Made available in DSpace on 2015-11-11T12:04:10Z (GMT). No. of bitstreams: 2 22.pdf: 3102930 bytes, checksum: 2f67ffbd3b5474aacabccf998ea6f22e (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Centro de Pesquisas Aggeu Magalhães. Recife, PE, Brasil / Este estudo visou a caracterização molecular de mecanismos de virulência e resistência aos antimicrobianos em isolados de K. pneumoniae MDR provenientes de um hospital universitário em Recife-PE. Seis isolados de K. pneumoniae produtores de carbapenemase foram obtidos de pacientes hospitalizados na UTI de um hospital universitário do Recife. Os isolados apresentaram resistência a todos os antimicrobianos beta-lactâmicos e quinolonas testados, mas sensibilidade a amicacina, polimixina B e tigeciclina, por meio de microdiluição em caldo. A tipagem molecular por PFGE revelou que os isolados são intimamente relacionados, apresentando três subclones distintos. Dois STs foram detectados, o ST340 e o ST11, ambos pertencentes ao CC258. Os genes blaKPC-2 e blaSHV-11 foram detectados em todos os isolados, seguido do gene blaCTX-M-15 em quatro dos seis isolados e por fim os genes blaCTX-M-2, qnrB19, aac(6')-31 em dois dos seis isolados. Os genes blaKPC-2 e blaCTX-M-15 estavam presentes em um mesmo plasmídeo de aproximadamente 133 Kb pertencente ao IncI-gama em quatro isolados. Nos demais isolados os genes blaKPC-2 e blaCTX-M-2 eram carreados também por um plasmídeo de, aproximadamente, 133 Kb, entretanto, não foi possível tipar o mesmo com as metodologia utilizada. O gene qnrB19 foi detectado sendo carreado por um plasmídeo de 15 Kb pertencente ao IncY. Todos os isolados apresentaram integron de classe 1, associado com a resistência aos aminoglicosídeos / Mutações na região QRDR de GyrA (Ser83Ile) e ParC (Ser80Ile) foram detectadas em todos os isolados analisados, sendo esse o principal mecanismo de resistência as quinolonas detectadas ao longo do estudo. Adicionalmente, a permeabilidade de membrana externa foi analisada, verificando-se a ausência da Ompk35 em todos os isolados e da OmpK36 em uma das amostras analisadas. A investigação dos genes de virulência revelou a presença de antígenos capsulares do tipo K2 entre os isolados. Genes codificadores das fímbrias do tipo I e III foram detectados, assim como genes envolvidos na síntese de LPS e operon da urease. A presenca de micro-organismos multirresistentes e virulentos em unidades hospitalares reforça a necessidade de medidas para a rápida contenção de possíveis infecções hospitalares causadas por esses patógenos

Orientador: Mara Correa Lelles Nogueira / Banca: Renata Cristina Picão / Banca: Eleni Gomes / Resumo: Pseudomonas aeruginosa é um bacilo Gram-negativo, aeróbio, não formador de esporos encontrado no solo, água, plantas e animais, incluindo os seres humanos, onde provoca infecções oportunistas. Infecções causadas por P. aeruginosa são de difícil tratamento devido a sua virulência e resistência a vários antimicrobianos. Os carbapenêmicos são geralmente ativos contra P. aeruginosa multirresistentes, mas as altas taxas de resistência a estas drogas estão se tornando comuns e podem indicar a produção de metalo-betalactamases (MβLs). O propósito deste estudo foi detectar e identificar, em cepas de P. aeruginosa resistentes a carbapenêmicos genes que codificam a produção de MβLs (blaSPM, blaIMP e blaVIM) e ESBLs (blaCTX-M e blaGES), e avaliar a similaridade genética entre as cepas. Foram avaliadas sessenta cepas de P. aeruginosa resistentes aos carbapenêmicos isoladas de pacientes do Hospital de Base de São José do Rio Preto, no período de junho de 2009 a dezembro de 2009. Os testes de sensibilidade foram realizados de acordo com a padronização do "Clinical and Laboratory Standards Institute" (CLSI) (2009) utilizando o método de disco-difusão. O teste fenotípico para a produção de MβLs foi realizado através do método de aproximação de discos, com os substratos ceftazidima e imipenem e com o inibidor de MβLs 2-MPA. A detecção dos genes de MβLs blaIMP, blaVIM e blaSPM e de ESBLs blaCTX-M e blaGES foi realizada por PCR, e a identificação através de seqüenciamento. A avaliação da similaridade genética entre as cepas foi realizada nas amostras produtoras de MβL e ESBLs do tipo CTX-M através de PFGE. No teste de suscetibilidade por disco-difusão 98,3% (59/60) das cepas apresentaram resistência ao imipenem e 75% (45/60) ao meropenem. Polimixina B foi o único agente a inibir o crescimento de 100% das amostras... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: Pseudomonas aeruginosa is a versatile microorganism, with low nutritional demands and easy proliferation in culture medium. It's a Gram-negative bacillus, aerobic, nonsporulated and it can be isolated from soil, water, plants and animals, including humans. P. aeruginosa infections are hard to treat because of its virulence and resistance to various antimicrobials. Carbapenens are usually active against multiresistant P. aeruginosa, but high levels of resistance to these antibiotics are becoming common and it can indicate metallo-beta-lactamases presence (MβLs). The purpose of this study was to detect and identify, in P. aeruginosa strains, MβL and ESBL encoding genes (blaSPM, blaIMP, blaVIM, blaCTX-M and blaGES) and to determine genetic similarity between the carrier strains. The study was done analyzing sixty P. aeruginosa strains