Conselho Nacional de Desenvolvimento Científico e Tecnológico / Buscamos detectar evidências da presença de genes envolvidos na produção de Enzimas Modificadoras de Aminoglicosídeos (EMAs), Beta-lactamases de espectro estendido (ESBLs) e Mecanismos Plasmidiais de Resistência a Quinolonas (PMQRs) em cepas de K. pneumoniae, K. ozaenae e E. coli isoladas de amostras de água de rios afluentes da Baía de Guanabara e de materiais clínicos de origem hospitalar, além de avaliar o "status sanitário" dos corpos aquáticos abordados no tocante à contaminação fecal recente e indicações de contaminação hospitalar e por outros ambientes de alta seletividade. As cepas de materiais clínicos foram selecionadas entre Maio e Julho de 2010, a partir da semeadura em meio de cultura contendo 8g/mL de gentamicina. As amostras de água foram coletadas em Abril e em Julho de 2009. Realizamos testes de colimetria, empregando para tal, a metodologia convencional e outra, na qual adicionamos 32g/mL de cefalotina e 8g/mL de gentamicina aos caldos Lactosado e Escherichia coli (caldo EC), a fim de detectar e quantificar coliformes resistentes. Para o isolamento das cepas empregamos meios de cultura contendo 32g/mL de cefalotina e 8g/mL de gentamicina. As cepas foram identificadas e submetidas a testes de susceptibilidade aos antimicrobianos (TSA), testes presuntivos para presença de ESBLs, extração de DNA plasmidial e ensaios de Reação em Cadeia de Polimerase (PCR) para a detecção dos genes. A utilização de agentes antimicrobianos nos testes de colimetria nos permitiu detectar a presença e quantificar coliformes totais e fecais resistentes nas amostras de água analisadas nos diferentes pontos. O TSA das cepas isoladas de amostras de água exibiu perfis de multirresistência, compatíveis com o de bactérias de origem hospitalar, semelhante ao encontrado nas cepas isoladas de materiais clínicos. Todas as cepas isoladas de amostras de água e 90% das cepas de materiais clínicos apresentaram pelo menos uma banda plasmidial. Os ensaios de PCR evidenciaram a presença de produtos de amplificação para EMAs, ESBLs e PMQRs, sendo que 7,4% das cepas de amostras de água e 20% das cepas de materiais clínicos apresentaram produtos de amplificação para as três classes de antimicrobianos. A realização de testes de colimetria empregando antimicrobianos, como gentamicina e cefalotina, pode ser uma ferramenta adicional importante ao teste convencional, quando o interesse for, o monitoramento e a prevenção de contaminação ambiental, especialmente associada a microrganismos carreando genes de resistência. O uso criterioso de antimicrobianos em atividades de cunho hospitalar e veterinário e medidas no sentido de prevenção de lançamento de esgoto e/ou tratamento dos efluentes, são fundamentais para o controle da disseminação de elementos genéticos de resistência transferíveis entre os microrganismos. A detecção e identificação de microrganismos apresentando elementos de resistência em ambiente extra-hospitalar como em água e solo, em particular, o emprego de testes de colimetria empregando antimicrobianos, se faz necessária, como forma de prevenção e controle de disseminação destes microrganismos com potencial de causar infecções em humanos e outros animais que eventualmente entram em contato com estes ambientes. / We seek to detect evidence of the presence of genes involved in the production of Aminoglycoside Modifying Enzymes (AME), Extended-spectrum beta-lactamases (ESBLs) and Plasmid Mechanisms of Resistance to Quinolones (PMQRs) in strains of K. pneumoniae, K. ozaenae and E. coli isolated from water samples from rivers of Guanabara Bay and clinical samples of hospital origin, and to evaluate the "health status" of water bodies addressed in relation to recent fecal contamination and signs of hospital contamination and other environments with high selectivity. The strains from clinical materials were selected between May and July 2010, using culture media containing 8g/mL gentamicin. Water samples were collected in April and July 2009. Colimetric assays were performed, using the conventional methodology and other which we added 32g/mL cephalothin and 8g/mL of gentamicin at Lactose and Escherichia coli broth (EC broth), in order to detect and to count resistant coliforms. For isolation of the strains we employed culture media containing 32g/mL cephalothin and 8g/mL gentamicin. The strains were identified and submitted to tests for antimicrobial susceptibility (TSA), presumptive tests for the presence of ESBLs, plasmid DNA extraction and tests of the Polymerase Chain Reaction (PCR). The use of antimicrobial agents in colimetric assays allowed us to detect and to count the resistant total and fecal coliforms in the water samples analyzed at different points. The TSA of the isolates recovered from water samples showed multidrug-resistance