating children, with higher (P &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05) concentrations in those who lived in the slum near the landfill (3.16 × 10(7) CFU/g of feces), comparing with the children from the slum away from the landfill (2.05 × 10(6) CFU/g of feces) and those from the high socioeconomic level group (3.93 × 10(5) CFU/g of feces). The prevalence of children who present breath methane was 53% in the slum near the landfill, 31% in the slum further away from the landfill and, 22% in the high socioeconomic level group. To live near a landfill is associated with higher concentrations of M. smithii in intestinal microbiota, comparing with those who live away from the landfill, regardless of their socioeconomics conditions.
SUMMARY - Traditionally the Laboratory of Clinical Microbiology uses the susceptibility test to t... more SUMMARY - Traditionally the Laboratory of Clinical Microbiology uses the susceptibility test to the novobiocin to distinguish the cli- nically significant species from SCoN, between them the Staphylococcus saprophyticus. Due to the increase of these microorganisms in the infections related to the health assistance, this study had as objective to relate two cases of bacteremia for SCoN novobiocin re- sistant
Revista Do Instituto De Medicina Tropical De Sao Paulo, 2003
Background: The integrin CD103 is preferentially expressed on intraepithelial T lymphocytes, and ... more Background: The integrin CD103 is preferentially expressed on intraepithelial T lymphocytes, and cells expressing this integrin may play a regulatory role in the microenvironment of the epithelial cell layer. Methods: The relative number of CD103 ؉ /CD4 ؉ T cells in the bronchoalveolar lavage was significantly elevated in all patients diagnosed with interstitial lung diseases compared with patients with other non-fibrotic disorders of the lung. Results: Analysis by flow cytometry showed that the CD103 ؉ and the CD103 ؊ subpopulations were memory T cells based on the high expression of CD45RO ؉ . However, the CD103 ؉ /CD4 ؉ T cells were CD25 low , CD27 ؊ , CD28 low , and CD62L ؊ , whereas the CD103 ؊ /CD4 ؉ T cells expressed CD25 and CD62L and were CD27 high and CD28 high . In addition, the CD103 ؉ /CD4 ؉ T cells expressed significantly higher quantities of VLA-1 and CD101 than did CD103 ؊ /CD4 ؉ T cells. Reverse transcriptase polymerase chain reaction analysis of purified CD103 ؉ and CD103 ؊ CD4 ؉ T cells showed production of tumor necrosis factor (TNF) ␣-R-1 (p55), TNF-␣-R-2 (p75), interferon ␥, interleukin-10, and TNF-␣ mRNA in both subpopulations. No interleukin-4 mRNA was detected in either subpopulation. Conclusions: CD103 ؉ /CD4 ؉ T cells represent a T-helper 1-like subpopulation in human lungs with a distinct effector phenotype. Despite the lack of CD27 and the low CD25 and CD28 expression, these cells show a high degree of activation. These results suggest that CD103 expressing CD4 T cells in the lung are continuously activated, long-living cells. Cytometry Part B (Clin. Cytometry) 54B:19 -27, 2003.
The reduction in time required to identify vancomycin-resistant enterococci (VRE) has gained incr... more The reduction in time required to identify vancomycin-resistant enterococci (VRE) has gained increased importance during hospital outbreaks. In the present study, we implemented a laboratory protocol to speed up the VRE screening from rectal samples. The protocol combines a medium for selective VRE isolation (VREBAC ® , Probac, São Paulo) and a multiplex PCR for detection and identification of vanA and vanB resistance genes. The screening performance was analyzed in 114 specimens collected from four intensive care units. The swabs were collected at two periods: (1) during a VRE outbreak (February 2006, n=83 patients) and (2) at the post-outbreak period, after adoption of infection control measures . Forty-one/83 VRE (49.4%) and 3/31(9.7%) VRE were found at the first and second period, respectively. All isolates harbored the vanA gene. In both periods, detection of the gene vanA parallels to the minimum inhibitory concentration values of >256 µ µ µ µ µg/mL and >48 µ µ µ µ µg/mL for vancomycin and teicoplanin, respectively. Multiplex PCR and conventional methods agreed in 90.2% for enterococci identification. Besides this accuracy, we also found a remarkable reduction in time to obtain results. Detection of enterococcal species and identification of vancomycin resistance genes were ready in 29.5 hours, in comparison to 72 hours needed by the conventional methods. In conclusion, our protocol identified properly and rapidly enterococci species and vancomycin-resistance genes. The results strongly encourage its adoption by microbiology laboratories for VRE screenning in rectal samples.
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Papers by Antonio Pignatari