resistant to carbapenens isolated at Hospital de Base de São José do Rio Preto, in the period of june/2009 to December/2009. The isolates were submitted to disc-diffusion susceptibility test, as standardized by the "Clinical and Laboratory Standards Institute" (CLSI) (2009). The phenotypic test for MβL production was performed by means of the double disk synergy method, having ceftazidime and imipenem used as substratum and 2-MPA as an inhibitor. The polymerase chain reaction (PCR) was used to detect the MβLs genes (blaIMP, blaVIM, blaSPM) and the ESBL genes (blaCTX-M and blaGES) and sequencing was carried out for their identification. The genetic similarity between the strains was evaluated in samples which were positive for MβLs and ESBLs genes using the PFGE technique. In disc-diffusion susceptibility test, 98,3% (59/60) of the strains were imipenem resistant and 75% (45/60) were meropenem resistant. All isolates were inhibited by Polymixin B. Tracheal aspirate were the most frequent isolated clinic specimen, with 40% (24/60) of total. / Mestre

Extended Spectrum β-Lactamases (ESBLs) are produced by the Enterobacteriaceae bacterial family, mainly by E. coli and K. pneumoniae. As these species are some of the main causes of urinary tract infections and sepsis, ESBL-production is of major concern. Occurrence of ESBLs also gives rise to concern as it is increasing epidemically. This because the genes coding for ESBLs (i.e. bla-genes) are located on plasmids replicating and spreading the replicated copies independently. Plasmids replicate by replicons. Plasmids with the same replicon variant are grouped into the same plasmid family. The aim of this study was to detect plasmid families carrying bla-genes in E. coli and K. pneumoniae from clinical (n = 6) and environmental water (n = 22) isolates. Plasmid family prevalence was examined. Association between plasmid families and bla-genes was also examined. Plasmid families were detected by a PBRT kit (PCR Based Replicon Typing), a multiplex PCR kit that detected 30 replicons, whereof 27 replicons representing the 27 plasmid families in Enterobacteriaceae, and three novel replicons. The IncF plasmid family was the most prevalent for both species in both clinical and environmental isolates. IncF seemed to be prevalent for all examined ESBLs, but it was difficult to associate one bla-gene with one plasmid family as most isolates carried several bla-genes and several plasmid families. / Extended Spectrum β-Lactamases (ESBLs) produceras av bakteriefamiljen Enterobacteriaceae, främst av E. coli och K. pneumoniae. Eftersom dessa arter är bland de vanligaste orsakerna till urinvägsinfektioner och sepsis är ESBL-produktion ett allvarligt problem. ESBL är också oroande eftersom det sprids epidemiskt. Detta möjliggörs av att generna som kodar för ESBLs (s.k. bla-gener) ligger på plasmider, som replikerar och sprider de replikerade plasmidkopiorna självständigt. Plasmider replikeras som s.k. replikon. Plasmider med samma replikonvariant tillhör samma plasmidfamilj. Syftet med detta arbete var att detektera plasmidfamiljer som bär bla-gener i E. coli och K. pneumoniae isolerade från kliniska prov (n = 6) och miljöprov (n = 22) från Helge Å. Plasmidfamiljernas prevalens undersöktes, liksom sambandet mellan plasmidfamiljer och bla-gener. Plasmidfamiljerna detekterades med ett PBRT-kit (PCR Based Replicon Typing), ett multiplext PCR-kit som detekterade 30 replikon varav 27 replikon som representerar de 27 plasmidfamiljer som finns i Enterobacteriaceae och tre nya replikon. Plasmidfamiljen IncF var vanligast förekommande i båda arter i både kliniska isolat och miljöisolat. IncF verkade förekomma för alla undersökta typer av ESBL, men det var generellt svårt att förknippa en bla-gen med en plasmidfamilj, eftersom de flesta isolaten bar flera bla-gener och flera plasmidfamiljer.

No description available.

Introdução - A crescente resistência antimicrobiana em bactérias responsáveis por infecções hospitalares é um grande desafio à Saúde Pública. as B-lactamases de espectro estendido (ESBL), que hidrolisam a maioria dos compostos B-lactâmicos, são reconhecidas mundialmente como um grande problema para pacientes hospitalizados, devido à localização de seus genes em elementos transferíveis, facilitando sua disseminação. Objetivo - Caracterizar geneticamente cepas de Enterobactérias produtoras de ESBL isoladas de pacientes de um hospital público da cidade de São Paulo. Material e métodos - Todas as cepas de enterobactérias produtoras de ESBL isoladas em um ano foram submetidas a análises moleculares pela PCR, com iniciadores específicos para oito genes bla, e as cepas de Klebsiella pneumoniae ESBL positivas (ESBL-Kp) identificadas nesse período foram comparadas pela técnica de PFGE.Resultados - Os genes, bla(tem), bla(shv), bla(ctx-m), bla(per-2) bla(veb) and bla(ges) foram identificados em 9 espécies: Klebsiella pneumoniae (71,5 por cento), Escherichia coli (13,5 por cento), Morganella morganii (6 por cento), Proteus mirabilis (3 por cento), Klebsiella oxytoca (1,5 por cento), Providencia rettgeri (1,5 por cento), Providencia stuartii (1,5 por cento), Enterobacter aerogenes (0,75 por cento). Os genes bla(per-1) e bla(oxa) não foram detectados. O PFGE revelou 8 perfis moleculares principais em 68,4 por cento das ESBL-Kp, e 31,6 por cento das cepas não estavam