Entre as ß-lactamases, as enzimas CTX-M têm despertado atenção especial pela alta incidência e grande capacidade de propagação. Eventos como recombinação gênica, transferência plasmideal e multirresistência podem ser a razão da manutenção e da ampla disseminação dos genes blaCTX-M. Este é um trabalho retrospectivo que teve como objetivo caracterizar genes blaCTX-M presentes em Klebsiella spp. Foram estudadas 27 linhagens de Klebsiella pneumoniae e 8 linhagens de Klebsiella oxytoca, produtoras de ?-lactamase de espectro estendido, isoladas de pacientes hospitalizados no período de janeiro a junho de 2000. A detecção e identificação dos genes blaCTX-M, assim como dos elementos relacionados com a mobilização destes genes, foi realizada por PCR e seqüenciamento. A localização genética e a mobilidade dos genes blaCTX-M foram pesquisadas por análise plasmideal e hibridação e por conjugação. Os perfis de sensibilidade das linhagens estudadas e das linhagens transconjugantes foram comparados pela determinação da concentração inibitória mínima de antibióticos das classes das cefalosporinas, cefamicinas, aminoglicosídeos e quinolonas. Foram encontrados genes blaCTX-M em plasmídeos conjugativos em 13 (37%) linhagens estudadas: blaCTX-M-9 em 4 K. oxytoca, e blaCTX-M-2 em 9 K. pneumoniae. Os genes blaCTX-M-9 estavam associados ao elemento de inserção ISEcp1, enquanto os genes blaCTX-M-2 estavam associados a integrons de classe I contendo ISCR1. O genes blaCTX-M-2, carreado por plasmídeo, pode estar relacionado com disseminação horizontal entre vários clones de K. pneumoniae, enquanto o gene blaCTX-M-9 foi encontrado sendo carreado por um único clone de K. oxytoca. Este estudo determinou a incidência e a diversidade de enzimas CTX-M no período estudado, além de fornecer dados epidemiológicos que podem explicar a sua prevalência no mundo e contribuir para o entendimento e controle da disseminação deste tipo de resistência. / CTX-M enzymes, the world\'s most prevalent ß-lactamases disseminate very easily. Genetic recombination, plasmid transference and multiresistance could be responsible for the wide spread of blaCTM-X genes. This retrospective study aims to characterize blaCTX-M genes found in Klebsiella spp. The strains were isolated in hospital patients from January to June 2000 and consisted of 27 ESBL-producing Klebsiella pneumoniae and 8 ESBL-producing Klebsiella oxytoca. PCR and sequencing were used in the detection and identification of blaCTX-M genes and genetic elements associated with their mobilization. Determination of genetic localization and mobility of blaCTX-M genes was by plasmid analyses, hybridization and transfer assays. The minimal inhibitory concentrations (MICs) of cephalosporins, cefamicins, aminoglycosides and quinolone antimicrobials evaluated the antibiotic susceptibility profile of transconjugants and strains in the study. The blaCTX-M genes were found in 13 strains (37%): blaCTX-M-9 in 4 K. oxytoca and blaCTX-M-2 in 9 K. pneumoniae. The insertion sequence ISEcp1 was associated with blaCTX-M-9 and blaCTX-M-2 was found in a class I integron bearing ISCR1. Plasmid blaCTX-M-2 genes dissemination was due to horizontal transfer among many K. pneumoniae clones, while blaCTX-M-9 dissemination was associated with a particular clone of K. oxytoca. The study characterized incidence and diversity of CTX-M enzymes during the period studied. Moreover it showed epidemiological data, which may explain CTX-M prevalence worldwide and contribute for the understanding and control of the resistance spread.