profiles, compatible with that of nosocomial bacteria, similar to that found in isolates recovered from clinical materials. All isolates from water samples and 90% of the isolates of clinical samples showed at least one plasmid band. PCR assays demonstrated the presence of amplification products to AME, ESBLs and PMQRs, and 7.4% of the isolates recovered of samples of water and 20% of the isolates of clinical materials showed amplification products for the three antimicrobial classes. The colimetric assays using antimicrobials as gentamicin and cephalotin, may be important additional tool to conventional colimetric test, when the interest is the monitoring and prevention of environmental contamination, especially associated with drug-resistant microorganisms, carrying resistance genes. We believe that besides the judicious use of antimicrobial in hospital and veterinary activities, measures to prevent discharge of sewage and / or sewage treatment, are essential to control the dissemination of transferable genetic elements of resistance among microorganisms. The detection and identification of microorganisms presenting genetic elements in environment, as water and soil, privately colimetric assays using antimicrobials, are necessary to prevent and to control of dissemination to these microorganisms with potential to infect humans and other animals in eventual contact with this environment.

Conselho Nacional de Desenvolvimento Científico e Tecnológico / Buscamos detectar evidências da presença de genes envolvidos na produção de Enzimas Modificadoras de Aminoglicosídeos (EMAs), Beta-lactamases de espectro estendido (ESBLs) e Mecanismos Plasmidiais de Resistência a Quinolonas (PMQRs) em cepas de K. pneumoniae, K. ozaenae e E. coli isoladas de amostras de água de rios afluentes da Baía de Guanabara e de materiais clínicos de origem hospitalar, além de avaliar o "status sanitário" dos corpos aquáticos abordados no tocante à contaminação fecal recente e indicações de contaminação hospitalar e por outros ambientes de alta seletividade. As cepas de materiais clínicos foram selecionadas entre Maio e Julho de 2010, a partir da semeadura em meio de cultura contendo 8g/mL de gentamicina. As amostras de água foram coletadas em Abril e em Julho de 2009. Realizamos testes de colimetria, empregando para tal, a metodologia convencional e outra, na qual adicionamos 32g/mL de cefalotina e 8g/mL de gentamicina aos caldos Lactosado e Escherichia coli (caldo EC), a fim de detectar e quantificar coliformes resistentes. Para o isolamento das cepas empregamos meios de cultura contendo 32g/mL de cefalotina e 8g/mL de gentamicina. As cepas foram identificadas e submetidas a testes de susceptibilidade aos antimicrobianos (TSA), testes presuntivos para presença de ESBLs, extração de DNA plasmidial e ensaios de Reação em Cadeia de Polimerase (PCR) para a detecção dos genes. A utilização de agentes antimicrobianos nos testes de colimetria nos permitiu detectar a presença e quantificar coliformes totais e fecais resistentes nas amostras de água analisadas nos diferentes pontos. O TSA das cepas isoladas de amostras de água exibiu perfis de multirresistência, compatíveis com o de bactérias de origem hospitalar, semelhante ao encontrado nas cepas isoladas de materiais clínicos. Todas as cepas isoladas de amostras de água e 90% das cepas de materiais clínicos apresentaram pelo menos uma banda plasmidial. Os ensaios de PCR evidenciaram a presença de produtos de amplificação para EMAs, ESBLs e PMQRs, sendo que 7,4% das cepas de amostras de água e 20% das cepas de materiais clínicos apresentaram produtos de amplificação para as três classes de antimicrobianos. A realização de testes de colimetria empregando antimicrobianos, como gentamicina e cefalotina, pode ser uma ferramenta adicional importante ao teste convencional, quando o interesse for, o monitoramento e a prevenção de contaminação ambiental, especialmente associada a microrganismos carreando genes de resistência. O uso criterioso de antimicrobianos em atividades de cunho hospitalar e veterinário e medidas no sentido de prevenção de lançamento de esgoto e/ou tratamento dos efluentes, são fundamentais para o controle da disseminação de elementos genéticos de resistência transferíveis entre os microrganismos. A detecção e identificação de microrganismos apresentando elementos de resistência em ambiente extra-hospitalar como em água e solo, em particular, o emprego de testes de colimetria empregando antimicrobianos, se faz necessária, como forma de prevenção e controle de disseminação destes microrganismos com potencial de causar infecções em humanos e outros animais que eventualmente entram em contato com estes ambientes. / We seek to detect evidence of the presence of genes involved in the production of Aminoglycoside Modifying Enzymes (AME), Extended-spectrum beta-lactamases (ESBLs) and Plasmid Mechanisms of Resistance to Quinolones (PMQRs) in strains of K. pneumoniae, K. ozaenae and E. coli isolated from water samples from rivers of Guanabara Bay and clinical samples of hospital origin, and to evaluate the "health status" of water bodies addressed in relation to recent fecal contamination and signs of hospital contamination and other environments with high selectivity. The strains from clinical materials were selected between May and July 2010, using culture media containing 8g/mL gentamicin. Water samples were collected in April and July 2009. Colimetric assays were performed, using the conventional methodology and other which we added 32g/mL cephalothin and 8g/mL of gentamicin at Lactose and Escherichia coli broth (EC broth), in order to detect and to count resistant coliforms. For isolation of the strains we employed culture media containing 32g/mL cephalothin and 8g/mL gentamicin. The strains were identified and submitted to tests for antimicrobial susceptibility (TSA), presumptive tests for the presence of ESBLs, plasmid DNA extraction and tests of the Polymerase Chain Reaction (PCR). The use of antimicrobial agents in colimetric assays allowed us to detect and to count the resistant total and fecal coliforms in the water samples analyzed at different points. The TSA of the isolates recovered from water samples showed multidrug-resistance profiles, compatible with that of nosocomial bacteria, similar to that found in isolates recovered from clinical materials. All isolates from water samples and 90% of the isolates of clinical samples showed at least one plasmid band. PCR assays demonstrated the presence of amplification products to AME, ESBLs and PMQRs, and 7.4% of the isolates recovered of samples of water and 20% of the isolates of clinical materials showed amplification products for the three antimicrobial classes. The colimetric assays using antimicrobials as gentamicin and cephalotin, may be important additional tool to conventional colimetric test, when the interest is the monitoring and prevention of environmental contamination, especially associated with drug-resistant microorganisms, carrying resistance genes. We believe that besides the judicious use of antimicrobial in hospital and veterinary activities, measures to prevent discharge of sewage and / or sewage treatment, are essential to control the dissemination of transferable genetic elements of resistance among microorganisms. The detection and identification of microorganisms presenting genetic elements in environment, as water and soil, privately colimetric assays using antimicrobials, are necessary to prevent and to control of dissemination to these microorganisms with potential to infect humans and other animals in eventual contact with this environment.

Após o surgimento e disseminação das β-lactamases de amplo espectro em membros da família Enterobacteriaceae, os antibióticos carbapenêmicos (imipenem, meropenemeertapenem) têm sido considerados a terapia de escolha devido à estabilidade apresentada contra estas enzimas. A desvantagem destes antibióticos é a sua capacidade de induzir resistência aos β-lactâmicos e a outros antibióticos quimicamente não relacionados. O imipenem tem favorecido a indução de cefalosporinases cromossômicas (AmpC) e também tem sido relacionado, in vivo, com a seleção de mecanismos intrínsecos de resistência, contribuindo com o perfil multi -droga resistente (MDR). Esse perfil é freqüentemente associado à diminuição da permeabilidade por alteração na síntese de porinas em conjunto com um aumento da atividade de bombas de efluxo, as quais não permitem o estabelecimento de uma concentração ativa do antibiótico no interior da célula bacteriana. O presente trabalho teve como objetivo avaliar o estabelecimento do perfil MDR em enterobactérias provenientes de isolados clínicos em função da exposição a diferentes concentrações de imipenemin vitro. A seleção do grupo das amostras estudadas foi feito por meio da determinação do perfil de sensibilidade dos isolados, tipagem molecular e ensaio de hidrólise de Imipenem. Nos isolados selecionados para a indução foi realizada numa etapa inicial (etapa basal) a análise de porinas de membrana externa por SDS-PAGE e o estudo de genes codificadores de β-lactamases pela técnica de PCR. O estudo do estabelecimento do perfil MDR foi feito por meio de passagens sucessivas das amostras em meio contendo concentrações sub-inibitórias de imipenem seguido de análise fenotípica (CIM e acúmulo do antibiótico intracelular e SDS-PAGE), e a análise da expressão gênica de genes associados a permeabilidade de membrana (ompC, ompF eAcrA) e genes reguladores(marA e ompR). Após a indução com o imipenem, 77% dos isolados induzidos aumentaram a CIM para os carbapenêmicos, mudando assim o perfil de