relacionadas. Conclusões - Os resultados de PCR revelaram uma grande variedade de grupos de ESBL, e aparentemente este é o primeiro relato de grupos GES e VEB em enterobactérias no Brasil. / Introduction - The increasing antimicrobial resistance in pathogenic bacteria causing nosocomial infections is a major public health challenge. The extended-spectrum β-lactamases (ESBL), which hydrolyze most of β-lactams, are recognized worldwide as a great problem to hospitalized patients, due to the transferable location of their genes, which facilitates their spreading. Objective - Genetically characterize ESBL-producing Enterobacteriaceae strains isolated from patients of a Public Hospital in the city of São Paulo. Material and Methods - All Enterobacteriaceae ESBL-producing strains isolated in an 1-year period were submitted to molecular analysis by PCR with specific primers for eight bla genes, and all ESBL Klebsiella pneumoniae (ESBL-Kp) identified in this period were compared by the PFGE technique. Results - Genes blaTEM, blaSHV, blaCTX-M, blaPER-2, blaVEB and blaGES were identified in 9 species: Klebsiella pneumoniae (71,5%), Escherichia coli (13,5%), Morganella morganii (6%), Proteus mirabilis (3%), Klebsiella oxytoca (1,5%), Providencia rettgeri (1,5%), Providencia stuartii (1,5%), Enterobacter aerogenes (0,75%) and Enterobacter cloacae (0,75%). Genes blaPER-1 and blaOXA were not detected in any strain. PFGE revealed 8 distinct main molecular patterns in 68,4% of ESBL-Kp, and 31,6% of the strains were totally unrelated. Conclusions - PCR results showed a great variety of ESBL groups in the institution, and apparently this is the first report of GES- and VEB-ESBL groups in enterobacteria in Brazil. The results suggest the spread of resistance genes in different strains of ESBL-Kp in some hospital wards, and also that some strongly related clones of these bacteria colonized patients from a neonatal ward in a 3-month period.

Introdução - A crescente resistência antimicrobiana em bactérias responsáveis por infecções hospitalares é um grande desafio à Saúde Pública. as B-lactamases de espectro estendido (ESBL), que hidrolisam a maioria dos compostos B-lactâmicos, são reconhecidas mundialmente como um grande problema para pacientes hospitalizados, devido à localização de seus genes em elementos transferíveis, facilitando sua disseminação. Objetivo - Caracterizar geneticamente cepas de Enterobactérias produtoras de ESBL isoladas de pacientes de um hospital público da cidade de São Paulo. Material e métodos - Todas as cepas de enterobactérias produtoras de ESBL isoladas em um ano foram submetidas a análises moleculares pela PCR, com iniciadores específicos para oito genes bla, e as cepas de Klebsiella pneumoniae ESBL positivas (ESBL-Kp) identificadas nesse período foram comparadas pela técnica de PFGE.Resultados - Os genes, bla(tem), bla(shv), bla(ctx-m), bla(per-2) bla(veb) and bla(ges) foram identificados em 9 espécies: Klebsiella pneumoniae (71,5 por cento), Escherichia coli (13,5 por cento), Morganella morganii (6 por cento), Proteus mirabilis (3 por cento), Klebsiella oxytoca (1,5 por cento), Providencia rettgeri (1,5 por cento), Providencia stuartii (1,5 por cento), Enterobacter aerogenes (0,75 por cento). Os genes bla(per-1) e bla(oxa) não foram detectados. O PFGE revelou 8 perfis moleculares principais em 68,4 por cento das ESBL-Kp, e 31,6 por cento das cepas não estavam relacionadas. Conclusões - Os resultados de PCR revelaram uma grande variedade de grupos de ESBL, e aparentemente este é o primeiro relato de grupos GES e VEB em enterobactérias no Brasil. / Introduction - The increasing antimicrobial resistance in pathogenic bacteria causing nosocomial infections is a major public health challenge. The extended-spectrum β-lactamases (ESBL), which hydrolyze most of β-lactams, are recognized worldwide as a great problem to hospitalized patients, due to the transferable location of their genes, which facilitates their spreading. Objective - Genetically characterize ESBL-producing Enterobacteriaceae strains isolated from patients of a Public Hospital in the city of São Paulo. Material and Methods - All Enterobacteriaceae ESBL-producing strains isolated in an 1-year period were submitted to molecular analysis by PCR with specific primers for eight bla genes, and all ESBL Klebsiella pneumoniae (ESBL-Kp) identified in this period were compared by the PFGE technique. Results - Genes blaTEM, blaSHV, blaCTX-M, blaPER-2, blaVEB and blaGES were identified in 9 species: Klebsiella pneumoniae (71,5%), Escherichia coli (13,5%), Morganella morganii (6%), Proteus mirabilis (3%), Klebsiella oxytoca (1,5%), Providencia rettgeri (1,5%), Providencia stuartii (1,5%), Enterobacter aerogenes (0,75%) and Enterobacter cloacae (0,75%). Genes blaPER-1 and blaOXA were not detected in any strain. PFGE revealed 8 distinct main molecular patterns in 68,4% of ESBL-Kp, and 31,6% of the strains were totally unrelated. Conclusions - PCR results showed a great variety of ESBL groups in the institution, and apparently this is the first report of GES- and VEB-ESBL groups in enterobacteria in Brazil. The results suggest the spread of resistance genes in different strains of ESBL-Kp in some hospital wards, and also that some strongly related clones of these bacteria colonized patients from a neonatal ward in a 3-month period.