Genetic typing of Klebsiella pneumoniae is used for epidemiological referencing. In the clinical setting it can be useful in outbreak investigations, understanding transmission and managing hospital infections. Multi-drug resistant bacteria exist and proliferate either due to natural selection of clonal lineages or the transfer of mobile genetic elements, sometimes in response to antibiotic-use selective pressure. Pulsed-field gel electrophoresis (PFGE) is highly discriminatory and the gold standard typing method for the characterisation of K. pneumoniae isolates. The aim of the study was to genetically characterise K. pneumoniae isolates by PFGE and multilocus sequence typing (MLST). One hundred unrepeated ESBL-producing K. pneumoniae isolates were collected from the National Health Laboratory Service (NHLS). The PFGE was performed on a Rotaphor VI system (Biometra, Germany). Clonal representatives were further characterised by MLST. All the strains were typeable by PFGE using XbaI, which discerned multiple pulsotypes and MLST identified 10 different STs including a novel sequence type, ST1632. The diverse pulsotypes of K. pneumoniae isolates are not suggestive of clonal spread of particular strains. The MLST results further confirmed the variability among isolates tested and elucidated several STs, some of which have been identified internationally and often associated with carbapenem-resistance. Data on K. pneumoniae STs is still limited in the South African clinical setting, although the close monitoring of resistance profiles and characterisation of isolates is imperative for outbreak analysis, identification of prominent STs in clinical settings as compared to international counterparts and surveillance of expanding resistance. / Dissertation (MSc (Medical Microbiology))--University of Pretoria, 2015. / Medical Microbiology / MSc (Medical Microbiology) / Unrestricted

β-lactam antibiotics have been the most widely used drug of choice to combat infectious disease caused by bacteria. Unfortunately, their effectiveness is drastically threatened by bacterial β-lactamases. β-lactamases is responsible for the resistance to most antibiotic drugs. For decades, β-lactam β-lactamases inhibitors have been used to reduce bacterial resistance; however, in this study 1,2,4-oxadiazolidinone derivatives as a non-β-lactam β-lactamases inhibitor against TEM-1 and P99 β-lactamases. The significance of oxadiazolidinone is the prominent five-membered ring scaffold in its structure, which is configurationally stable and present in other biologically active compounds such as linezolid and avibactam. Oxadiazolidinones were synthesized by treating nitrones with isocyanates. The synthesized compounds were characterized using 1H and 13C NMR, GC-MS, and FTIR. Afterward, they were tested using Nitrocefin as substrate to determine their effectiveness against TEM-1 and P99 serine β-lactamase. Compound 2a-2c, and 3 showed inhibition ranging from 12-38%.

Les azasulfurylpeptides sont des mimes peptidiques auxquels le carbone en position alpha et le carbonyle d’un acide aminé sont respectivement remplacés par un atome d’azote et un groupement sulfonyle (SO2). Le but premier de ce projet a été de développer une nouvelle méthode de synthèse de ces motifs, également appelés N-aminosulfamides. À cette fin, l’utilisation de sulfamidates de 4-nitrophénol s’est avérée importante dans la synthèse des azasulfuryltripeptides, permettant le couplage d’hydrazides avec l’aide d’irradiation aux micro-ondes (Chapitre 2). Par la suite, en quantité stoechiométrique d’une base et d’un halogénure d’alkyle, les azasulfurylglycines (AsG) formés peuvent être chimiosélectivement alkylés afin d’y insérer diverses chaînes latérales. Les propriétés conformationnelles des N-aminosulfamides à l’état solide ont été élucidées grâce à des études cristallographiques