resistência observado na etapa basal Também foi afetado o perfil de resistência para outros antibióticos não relacionados a β-lactámicos, porém numa percentagem menor. Com relação à alteração da permeabilidade, a perda de porina foi observada apenas para um isolado, no entanto a diminuição na expressão gênica de Omp36 foi significativa desde o começo da indução. A expressão da bomba de efluxoAcrAB foi afetada pela indução com imipenem, aumentando significativamente a expressão de AcrA, enquanto os reguladores estudados, MarA e OmpR tiveram a sua expressão induzida pelo imipenem. Foi possível observar também associação do nível de expressão gênica do regulador MarA com a expressão de AcrA,porém não foi possível observar uma associação estatisticamente significativa deste regulador com o perfil de expressão de OMPs. A indução de OmpR foi associado com um aumento da expressão de RNAm de Omp35, já para Omp36 foi possível observar apenas uma tendência na repressão deste gene. O estudo da resposta destes genes reguladores e determinantes de resistência, em resposta à exposição ao com o imipenem in vitro, permitiu reportar o comportamento molecular da bactéria numa resposta adaptativa no estagio inicial do estabelecimento do fenótipo MDR. A utilização de isolados clínicos com diversos determinantes de resistência permitiu observar a variabilidade nas respostas adaptativas das enterobacterias, o que é fundamental para a compreensão dos mecanismos de adaptação da bactéria e sua contribuição na falha terapêutica. / After emergence and broad dissemination of extended spectrum β-lactamases into the Enterobacteriaceae family, the carbapenemic antibiotics (imipenem, meropenem and ertapenem) have been considered the chosen therapy in the treatment of nosocomial infections by the stability that these antibiotics show to these enzymes. The disadvantage of carbapenems is theirs capacity to induce resistance against β-lactamics and to other chemically unrelated antibiotics. The imipenem has been shown to induce chromosomal cephalosporinases (AmpC) and it was also related, in vivo, with the selection of intrinsic mechanism leading to multi-drug resistance profile (MDR). This profile is usually associated with membrane impermeability due to reduced outer membrane porin synthesis with an incremented activity of efflux pumps, which results in a reduced concentration of antibiotics inside the bacteria. This study aimed to evaluate the establishment of the MDR profile in Enterobacteriaceae from clinical isolates by exposure to different concentrations of imipenem in vitro. The selection of the study group was performed by determination of antibiotic susceptibility profile,molecular typing and hydrolysis assay of imipenem. In the selected isolates submitted to induction, in an initial step (baseline), was performed the outer membrane porin analysis by SDS-PAGE and the gene-specific amplification of B-lactamase enzymes by PCR. The study of the establishment of MDR was performed by progressive passages with subclinical concentrations of imipenem, followed each one by the evaluation of phenotypic profile (MIC, accumulation antibiotic in celland SDS-PAGE) and gene expression analysisof genes related to membrane permeability (ompC, ompF and acrA) and regulatory genes(MarA and ompR). After induction with imipenem, 77 % of the isolates increased the MIC for the carbapenems, changing the resistance profile at the baseline. In a lesser percentage, the resistance profile to other β-lactams-unrelated antibiotics was also affected. Loss of porin was observed only for an isolated, however a significantly decreased Omp36 mRNA expression was observed from the start of induction. The expression of the efflux pump AcrAB ,was also affected by the imipenem induction, significantly increasing the AcrA gene expression, whereas the studied regulatory genes,MarA and OmpR,were induced by the imipenem. It was also possible to observe an association between the expression of the regulator MarA and the expression of AcrA, nevertheless no association was observed between this regulator and OMPs . OmpR induction was associated with an increased Omp35mRNA expression, however only a trend for the repression of Omp36was observed. The study of the response of these regulatory genes and genetic determinants of resistance, in response to the imipenem exposure in vitro, allowed to report the molecular behavior of the bacteria in an adaptive response in the initial stage of the establishment of a MDR phenotype. The use of clinical isolates with diverse resistance determinants allowed observing the variability in adaptive responses in enterobacteria, which is important to understand the adaptive mechanisms of bacteria to this antibiotic, the involvement in the emergence of the MDR profile and its contribution to the treatment failure.