<p>Escherichia coli i Klebsiella pneumoniae su među najznačajnijim uzročnicima infekcija kod ljudi. Problem predstavljaju multirezistentni sojevi koji se javljaju ne samo u bolničkom nego i u vanbolničkom okruženju. Karbapenemi, beta-laktami sa naj&scaron;irim spektrom delovanja, spadaju u lekove poslednje linije odbrane. Rezistencija na karbapeneme među enterobakterijama je u porastu &scaron;irom sveta. Može nastati usled prisustva karbapenemaza, enzima koji degradiraju karbapeneme, ili usled hiperprodukcije AmpC cefalosporinaza ili beta-laktamaza pro&scaron;irenog spektra uz gubitak porina. Geni koji kodiraju karbapenemaze se nalaze na mobilnim genetičkim elementima koji im omogućavaju brz prenos. Najče&scaron;će karbapenemaze su KPC, NDM, VIM, IMP i OXA-48 enzimi. Detekcija sojeva koji produkuju karbapenemaze nije moguća samo na osnovu profila rezistencije izolata, s obzirom da minimalne inhibitorne koncentracije karbapenema mogu biti u referentnom opsegu. Svaki izolat sa smanjenom osetljivo&scaron;ću na karbapeneme bi trebalo ispitati kako bi se sprečilo njihovo &scaron;irenje. Detekcija karbapenemaza može da se zasniva na fenotipskim i genotipskim metodama. Ciljevi istraživanja su bili da se utvrdi postojanje rezistencije na karbapeneme kod multirezistentnih izolata Escherichia coli i Klebsiella pneumoniae iz kliničkih uzoraka, da se dokaže produkcija karbapenemaza kori&scaron;ćenjem fenotipskih i genotipskih testova, kao i da se analizira osetljivost izolata Escherichia coli i Klebsiella pneumoniae sa molekularno dokazanim karbapenemazama. Istraživanje je sprovedeno kao prospektivna studija u periodu 01.11.2013. do 01.11.2014. godine u Centru za mikrobiologiju Instituta za javno zdravlje Vojvodine u Novom Sadu. U istraživanje je bilo uključeno 300 multirezistentnih izolata Escherichia coli i Klebsiella pneumoniae konsekutivno izolovanih iz kliničkih uzoraka (krv, punktat, sekret iz donjeg respiratornog trakta, urin i sekret rana) hospitalizovanih pacijenata. Identifikacija do nivoa vrste je vr&scaron;ena klasičnim bakteriolo&scaron;kim metodama. Za ispitivanje osetljivosti kori&scaron;ćeni su disk difuziona metoda i gradijent testovi. Vrednosti minimalnih inhibitornih koncentracija su ispitane automatizovanim Vitek 2 sistemom (BioM&eacute;rieux, Francuska), a interpretacija izvr&scaron;ena u skladu sa preporukama CLSI (Clinical Laboratory Standards Institute). Za fenotipsko testiranje prisustva betalaktamaza pro&scaron;irenog spektra kori&scaron;ćen je kombinovani disk test. Za fenotipsko testiranje prisustva karbapenemaza kod sojeva rezistentnih na karbapeneme kori&scaron;ćen je kombinovani disk test i test sinergizma sa dva diska. Detekcija gena za beta-laktamaze blaCTXM, gena za karbapenemaze blaKPC, blaVIM, blaNDM, blaIMP i blaOXA-48-like izvr&scaron;ena je metodom lančane reakcije polimeraze. Genotipizacija odabranih izolata Klebsiella pneumoniae izvr&scaron;ena pomoću repetitivne lančane reakcije polimeraze kori&scaron;ćenjem DiversiLab sistema (BioM&eacute;rieux, Francuska). Od 300 multirezistetntnih izolata, bilo je 242 (80,7%) Klebsiella pneumoniae i 58 (19,3%) Escherichia coli izolovanih iz kliničkih uzoraka. Smanjenu osetljivost na bar jedan karbapenem (imipenem, meropenem, ertapenem) pokazalo je 179 (59,7%) izolata. Fenotipski test za dokazivanje produkcije betalaktamaza pro&scaron;irenog spektra bio je pozitivan kod 87/171 (50,9%) izolata. Gen blaCTX-M je dokazan kod 111/121 (91,7%) izolata. Fenotipski test za dokazivanje karbapenemaza bio je pozitivan kod 65/179 (36,3%) izolata, kod 63 (96,9%) je ukazivao na prisustvo metalo-beta laktamaza, a kod 2 (3,1%) na prisustvo karbapenemaza iz grupe A. Senzitivnost fenotipskog testa za dokazivanje karbapenemaza klase A i B iznosila je 100,0%, specifičnost 96,6%, a ukupna tačnost 97,6%. Karbapenemaze su nađene kod 79/179 (44,1%) izolata rezistentnih na karbapeneme. Gen blaNDM nađen je kod 58 (32,4%) izolata, blaOXA- 48-like kod 11 (6,1%), a blaKPC kod 2 (1,1%) izolata. Geni blaVIM i blaIMP nisu detektovani. Kod 8 (4,5%) izolata nađena su 2 gena koja kodiraju karbapenemaze, blaNDM i blaOXA-48-like. Određivanjem osetljivosti disk difuzionom metodom i automatizovanim Vitek 2 sistemom, izolati koji produkuju karbapenemaze pokazivali su smanjenu osetljivost na sve testirane beta-laktame i gentamicin, odnosno tobramicin. Visok procenat rezistenicije izolati su pokazali u odnosu na ciprofloksacin, levofloksacin i trimetoprim/sulfametoksazol. Najefikasniji antibiotski lekovi su bili amikacin, tigeciklin, fosfomicin i kolistin. Poređenjem minimalnih inhibitornih koncentracija izolata koji produkuju i izolata koji ne produkuju karbapenemaze utvrđena je statistički značajna razlika za meropenem, imipenem, ertapenem, amikacin, gentamicin. Genotipizacijom odabranih izolata Klebsiella pneumoniae kori&scaron;ćenjem DiversiLab sistema klonalno &scaron;irenje je dokazano među izolatima koji produkuju NDM i OXA-48-like karbapenemaze u okviru iste zdravstvene institucije, ali i među različitim zdravstvenim ustanovama. Među izolatima rezistentnim na karbapeneme Klebsiella pneumoniae se če&scaron;će izoluje od Escherichia coli. Kod