par rayons X : elles possèdent une structure tétraédrique autour de l’atome de soufre, des traits caractéristiques des azapeptides et des sulfonamides, ainsi que du potentiel à favoriser la formation de tours gamma (Chapitre 3). Après le développement d’une méthode de synthèse des N-aminosulfamides en solution, une approche combinatoire sur support solide a également été élaborée sur la résine amide de Rink afin de faciliter la génération d’une librairie d’azasulfurylpeptides. Cette étude a été réalisée en employant le growth hormone releasing peptide 6 (GHRP-6, His-D-Trp-Ala-Trp-D-Phe-Lys-NH2). Ce dernier est un hexapeptide possédant une affinité pour deux récepteurs, le growth hormone secretagogue receptor 1a (GHS-R1a) et le récepteur cluster of differenciation 36 (CD36). Une affinité sélective envers le récepteur CD36 confère des propriétés thérapeutiques dans le traitement de la dégénérescence maculaire liée à l’âge (DMLA). Six analogues d’azasulfurylpeptides de GHRP-6 utilisés comme ligands du CD36 ont été synthétisés sur support solide, mettant en évidence le remplacement du tryptophane à la position 4 de GHRP-6 (Chapitre 4). Les analogues de GHRP-6 ont été ensuite analysés pour leur capacité à moduler les effets de la fonction et de la cascade de signalisation des ligands spécifiques au Toll-like receptor 2 (TLR2), en collaboration avec le Professeur Huy Ong du département de Pharmacologie à la Faculté de Pharmacie de l’Université de Montréal. Le complexe TLR2-TLR6 est reconnu pour être co-exprimé et modulé par CD36. En se liant au CD36, certains ligands de GHRP-6 ont eu un effet sur la signalisation du TLR2. Par exemple, les azasulfurylpeptides [AsF(4-F)4]- et [AsF(4-MeO)4]-GHRP-6 ont démontré une capacité à empêcher la surproduction du monoxyde d’azote (NO), un sous-produit réactif formé suite à l’induction d’un signal dans les macrophages par des ligands spécifiques liés au TLR2, tel le fibroblast-stimulating lipopeptide 1 (R-FSL-1) et l’acide lipotéichoïque (LTA). En addition, la sécrétion du tumor necrosis factor alpha (TNFa) et du monocyte chemoattractant protein 1 (MCP-1), ainsi que l’activation du nuclear factor kappa-light-chain-enhancer of activated B cells (NF-kB), ont été réduites. Ces résultats démontrent le potentiel de ces azasulfurylpeptides à pouvoir réguler le rôle du TLR2 qui déclenche des réponses inflammatoires et immunitaires innées (Perspectives). Finalement, le potentiel des azasulfurylpeptides d’inhiber des métallo-bêta-lactamases, tels le New-Delhi Metallo-bêta-lactamase 1 (NDM-1), IMP-1 et le Verona Integron-encoded Metallo-bêta-lactamase 2 (VIM-2), a été étudié en collaboration avec le Professeur James Spencer de l’Université de Bristol (Royaumes-Unis). Certains analogues ont été des inhibiteurs micromolaires du IMP-1 (Perspectives). Ces nouvelles voies de synthèse des azasulfurylpeptides en solution et sur support solide devraient donc permettre leur utilisation dans des études de relations structure-activité avec différents peptides biologiquement actifs. En plus d'expandre l'application des azasulfurylpeptides comme inhibiteurs d'enzymes, cette thèse a révélé le potentiel de ces N-aminosulfamides à mimer les structures secondaires peptidiques, tels que les tours gamma. À cet égard, l’application des azasulfurylpeptides a été démontrée par la synthèse de ligands du CD36 présentant des effets modulateurs sur le TLR2. Compte tenu de leur synthèse efficace et de leur potentiel en tant qu’inhibiteurs, les azasulfurylpeptides devraient trouver une large utilisation dans les sciences de peptides pour des applications dans la médecine et de la chimie biologique. / The azasulfurylpeptides are peptide mimics in which the alpha carbon and the carbonyl of an amino acid residue are respectively replaced by a nitrogen atom and a sulfonyl group (SO2). The primary goal of this doctorate