Introduktion Antibiotikaresistens är ett globalt växande problem. Till gruppen β-laktamantibiotika hör piperacillin-tazobaktam och cefotaxim som båda verkar genom att försvaga cellväggen med kovalenta bindningar till peptidoglykanlagret som lyserar cellen. E. coli och K. pneumoniae tillhör gruppen Enterobacteriaceae, som är en del av den humana tarmfloran och ofta förekommande vid urinvägsinfektion och sepsis. Utvidgat Spektrum β-Laktamas (ESBL) är ett enzym som finns hos Enterobacteriaceae och som hydrolyserar β-laktamantibiotika. Matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) är en kvalitativ analysteknik för detektion av kemiska föreningar i avseende på massa och laddning. Kännedom om antibiotikametaboliters molekylvikt vid hydrolys möjliggör detektion. Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) är en högsensitiv kvantifieringsmetod som separerar molekyler i avseende på polaritet för vidare detektion i avseende på massa och laddning. Syfte Syftet med denna studie var att vidareutveckla en snabb och effektiv metod för att påvisa nedbrytning av piperacillin-tazobaktam och cefotaxim i blodplasma med LC-MS/MS. Material och Metod Tiofaldigt sjunkande koncentrationer av piperacillin-tazobaktam från 2000 till 2 µg/ml, och cefotaxim med koncentrationerna 500 till 0,5 µg/ml analyserades med MALDI-TOF MS, dels intakt men även med bakterierna E. coli och K. pneumoniae med uttryck av olika resistensmekanismer. Vid optimerade koncentrationer spikades plasmaprover med nedbrutet antibiotika som sedan kvantifierades med LC-MS/MS. Resultat Lägsta detektionsgräns med MALDI-TOF MS för intakt och hydrolyserat piperacillin-tazobaktam var 20/2,5 µg/ml. För cefotaxim var lägsta gränsen 5 µg/ml. Med kliniskt relevanta blodkoncentrationer gick hydrolys inte att detektera för. Med tre bakteriekolonier/50 µl kunde dock hydrolys detekteras och kvantifieras med LC-MS/MS. Slutsats Detektion av β-laktamantibiotika är möjligt med både MALDI-TOF MS och LC-MS/MS. För att påvisa hydrolys krävdes större mängder bakterier än förväntat med LC-MS/MS. / Introduction Antibiotic resistance is a global growing problem. Piperacillin-tazobactam and cefotaxime are parts of the group β-lactam antibiotics. The common feature is to inhibit the cell wall synthesis by covalent bindings to the peptidoglycan layer and thereby causing lysis of the bacterial cell. E. coli and K. pneumoniae are members of the Enterobacteriaceae which is a part of the human normal flora but also are commonly associated with urinary tract infections which sometimes develops into to sepsis. Extended Spectrum β-Lactamases (ESBLs) are enzymes with hydrolytic abilities acting on β-lactam antibiotics, expressed by Enterobacteriaceae. The qualitative, Matrix assisted laser desorption ionization time of flight mass spectrometry (MALDI-TOF MS) can be used to detect chemical compounds in the ratio of mass to charge in accordance to their molecular weight. Liquid Chromatography Tandem Mass Spectrometry (LC-MS/MS) is a highly sensitive two-step method of quantification which first separate molecules by their polarity attraction force and then by the ratio of mass to charge. Aim The aim of this study was to develop a fast and efficient method to determine degradation of piperacillin-tazobactam and cefotaxime in blood plasma by LC-MS/MS. Method Tenfold dilution of piperacillin-tazobactam in concentrations of 2000 to 2 µg/ml, and cefotaxime in concentrations of 500 to 0,5 µg/ml where analyzed by MALDI-TOF MS, intact and also with the bacteria E. coli and K. pneumoniae with different expression of antibiotic resistance. Optimized concentrations where fixed in blood plasma and then quantified by LC-MS/MS. Result The detection limit by using MALDI TOF MS of hydrolyzed as well as non-hydrolyzed piperacillin-tazobactam was 20/2,5 µg/ml. The detection limit in cefotaxime was 5 µg/ml. Hydrolysis could not be detected in clinically fixed blood concentrations. Detection and quantification of hydrolysis by LC-MS/MS was possible in a concentration of three bacteria colonies/50 µl. Conclusion It is possible to detect hydrolysis in both MALDI TOF MS and LC-MS/MS. A larger amount of bacteria than expected was needed to demonstrate hydrolysis In LC-MS/MS.