izolata koji su pokazali smanjenu osetljivost prema bar jednom karbapenemu, karbapenemaze su detektovane u manje od polovine izolata. Kod ostalih izolata dokazane su beta-laktamaze pro&scaron;irenog spektra koje uz gubitak porina mogu uzrokovati rezistenciju na karbapeneme. Kod izolata Klebsiella pneumoniae sa dokazanim genima koji kodiraju karbapenemaze detektovani su pojedinačni blaKPC, blaNDM i blaOXA-48-like geni, kao i kombinacija gena blaNDM i blaOXA-48-like. Kod izolata Escherichia coli nađeni su samo blaNDM geni. Najefikasniji antibiotski lekovi za izolate koji produkuju karbapenemaze su amikacin, tigeciklin, fosfomicin i kolistin. Izolati sa dokazanim karbapenemazama pokazuju rezistenciju na veći broj antibiotika u odnosu na izolate koji ne produkuju karbapenemaze. Dokazano je klonalno &scaron;irenje izolata Klebsiella pneumoniae koji produkuju karbapenemaze. Testove za fenotipsku detekciju karbapenemaza bi trebalo koristiti i u rutinskim mikrobiolo&scaron;kim laboratorijama u skladu sa EUCAST (European Committee on Antimicrobial Susceptibility Testing) preporukama, a konačnu potvrdu treba izvr&scaron;iti molekularnim metodama u referentnoj laboratoriji.</p> / <p>Escherichia coli and Klebsiella pneumoniae are among the most common human pathogens. Multiresistant strains are emerging not only in hospital settings, but also in the community representing a major concern. Carbapenems, beta-lactams with the broadest spectrum of activity are considered to be antibiotics of last resort. Resistance to carbapenems among enterobacteria is spreading worldwide. It is mainly caused by carbapenemases, enzymes capable of degrading carbapenems or by hyperproduction/overexpression of AmpC betalactamases or extended spectrum betalactamases with porin loss. Carbapenemaseencoding genes are usually located on mobile genetic elements providing their fast transfer. The most common carbapenemases are KPC, NDM, VIM, IMP and OXA-48. The detection of carbapenemase-producer cannot rely only on the resistance profile as their minimal inhibitory concentration values may sometimes lay within the susceptibility range. Therefore, every multidrug-resistant isolates with lower susceptibility to carbapenems should be tested for the presence of carbapenemases in order to prevent further spreading. The detection of carbapenemases is based on phenotypic and genotypic methods. The aims of the study were to determine the occurrence of carbapenem resistance in multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolated from clinical samples, to detect carbapenemase production using both phenotypic and genotypic methods and to analyze the susceptibility of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae. The study was conducted from 1st November 2013 to 1st November 2014 at the Center for Microbiology in the Institute for Public Health of Vojvodina, Novi Sad, Serbia. The study included 300 nonrepetitive multidrug-resistant strains of Escherichia coli and Klebsiella pneumoniae isolated from clinical specimen (blood, aspirates, lower respiratory tract secretions, urine and wound secretion) of hospitalized patients. Identification of isolated strains was done using conventional bacteriological methods. Antimicrobial susceptibility was tested using the disk diffusion method and MIC test strips. Minimal inhibitory concentrations were determined using Vitek 2 Compact automated system (BioM&eacute;rieux, France), interpreted according to the CLSI (Clinical and Laboratory Standards Institute) recommendations. Phenotypic testing of extended-spectrum beta-lactamases production was done using combined disk test. Phenotypic testing of carbapenemase production was done by combined disk test and double-disk synergy test. Detection of blaCTX-M, gene encoding extended-spectrum beta-lactamases and blaKPC, blaVIM, blaNDM, blaIMP i blaOXA-48-like, genes encoding carbapenemases was done using PCR. Genotyping of selected Klebsiella pneumoniae isolates was done by repPCR using DiversiLab system (BioM&eacute;rieux, France). From the total of 300 multiresistant isolates, 242 (80.7%) were Klebsiella pneumoniae and 58 (19.3%) were Escherichia coli obtained from clinical samples. Reduced susceptibility to at least one carbapenem (imipenem, meropenem, ertapenem) was found in 179 (59.7%) isolates. Phenotypic test for extended-spectrum betalactamases production was positive in 87/171 (50.9%) isolates. A total of 111/121 (91.7%) isolates harbored blaCTX-M. Phenotypic test for carbapenemase production was positive in 65/179 (36.3%) isolates, 63 (96.9%) indicating the presence of metallo-beta-lactamases and 2 (3.1%) indicating the presence of class A carbapenemases. Sensitivity of the phenotypic test for carbapenemase production of class A and B was 100.0%, specificity 96.6% and overall accuracy 97.6%. Carbapenemases were detected in 79/179 (44.1%) carbapenemresistant isolates. Gene blaNDM was found in 58 (32.4%) isolates, blaOXA-48-like in 11 (6.1%) and blaKPC in 2 (1.1%) isolates. Genes blaVIM and blaIMP were not detected. In 8 (4.5%) isolates 2 genes encoding carbapenemases were found, blaNDM and blaOXA-48-like. Using both disk