project was to develop a new effective method for the synthesis of these motifs, also called N-aminosulfamides. Towards this aim, the use of 4-nitrophenyl sulfamidates turned out to be important in the synthesis of azasulfuryltripeptides, allowing hydrazide couplings under micro-wave irradiation (Chapter 2). Side-chain diversity was then added using a stoichiometric amount of base and different alkyl halides to alkylate chemoselectively the azasulfurylglycine (AsG) residue. The conformational properties of the N-aminosulfamides in the solid state were studied using X-Ray crystallography, which showed a tetrahedral geometry about the sulfur atom, features of azapeptides and sulfonamides, as well as potential to favor the formation of gamma turns (Chapter 3). Following the development of the synthesis of these N-aminosulfamides in solution, a combinatorial approach on solid support was elaborated on Rink amide resin to generate a library of azasulfurylpeptides. The study was performed using the Growth Hormone Releasing Peptide 6 (GHRP-6, His-D-Trp-Ala-Trp-D-Phe-Lys-NH2). The latter is a hexapeptide that has affinity for two receptors, the Growth Hormone Secretagogue Receptor 1a (GHS-R1a) and the Cluster of Differenciation 36 (CD36) receptor. Selective binding to the CD36 receptor has therapeutic potential in the treatment of age-related macular degeneration (AMD). Six azasulfurylpeptide analogs were synthesized on solid support by replacing tryptophan at the 4th position of GHRP-6 with different N-aminosulfamide residues (Chapter 4). The GHRP-6 analogs were tested for their ability to mediate the effects of receptor-specific ligands on the function and downstream signaling of the Toll-Like Receptor 2 (TLR2), in collaboration with Professor Huy Ong at the department of Pharmacology in the Faculty of Pharmacy at the Université de Montréal. The TLR2-TLR6 complex is known to be co-expressed and modulated by CD36. On binding to CD36, certain GHRP-6 ligands exhibited effects on the signaling of TLR2. For example, the azasulfurylpeptides [4-F-AsF4]- and [4-MeO-AsF4]-GHRP-6 prevented the overproduction of nitric oxide (NO), a reactive oxygen species formed following the induction of signal in macrophages on binding of TLR2-specific ligands, such as the Fibroblast-Stimulating Lipopeptide 1 (R-FSL-1) and lipoteichoic acid (LTA). Furthermore, the secretion of the Tumor Necrosis Factor Alpha (TNFa) and Monocyte Chemoattractant Protein 1 (MCP-1), as well as the activation of the Nuclear Factor Kappa-light-chain-enhancer of activated B cells (NF-kB), all were reduced. These results offer promise for regulating Toll-like receptor roles in triggering innate immunity and inflammatory responses (Perspectives). Finally, the potential of the azasulfurylpeptides to inhibit metallo-bêta-lactamases, such as the New-Delhi Metallo-β-lactamase 1 (NDM-1), IMP-1 and the Verona Integron-encoded Metallo-bêta-lactamase 2 (VIM-2), has been studied in collaboration with Professor James Spencer at the University of Bristol (United-Kingdom). Some analogs were micromolar inhibitors of IMP-1 (Perspectives). These new approaches for the synthesis of azasulfurylpeptides in solution and on solid support should enable their use in studies of structure-activity relationships with different biologically active peptides. In addition to expanding the application of azasulfurylpeptides as enzyme inhibitors, this thesis has revealed the potential of these N-aminosulfamides to mimic the peptide secondary structures, such as gamma turns. Application of azasulfurylpeptides in this respect has been demonstrated by the synthesis of CD36 ligands exhibiting modulatory effects on the TLR2. Considering their effective synthesis and potential as inhibitors, azasulfurylpeptides should find broad use in peptide science for applications in medicine and chemical biology.