Background. Carbapenem-resistant Enterobacteriaceae, including Escherichia coli and Klebsiella pneumoniae, are newly emerging pathogens of public health importance. Currently no nationally representative or mandatory surveillance or reporting system exists to examine trends of these important pathogens. Objective. The purpose of the current study was to estimate trends in overall microbial burden and carbapenem resistance in E. coli and K. pneumoniae and to understand the extent to which hospitals which report to voluntary surveillance systems represent all hospitals in the United States. Design. We conducted a descriptive study to compare the hospitals participating in voluntary reporting systems of the University HealthSystem Consortium and the National Healthcare Safety Network with the Healthcare Utilization Project’s Nationwide Inpatient Sample, a nationally representative sample of hospital discharges. Methods. Descriptive analyses examined hospital characteristics (region, bed size, hospital control, teaching status, case mix index) and patient characteristics (age, sex, race/ethnicity, admission source, admission type, discharge status, primary payer) of participant hospitals versus all US hospitals. ICD-9-CM codes identified discharges coded for E. coli and K. pneumoniae diagnoses; linear regression was used to evaluate trends in overall microbial burden of E. coli and K. pneumoniae in all US Hospitals and US Academic Centers. Trends in E. coli and K. pneumoniae resistance to carbapenem were also evaluated in hospitals participating in voluntary surveillance systems (n=13). Results. Between 2002 and 2007, slight increasing trends in burden of both E. coli and K. pneumoniae were observed (E. coli: slope = 0.0537; K. pneumoniae slope = 0.0168). Hospitals participating in voluntary surveillance systems are larger and care for fewer elderly patients than all US hospitals. Conclusions. These results suggest that hospitals that participate in voluntary surveillance systems like the National Healthcare Safety Network and the University HealthSystem Consortium may underrepresent trends in smaller hospitals, as well as those that treat elderly patients. Increasing overall burden of infection due to these isolates only reinforces the importance carbapenem resistance in E. coli and K. pneumoniae. This important public health threat may warrant the creation of a national, mandatory reporting system for these and other antimicrobial resistant organisms.

Made available in DSpace on 2014-06-11T19:22:21Z (GMT). No. of bitstreams: 0 Previous issue date: 2005-08-15Bitstream added on 2014-06-13T18:48:56Z : No. of bitstreams: 1 rodrigues_lo_me_arafcf.pdf: 364674 bytes, checksum: 25ad80987f7d2eb4d8bf537154a09922 (MD5) / Universidade Estadual Paulista (UNESP) / A produção de beta-lactamase de espectro estendido (ESBL) em membros da família Enterobacteriaceae pode conferir resistência a cefalosporinas de amploespectro, aztreonam e penicilinas. Devido a esse fenômeno, a detecção exata dos produtores de ESBL é essencial para a seleção apropriada da antibioticoterapia. Para detectar a produção de beta-lactamase de espectro estendido (ESBL) em bacilos Gram-negativos, foi usado um teste de triagem com os discos de aztreonam (ATM), ceftazidima (CAZ), cefotaxima (CTX) e ceftriaxona (CRO) sobre 300 cepas, das quais trinta e cinco eram suspeitas da presença de ESBL. A produção de ESBL foi demonstrada por três métodos fenotípicos confirmatórios de fácil utilização. Os três testes fenotípicos para confirmar a produção de ESBL incluíram o teste do sinergismo (double disk), E-test? ESBL e disco combinado. Os discos utilizados no teste do sinergismo e do disco combinado foram: aztreonam (30?g-ATM), cefotaxima (30?g-CTX), ceftazidima (30?g-CAZ), cefpodoxima (10?g-CPD) ceftriaxone (30?g-CRO) e amoxicilina+ácido clavulânico(30?g-AMC), cefotaxima+ácido clavulânico (30?g-10?g), ceftazidima+ácido clavulânico (30?g- 10?g), cefpodoxima+ácido clavulânico (10?g-1? g). Para E-test foram utilizadas fitas contendo as cefalosporinas: ceftazidima versus ceftazidima/ácido clavulânico; cefotaxima versus cefotaxima/ácido clavulânico. Os testes fenotípicos confirmaram a presença de ESBL em cinco