diffusion method and Vitek 2 automated system for antimicrobial susceptibility testing carbapenemase-producing isolates were resistant to all beta-lactams and also to gentamicin and tobramicin respectively. Resistance rates were high for ciprofloxacin, levofloxacin and cotrimoxazole. Good activity maintained for amikacin, tigecycline, fosfomycin and colistin. Comparing minimal inhibitory concentrations of carbapenemaseproducing isolates and non-carbapenemase producers, significant difference was found for meropenem, imipenem, ertapenem, amikacin and gentamicin. Genotyping of selected Klebsiella pneumoniae isolates using DiversiLab system, revealed the clonal spread of NDM- and OXA-48-like-producers not only within one healthcare-setting, but also between different healthcare centers. Among carbapenem-resistant isolates, Klebsiella pneumoniae was found more often than Escherichia coli. Carbapenemases were detected in less than 50% of isolates resistant to at least one carbapenem. In other carbapenem resistant isolates extended-spectrum betalactamases were confirmed most likely causing carbapenem-resistance with porin deficiency or porin loss. Among carbapenemase-producing Klebsiella pneumoniae blaKPC, blaNDM and blaOXA-48-like genes were detected, as well as combination of 2 genes blaNDM and blaOXA-48-like. In carbapenemase-producing Escherichia coli only blaNDM was found. The most efficient antimicrobial drugs among tested carbapenemase-producing isolates were amikacin, tigecycline, fosfomycin and colistin. Carbapenemase-producing isolates were resistant to more antimicrobial agents compared to non-carbapenemase producers. Clonal dissemination of carbapenemase-producing Klebsiella pneumoniae was confirmed. Phenotypic detection of carbapenemase production should be done in routine microbiology laboratories according to EUCAST (European Committee on Antimicrobial Susceptibility Testing) recommendations. Final confirmation should be done by molecular methods in the reference laboratory.</p>

Les antibiotiques β-lactamines sont parmi les médicaments antimicrobiens les plus anciens et les plus utilisés. L'enzyme bactérienne β-lactamase hydrolyse l'antibiotique β-lactame en cassant la structure de base "anneau β-lactame". Pour identifier les nouvelles β-lactamases, une étude complète a été réalisée dans diverses bases de données biologiques telles que Human Microbiome Project, env_nr et NCBI nr. L'analyse a révélé que les séquences ancestrales putatives et les recherches de profil HMM jouaient un rôle important dans l'identification de la base de données homologue et métagénomique à distance dans l'enzyme β-lactamase existante comme matière noire. Les larges analyses phylogénétiques des β-lactamases existantes et nouvellement identifiées représentent les nouveaux clades dans les arbres. En outre, l'activité d'hydrolyse des antibiotiques β-lactamines de séquences nouvellement identifiées (provenant d'archées et d'humains) a été étudiée en laboratoire, ce qui montre l'activité de la β-lactamase. La deuxième phase de l'étude a été entreprise pour examiner l'évolution fonctionnelle des β-lactamases. Premièrement, des séquences de protéines ß-lactamase 1155 ont été extraites de la base de données ARG-ANNOT et des valeurs CMI la littérature correspondante. Les résultats ont révélé que l'activité fonctionnelle de la β-lactamase évoluait de manière convergente au sein de la classe moléculaire. La troisième phase de cette thèse représente le développement d'une base de données intégrative de β-lactamases. La base de données publique actuelle de β-lactamases a des informations limitées, par conséquence, une base de données intégrative a été développée. / The β-lactam antibiotics are one of the oldest and widely used antimicrobial drugs. The bacterial enzyme β-lactamase hydrolyzes the β-lactam antibiotic by breaking the core structure “β-lactam ring”. To identify the novel β-lactamases a comprehensive investigation was performed in different biological databases such as Human Microbiome Project, env_nr, and NCBI nr. The analysis revealed that putative ancestral sequences and HMM profile searches played a significant role in the identification of remote homologous and uncovered the existing β-lactamase enzyme in the metagenomic database as dark-matter. The comprehensive phylogenetic analyses of extant and newly identified β-lactamase represent the novel clades in the trees. Further, the β-lactam antibiotic hydrolysis activity of newly identified sequences (from archaea and human) was investigated in laboratory, which shows β-lactamase activity.The second phase of the investigation was undertaken to examine the functional evolution of β-lactamases. First, 1155 β-lactamase protein sequences were retrieved from ARG-ANNOT database and MIC values from the corresponding literature. The results revealed that the functional activity of β-lactamase evolved convergently within the molecular class.The third phase of this thesis presents development of an integrative β-lactamase database. The existing public database of β-lactamase has limited information, therefore, an integrative database was developed.