L'augmentation des résistances aux antibiotiques ces dernières années et le faible nombre de nouveaux antibiotiques récemment approuvés ont suscité un intérêt considérable pour les associations médicamenteuses. Parmi celles-ci, les associations β-lactamine-inhibiteur de β-lactamases, comme l’aztréonam-avibactam (ATM-AVI), visent à surmonter la résistance due à la production de β-lactamases, l'un des principaux mécanismes de résistance chez les bactéries à Gram négatif. Cependant, les interactions PD entre molécules associées peuvent être complexes. Afin de mieux comprendre la PK/PD de l’ATM-AVI, deux problématiques ont été abordées dans cette thèse :i. La PK de l’ATM-AVI au site infectieux. Une étude de microdialyse réalisée chez le rat avec ou sans péritonite a montré que la distribution de l’ATM-AVI dans le liquide péritonéal était rapide et que les concentrations au site infectieux pourraient être prédites à partir des concentrations sanguines.ii. L’interaction PD entre ATM et AVI. Des études de checkerboard analysées avec un modèle Emax ont permis de caractériser l’effet de l’AVI sur la CMI de l’ATM en termes d’efficacité et de puissance en présence de souches multi-résistantes. Pour compléter ces résultats, un modèle PK/PD a été développé à partir de données in vitro afin d’évaluer l’évolution de l’effet combiné de l’ATM-AVI au cours du temps et d’étudier la contribution individuelle de chacun des effets de l’AVI à l’activité combinée. Selon les résultats de cette modélisation, l’activité bactéricide de l’association serait principalement expliquée par l’effet potentialisateur de l’AVI et ce malgré sa capacité à prévenir la dégradation de l’ATM de manière efficace. / The rapid increase in antibiotic resistance during the last decades and the few numbers of recently approved new antibiotics lead to a significant interest to drug combinations. Among these combinations, the β-lactam-β-lactamase inhibitor combination, such as aztreonam-avibactam (ATM-AVI), is one strategy that aims to overcome the resistance due to β-lactamases production, one of the most relevant mechanisms of resistance in Gram-negative bacteria. However, drug interactions can be complex. To better understand the PK/PD of ATM-AVI, two issues have been addressed in this thesis: i. ATM-AVI PK at the infection site. A microdialysis study performed in rats with or without peritonitis showed that ATM and AVI distribution in intraperitoneal fluid was rapid and that concentrations at the target site could be predicted from blood concentrations.ii. PD interaction between ATM and AVI. Checkerboard experiments analyzed with an Emax model have been used to characterize AVI effect on ATM MIC in terms of efficacy and potency in the presence of various multi-drug resistant strains. A PK/PD model was developed based on in vitro data to describe the time-course of ATM-AVI combined effect and to investigate the individual contribution of each of the AVI effects to the combined activity. According to the modeling results, the combined bactericidal activity was mainly explained by AVI enhancing effect, even though AVI demonstrated high efficiency to prevent ATM hydrolysis.

Our research aim was to design, synthesize, and study the competitive enzyme inhibition kinetics of pyrrolo[2,1-c][1,4]benzodiazepine (PBD) derivatives as potential non-²-lactam ²-lactamase inhibitors. All compounds (1-13) passed the Lipinski’s rule of 5 test and were docked into the active site of TEM-1 ²-lactamase. PBD derivatives 1-7 were synthesized in high yields and tested for their potency against TEM-1 and P99 ²-lactamases. Kinetic data showed that compounds 1, 4, 5, and 7 possessed inhibitory activity against TEM-1 ranging from 4-34 %. Docking results revealed significant interactive spanning of the active site of TEM-1 by PBDs. The limited inhibitory activity of the compounds, 1-7 could be attributed to the lack of solubility and bulky nature of the molecules, thus limiting the optimal ligand-enzyme interactions. 1,2,4- Oxadiazolinones (8-13) were further synthesized to reduce the steric hindrance of the PBD scaffolds while promoting the electrophilicity of the potentially active lactam and also evaluated for potency.

Pyrrolo[2,1-c][1,4]benzodiazepine (PBD) derivatives possess cancerostatic and anti-infective properties thus making them candidates of possible antibacterial agents. ²-lactam antibiotics are vital weapons for the treatment of bacterial infections, but their existence and effectiveness has been faced with resistance from ²-lactamases. Therefore, the need for new effective antimicrobial drugs is very crucial. In this work, we synthesized in high yields, PBD analogs 1−3, 5 and 7−9 in three to four synthetic steps from commercially available L-proline and isatoic anhydride. MTT Assay was employed to test the in vitro cytotoxicity of PBD analogs 1, 2, 5 and 7 on cancer cell lines including MCF-7, SKBR-3, SKMEL-2, CaCo 2 and Mia Paca. These compounds decreased the cell viability of MCF-7 by roughly 20% however, 1 and 5 had no effect on the SKMEL-2 cell lines. The inhibitory efficacy of these PBDs were also tested against TEM-1 and P99 Serine class A and C ²-lactamases.

La propagation de bactéries à Gram négatif multirésistantes aux antibiotiques représente un problème de santé publique majeur urgent à résoudre car le risque d’un retour à l’ère pré-antibiotique est réel. Parmi les modes de résistance existant, la production de métallo-B-lactamases (MBLs) responsables de l’inactivation des B-lactamines, la famille d’antibiotiques la plus utilisée, représente un challenge thérapeutique.Les travaux décrits dans ce manuscrit concernent la synthèse, la caractérisation et l’évaluation biologique de composés construits autour d’un cœur 2,4-dihydro-3H-1,2,4-triazole-3-thione substitués en deux positions. En se basant sur des études de criblage in silico et des études cristallographiques ayant permis d’identifier ce noyau comme un bon candidat dans le développement d’inhibiteurs de MBLs, la synthèse de différentes séries d’analogues a été entreprise afin d’identifier de nouveaux inhibiteurs pouvant potentiellement atteindre les tests cliniques.Dans un premier temps, une série de composés 4-amino-1,2,4-triazole-3-thione substitués en position 5 a été préparée en suivant des voies de synthèse classiques. Différentes séries ont ensuite été développées en introduisant une diversité structurale et fonctionnelle en position 4. Ces composés ont ensuite été testés sur des enzymes représentatives des 3 sous-classes de MBLs et les plus intéressants ont été évalués sur bactéries résistantes recombinantes.Afin de réaliser une évaluation rapide des produits synthétisés au sein du laboratoire, une méthode de criblage à moyen débit en plaque 96 puits sur cinq MBLs représentatives a été mise au point et validée grâce à l’appui de nos collaborateurs spécialistes des MBLs. / The spread of multiresistant Gram negative bacteria is a growing threat to public health and the risk of return to the pre-antibiotic era is real. Among existing resistance modes, the production of metallo-B-lactamases (MBLs) responsible of the inactivation of B-lactams, the most used family of antibiotics, represents a therapeutical challenge.This manuscript describes the synthesis, characterization and biological evaluation of compounds built on a 2,4-dihydro-3H-1,2,4-triazole-3-thione scaffold substituted on two positions. Based on previous in silico screening and crystallographic studies, which identified this structure as a good candidate for MBLs inhibition, several series have been developed to found new inhibitors that could potentially be amenable to clinical development.First, 1,2,4-triazole-3-thione compounds substituted at position 5 have been prepared following classical pathways. Then, several series have been developed where the structural and functional diversity was introduced at position 4. Compounds have been tested on representative MBLs of the three sub-classes and the most interesting ones on recombinant resistant bacteria.To perform a rapid screening of compounds in the laboratory, a method of medium throughput screening inhibition tests on five MBLs performed in 96-wells plate has also been developed and validated during this study with the help of our collaborators specialists of MBLs

This thesis describes the detection, and characterization of putative extended-spectrum β-lactamases (ESBLs) producing Escherichia coli isolated from feedlot cattle in southern Alberta. Cattle either received no antimicrobials or were administered subtherapeutic antimicrobials in feed. In total, 7,184 E. coli isolates were collected, and screened for resistance to either ceftazidime (2μg mL-1 ) or cefpodoxime (2μg mL-1), and from these results 237 E. coli isolates were considered presumptive ESBL producers. Antimicrobial resistant bacteria were isolated throughout the experiment; however, ESBL-producing E. coli were not prevalent throughout the study. In total, only three isolates (B221B1, C152C1, C98A1) exhibited the ESBL phenotype. Molecular subtyping of these isolates revealed no clonality between these strains. Molecular characterization of the 237 isolates investigated in this study revealed blaTEM to be the most prevalent AMR determinant among the ampicillin-resistant isolates with resistance to ceftazidime (2μg mL-1 ) or cefpodoxime (2μg mL-1). These data suggest that ESBLs are not frequent