Submitted by Edisangela Bastos (edisangela@ufpa.br) on 2015-06-29T18:23:12Z No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) Dissertacao_InvestigacaoGenesBla.pdf: 1111769 bytes, checksum: 0a840604d3d503325d9540739858f390 (MD5) / Approved for entry into archive by Ana Rosa Silva (arosa@ufpa.br) on 2015-07-23T13:49:39Z (GMT) No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) Dissertacao_InvestigacaoGenesBla.pdf: 1111769 bytes, checksum: 0a840604d3d503325d9540739858f390 (MD5) / Made available in DSpace on 2015-07-23T13:49:39Z (GMT). No. of bitstreams: 2 license_rdf: 22974 bytes, checksum: 99c771d9f0b9c46790009b9874d49253 (MD5) Dissertacao_InvestigacaoGenesBla.pdf: 1111769 bytes, checksum: 0a840604d3d503325d9540739858f390 (MD5) Previous issue date: 2012 / As beta-lactamases são produzidas por bactérias gram-positivas e gram-negativas. Cerca de 40% a 50% das mulheres desenvolveram um infecção urinária durante a sua vida adulta. O objetivo o presente trabalho foi realizar a caracterização dos genes Bla SHV, Bla TEM e Bla CTX-M produtoras de beta-lactamases de espectro estendido em E. coli e Klebsiella spp isoladas de gestante com infecção do trato urinário atendidas na Unidade Básica de Saúde de Imperatriz - MA no período de maio a agosto de 2012. Participaram do presente estudo 50 de mulheres grávidas maiores de 18 anos, que apresentaram sintomas com caracterização clínica de infecção do trato urinário (ITU), referenciadas no ambulatório na Unidade Básica de Saúde Imperatriz - MA. Foi coletada urina, para realização da urinocultura e antibiograma, posteriormente foi realizado a Reação em Cadeia da Polimerase (PCR) detectar a presença dos genes Bla SHV, Bla TEM e Bla CTX-M produtores das enzimas Beta-lactamases. A média de idade destes pacientes foi de 21 anos, sendo 42% estando na faixa etária de 18 a 25 anos, 70% destas tem residência fixa em Imperatriz e os outros 30% são oriundos de outros municípios. Entre estas, 24% das voluntárias já apresentaram ITU durante a gravidez e fora do estado gravídico e 80% delas afirmaram fazer o uso de antibióticos sem prescrição médica. Das 12 amostras com crescimento microbiológico positivo, 11 foram positivas para Escherichia coli com resultados do antibiograma que apresentaram resistência para o antibiótico cefalotina, em 91,7%. Sendo isolado, uma cepa de Klebsiella ssp, e esta apresentou resistência a todos os antibióticos testados. Pela análise dos resultados da PCR das amostras isoladas, os três genes Bla SHV, Bla TEM e Bla CTX-M, não foram observadas nas amostras P9, P11 e P12, porém nas demais amostras houve a ocorrência de pelo menos um dos genes. Este estudo confirmou a presença dos três tipos de genes (Bla SHV, Bla TEM e Bla CTX-M) entre as amostras estudada. / Beta-lactamases are produced by gram-positive and gram-negative bacteria. About 40% to 50% of women developed a urinary tract infection during their adult life. The aim of the present study was the characterization of genes Bla SHV, Bla TEM e Bla CTX-M beta-lactamase-producing extended-spectrum E. coli and Klebsiella spp isolated from pregnant women with urinary tract infection treated at a Basic Health Unit of Empress - MA from May to August 2012. The study included 50 pregnant women over 18 years who presented with symptoms clinical characterization of urinary tract infection (UTI), referenced in the clinic in the Basic Health Empress - MA. Urine was collected for urine culture and sensitivity of achievement, subsequently was performed Polymerase Chain Reaction (PCR) to detect the presence of genes Bla SHV, Bla TEM e Bla CTX-M, enzymes producing beta-lactamases. The mean age of these patients was 21 years, 42% being aged 18 to 25 years, 70% of these fixed address in Empress and the other 30% come from other municipalities. Among these, 24% of the volunteers already had UTI during pregnancy and pregnancy out of state and 80% of them reported using antibiotics without prescription. Of the 12 samples with positive microbiological growth, 11 were positive for Escherichia coli with the antibiogram results that were resistant to the antibiotic cephalothin at 91.7%. Being isolated, a strain of Klebsiella spp, and this was resistant to all antibiotics tested. By analyzing the results of PCR samples isolated three genes Bla SHV, Bla TEM e Bla CTX-M, were not observed in samples P9, P11 and P12, but in the other samples was the occurrence of at least one of the genes. This study confirmed the presence of three types of genes (Bla SHV, Bla TEM e Bla CTX-M) among the samples studied.

OBJETIVO: Establecer la contribución de los integrones de clase 1 a la resistencia antibiótica en aislados clínicos de enterobacterias de dos contextos epidemiológicos: zoonosis por Salmonella enterica e infección por Klebsiella pneumoniae resistente a amoxicilina/clavulánico (ACL) adquirida en un centro sociosanitario. AISLADOS: Se estudiaron (a) 92 aislados humanos de Salmonella enterica serotipo Typhimurium (ST) recuperados entre 2004 y 2006 en el laboratorio de microbiología del Hospital Verge de la Cinta de Tortosa (35 aislados adicionales de una colección de 2000-2001 para estudios de epidemiología molecular) y 382 aislados de S. enterica de otros serotipos (SNT) recuperados en ese laboratorio en 2001 y entre 2004 y 2009 (b) 45 aislados de K. pneumoniae resistentes a ACL y sensibles a cefazolina y dos resistentes a ACL con fenotipo sugestivo de AmpC plasmídica y resistencia transferible a quinolonas recuperados entre 2006 y 2008 de muestras clínicas de pacientes de un centro sociosanitario de la región sanitaria Terres de l’Ebre. RESULTADOS: (a) Salmonella enterica: El 77,2% de los aislados de ST y el 16,5% de los de SNT fueron resistentes a más de dos familias de antibióticos (MDR). El 3,3% de los aislados de ST y el 41% de los de SNT fueron resistentes a ácido nalidíxico y sólo se constató resistencia a ciprofloxacino en tres aislados de S. Kentucky. Las β-lactamasas presentes en los aislados de ST resistentes a amoxicilina (60,9%) fueron OXA-1 (52%), TEM-1 (32%) y PSE-1 (18,7%) y en los aislados resistentes de SNT (24,3%) TEM-1 (90,3%), CTX-M-9 (1 aislado de S. Virchow y 1 aislado de S. Grumpensis qnrA1 positivo), CTX-M-15 (1 aislado de S. Kapemba) y DHA-1 (1 aislado de S. Newport qnrB4 positivo); ésta es la primera descripción de β-lactamasas de espectro extendido en S. Kapemba y S. Grumpensis. 