among Canadian feedlot cattle and MDR resistance (55 of 237) was observed but is not prominent among both the subgroup and total isolates collected. It was determined that isolate B221B1 was ESBL-producing, and harboured the blaTEM-1 gene. The genes responsible for ESBL production in isolates C98A1 and C152C1 were not characterized. In order to characterize the antimicrobial resistance (AMR) genes coding for ESBL-production in these 2 isolates, cloning and conjugation experiments were attempted. However, I was unable to resolve the mechanism responsible for ESBL phenotype in these two isolates. The results of this study imply that the development of ESBL-producing E. coli is complex, and is probably affected by both the administration of antimicrobials and numerous other presently undefined environmental factors. / xii, 104 leaves : ill. ; 28 cm

Submitted by Alessandra Portugal (alessandradf@ioc.fiocruz.br) on 2013-09-24T14:50:16Z No. of bitstreams: 1 Thiago Pavoni.pdf: 1955163 bytes, checksum: b15140ec10d9f1473101f075a2a57a86 (MD5) / Made available in DSpace on 2013-09-24T14:50:16Z (GMT). No. of bitstreams: 1 Thiago Pavoni.pdf: 1955163 bytes, checksum: b15140ec10d9f1473101f075a2a57a86 (MD5) Previous issue date: 2011 / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Rio de Janeiro, RJ, Brasil / Drogas antimicrobianas e bactérias resistentes aos antimicrobianos estão disseminadas em grandes quantidades no ambiente, como resultado do aumento e freqüente uso indiscriminado dos antibióticos. Bactérias e seus genes de resistência têm sido detectados em diferentes ambientes, tais como esgoto hospitalar, esgoto doméstico e águas de rios contaminados. O esgoto hospitalar é um importante poluente, representando riscos para a saúde pública se chegar aos sistemas de distribuição. Ambientes fortemente seletivos, como os hospitais, permitem a geração bactérias resistentes, as quais podem ser lançadas no esgoto hospitalar. O presente trabalho tem como objetivo investigar a presença bactérias resistentes aos antimicrobianos em efluentes de uma estação de tratamento de esgoto hospitalar no Rio de Janeiro, avaliando o potencial do sistema de tratamento para a eliminação de micro-organismos. A estação de tratamento de esgoto fica localizada na região metropolitana. O sistema de lodo ativado por aeração prolongada é constituído por três partes básicas: o tanque de aeração, o decantador e o tanque de cloração. Vinte e quatro amostras de esgoto foram coletadas no período de Julho a Dezembro de 2008. Oito amostras (1000 mL) foram coletadas a partir de diferentes pontos: afluente, efluente do tanque decantador e efluente clorado. Micro-organismos indicadores também foram investigados. Os isolados bacterianos foram identificados a partir de provas bioquímicas convencionais. A sensibilidade aos antimicrobianos das bactérias isoladas foi determinada através do método fenotípico de difusão em ágar, de acordo com as orientações do Clinical and Laboratory Standards Institute (CLSI). A identificação da produção fenotípica de beta-lactamases de espectro estendido e de carbapenemases entre os isolados também seguiram as recomendações do CLSI. Ensaios de PCR foram processados para a identificação dos genes blaKPC, blaTEM, blaSHV e blaCTX-M. A genotipagem das amostras bacterianas foi realizada por eletroforese em gel de campo pulsado. Concentrações significativas de coliformes totais e fecais foram detectadas nos efluentes hospitalares. Um total de 226 isolados foi identificado, entre os quais 213 (94%) pertenciam à família Enterobacteriaceae. Outros grupos de micro-organismos, como Pseudomonas aeruginosa, Acinetobacter baumannii e Aeromonas spp., foram também observados. A maioria das cepas era sensível ao imipenem e ao meropenem; e resistente à cefalotina, à cefotaxima e ao sulfametoxazol-trimetoprim. O fenótipo de ESBL foi caracterizado em 97 (43%) isolados. Os produtores de ESBL mais comuns foram: Klebsiella pneumoniae, Enterobacter cloacae e Escherichia coli. Micro-organismos patogênicos e altas taxas de resistência ainda puderam ser observados nos efluentes clorados. Os genes blaTEM, blaSHV e blaCTX-M foram detectados em 82%, 48% e 67% dos isolados do efluente hospitalar, respectivamente. Em muitos isolados, a