56 aislados de ST y 35 de SNT, todos excepto uno MDR, poseían integrones de clase 1. En ST los aislados predominantes fueron los que albergaban el integrón de región variable (RV) blaOXA-1-aadA1, cuya frecuencia superaba la registrada para el conjunto de España, seguidos de los aislados con el perfil de integrones aadA2 + blaPSE-1 típico de la presencia de SGI1; la mayoría de aislados con uno u otro perfil de integrones estaban relacionados clonalmente. En SNT se identificaron 11 tipos de integrones en 15 serotipos distintos (incluidos S. Kapemba, S. Mikawasima y S. ser [9,12:Iv:i:-] en los que no se habían descrito previamente), siendo los de RV dfrA1-aadA1, dfrA17-aadA5 y dfrA12-orf-aadA2 los presentes en mayor número de serotipos; en los dos aislados blaCTX-M-9 positivos, este gen estaba ubicado en un integrón complejo cuya RV 1 fue dfrA16-aadA2 en S. Virchow y aadB-aadA2 en S. Grumpnesis. Se detectaron dos variantes de integrones atípicos asociados a sul3: dfrA12-orF-aadA2-cmlA-aad1 (5 aislados de ST y 4 de S. Enteritidis) y estX-psp (2 S. Grumpensis). Este último integrón y el de RV aadA13-sat, también identificado en S. Grumpensis, no se habían descrito anteriormente en S. enterica. (b) Klebsiella pneumoniae centro socio-sanitario: Todos los aislados resistentes a ACL y sensibles a cefazolina producían una penicilinasa resistente a inhibidores, IRT-11 (n=19) u OXA-1 (n=26). Los aislados productores de IRT-11 se agrupaban en tres clones y sólo uno portaba un integrón de clase 1 (RV dfrA12-orf-aadA2); este es el segundo caso comunicado de brote nosocomial por producción de un enzima IRT. Todos los aislados productores de OXA-1 eran MDR y 23 de ellos acarreaban un integrón de clase 1, transferible por conjugación y asociado a qnrS2, de RV [aac (6’)-1b-cr- blaOXA1-catB3-arr3], que en tres aislados era defectivo en 3’. Los aislados se agrupaban en tres clones diferentes según poseyesen integrones de clase 1 convencionales, defectivos o no presentaran integrones. Un integrón de idéntica RV y vinculado a blaDHA-1 y qnrB4 en un integrón complejo de nueva estructura (Genbank GU906294) muy semejante a In37 y del que se diferenciaba por haber sufrido la deleción, por la inserción de IS26, de la región comprendida entre la primera copia de 3’CS y qnrB4, se detectó en otros dos aislados MDR de K. pneumoniae, indistinguibles genéticamente y qnrS2 positivos. / The aim of this work was to assess the contribution of class 1 integrons to antimicrobial resistance in clinical isolates of Enterobacteriaceae of human origin from two epidemiological settings: zoonosis caused by Salmonella enterica and infection due to amoxicillin-clavulanate(ACL)-resistant Klebsiella pneumoniae acquired in a chronic care center. RESULTS: (a) S. Typhimurium: 71 of the 92 isolates recovered from 2004 to 2006 at the microbiology laboratory of Hospital Verge de la Cinta (Tortosa. Catalonia. Spain) were multidrug-resistant (MDR), of which 56 carried class 1 integrons. Isolates bearing the blaOXA-1-aadA1 variable region integron were the commonest among this serovar, showing a higher frequency than that reported in other areas of Spain, followed by isolates exhibiting the integron profile typical of SGI1 (aadA2 + blaPSE-1); most isolates displaying any of these two integron profiles shared identical genotype. Five isolates possessed a sul3-associated class 1 integron whose structure was 5’CS–dfrA12–orfF–aadA2–cmlA1–aadA1–qacH–IS440–sul3. (b) Non-Typhimurium S. enterica: 16.5% of the 382 isolates recovered in 2001 and from 2004-2009 at the same laboratory were MDR and 35 carried class 1 integrons. Overall, 11 different class 1 integrons were identified in 15 distinct serotypes (including S. Kapemba, S. Mikawasima and S. ser [9,12:Iv:i:-], where they had not been previously described), being those with dfrA1-aadA1, dfrA17-aadA5 and dfrA12-orf-aadA2 variable regions the most widely distributed. Two isolates (one qnrA1 positive S. Grumpensis and one S. Virchow) bore a complex class 1 integron linked to blaCTX-M-9 and 4 S. Enteritidis and 2 S. Rissen carried atypical sul3-type integrons (5’CS–dfrA12–orfF–aadA2–cmlA1–aadA1–qacH–IS440–sul3 and 5’CS–estX-psp-IS440–sul3, respectively). The former integron and the aadA13-sat one, detected in S. Grumpensis, had never been reported before in S. enterica. (c) Klebsiella pneumoniae: 47 ACL-resistant (45 cefazolin-susceptible and 2 broad-spectrum-cephalosporin-resistant) isolates, recovered between 2006 and 2008 from patients attending a chronic care center, were investigated. All cefazolin-susceptible isolates produced an inhibitor-resistant penicillinase, IRT 11 (n= 19) or OXA-1 (n=26); 23 OXA-1-producing isolates harboured a class 1 integron, associated with qnrS2, with the aac(6’)- Ib-cr, blaOXA-1, catB3, arr3 cassette arrangement (in 3 cases the integron was defective in 3’ end). An integron with identical structure, linked to blaDHA-1 and qnrB4 within an In37-like complex class 1 integron of novel structure (Genbank GU906294), was found in two epidemiologically closely related qnrS2 positive isolates.