ocorrência de mais de um tipo de ESBL foi observada, sendo a associação dos tipos TEM e CTX-M a mais frequente. O gene blaKPC foi detectado em dois isolados do efluente. Foi possível observar isolados clínicos e do esgoto geneticamente relacionados. Concluímos que, apesar do tratamento, o esgoto hospitalar pode ser considerado um veículo ambiental de disseminação de bactérias multirresistentes. A ocorrência destes micro-organismos nos efluentes é preocupante e tem impacto sobre a saúde pública. Medidas urgentes são necessárias para enfrentar este problema. Vale ressaltar que, em muitos países em desenvolvimento, os efluentes hospitalares não recebem tratamento adequado. / Antimicrobial drugs and antimicrobial - resistant bacteria are discharged in large quantities in the environment as a result of increasing ly frequent and indiscriminate use of antibiotics . Antimicrobial - resistant bacteri a and antimicrobial - resistant genes have been detected in different environments, such as domestic sewage, hospital sewage and sewage - contaminated river waters. Hospital sewage is an important pollutant , representing risks to public health if it reaches th e distribution system. The occurrence of strongly selective environments, such as hospitals, leads to an incre ase of multiresistant bacteria, which can be released in hospital sewage. The aim of this study was to investigate the antimicrobial - resistant bac teria isolated from a hospital sewage treatment plant in Rio de Janeiro city, evaluating the treatment plant’s potential to remove these microorganisms. The sewage treatment plant serve a hospital located in the metropolitan area of the Rio de Janeiro city (RJ), Brazil. The extended aeration activated sludge plant is divided into three parts, an aeration tank, a clarifier tank and a chlorine contact tank. During the study, twenty - four sewage samples were collected in the period from July to December 2008. E ight samples (1000 ml) were collected on each day from the following: influent; clarifier tank effluent; and chlorine contact tank effluent. Total and faecal coliforms concentrations were also determined . Isolates were identified using established biochemi cal procedures. The antimicrobial susceptibilities of bacterial isolates were determined using the agar diffusion method according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Isolates were screened for the KPC - and ESBL - producing phen otype according to the CLSI. PCR experiments were used for the molecular detection of bla KPC , bla TEM , bla SHV and bla CTX - M genes. The genetic relat ionships of isolates were determined by PFGE. High concentrations of total and faecal coliforms were detected in the influent , clarifier tank and chlorine contact tank effluent. A total of 226 isolates were identified, among which 213 (94%) were Enterobacteriaceae . In addition , Pseudomonas aeruginosa , Acinetobacter baumannii and Aeromonas spp . in hospital effluent were observed . The majority of the strai ns were susceptible to imipenem and meropenem and resistant to cefalothin, cefotaxime and trimethoprim - sulphametoxazole. ESBL phenotype was characterized in 97 (43%) isolates. The most common ESBL - producing isolates were: Klebsiella pneumoniae , Enterobacter cloacae , and Escherichia coli . Pathogenic microorganisms and higher antimicrobial resistance rates were detected in chlorine contact tank effluent. The bla TEM , bla SHV and bla CTX - M genes were detected in 82%, 48% a nd 67% of isolates respectively. Many of the isolates harboured other β - lactam resistance enzymes and the a ssociation of types TEM and CTX - M was more frequent. The bla KPC was detected in isolates from effluents. PFGE analysis revealed clonal types among cl inical isolates and isolates from effluents. Despite the treatment of the wastewater, hospital effluent may be considered as a potential environmental vehicle of multiresi s tant microorganisms. The occurrence of multiresistant bacteria isolates in hospital effluents is worrisome and has a real impact on public health. Urgent measures are necessary in order to counteract this problem. It should be noted that effluents from hospitals in developing countries do not receive adequate treatment