cepas de enterobactérias (1,66%). Todos os métodos são de fácil execução, contudo o método do Etest requer experiência para interpretar os resultados. Os três testes oferecem uma solução viável para confirmar a produção de ESBL no laboratório clínico. / The production of extended spectrum beta-lactamase (ESBL) in the members of the family Enterobacteriaceae can check resistance to cephalosporins of extended-spectrum, aztreonam and penicilins. Due to this phenomenon, the exact detection of the producers of ESBL are essential for the appropriate selection of antimicrobial therapy. To detect the production of extended spectrum beta-lactamase (ESBL) in Gram-negative bacilli, a test of screening was used with the discs of aztreonam (ATM), ceftazidime (CAZ), cefotaxime (CTX) e ceftriaxone (CRO) in 300 strains, of which thirty-five were suspicious of the presence of ESBL. The production of ESBL was demonstrated by three phenotypic methods confirmed of easy utilization. The three phenotypic tests to confirm the production of ESBL included the test of sinergy (double disk), E-test? ESBL and combination disk. The disks used on the test sinergy and the combination disk were: aztreonam (30?g-ATM), cefotaxime (30?g-CTX), ceftazidime (30?g-CAZ), cefpodoxime (10?g-CPD) ceftriaxone (30?g- CRO) e amoxicillin+clavulanic acid (30?g-AMC), cefotaxime+clavulanic acid (30?g- 10? g), ceftazidime+clavulanic acid (30?g-10? g), cefpodoxime+clavulanic acid (10?g- 1? g). For E-test, were utilized strips containing the cephalosporins: ceftazidime and ceftazidime/clavulanic acid; cefotaxime and cefotaxime/clavulanic acid. The phenotypic tests confirmed the presence of ESBL in five strains Enterobacteriaceae (1,66%). All of the methods are of easy execution; however, the method of Etest requires experiment to interpret the results. The three tests offer a viable solution to confirm the production of ESBL on a clinic laboratory.

Made available in DSpace on 2016-04-28T20:17:28Z (GMT). No. of bitstreams: 1 2008 - Ronaldo Leao Guimaraes.pdf: 352046 bytes, checksum: 7639df2176f027af3722d0b90e93a856 (MD5) Previous issue date: 2008-12-01 / The aim of this study was to evaluate the presence of Vibrio sp., Aeromonas sp. and Enterobacteriaceae in marine and farmer shrimp. For this, 20 samples of marine shrimp (Penaeus sp.) were collected from Itajuru channel, Cabo Frio, RJ, and other 20 samples of farmer shrimp were acquired in municipal market of Cabo Frio, RJ between January to August 2007. These samples were processed using standard methodology and inoculated in selective media for the research of these microorganisms. The isolates identification was performed by specific biochemical tests. 88 strains were isolated; 51.1% belonging to Vibrio sp., 28.5% to Aeromonas sp. and 20.4% to Plesiomonas shigelloides. It was not detected the presence of E. coli or Salmonella. Among the Vibrio sp., there was a prevalence of Vibrio alginolyticus with 45% and Vibrio parahaemolyticus with 10.5%. Aeromonas hydrophila contributed with 30% of the isolates of this genus and 83.3% of the isolates from Plesiomonas shigelloides were obtained from marine shrimp while 16.7% were obtained from farmer shrimp. The results show a high frequency of potentially pathogenic strains in these shrimps, emphasizing the importance of monitoring these organisms not only to shrimp industry but also to public health. / Este trabalho teve como objetivo pesquisar em camar?es de vida livre e criados em cativeiro a presen?a de microrganismos dos g?neros Vibrio, Aeromonas e representantes da fam?lia Enterobacteriaceae. Para tal, foram coletadas 20 amostras de camar?o de vida livre (Penaeus sp.) do canal de Itajuru, Cabo Frio, RJ; e outras 20 amostras de camar?o de cativeiro do com?rcio local deste munic?pio, no per?odo de Janeiro a Agosto de 2007. Estas amostras foram processadas seguindo metodologia padr?o e inoculadas em meios seletivos para a pesquisa dos microrganismos citados. A identifica??o dos isolados foi realizada atrav?s de testes bioqu?micos espec?ficos. 88 cepas foram isoladas, das quais, 51,1% pertencente ao g?nero Vibrio, 28,5% ao g?nero Aeromonas e 20,4% a Plesiomonas shigelloides. Em nenhuma amostra foi detectada a presen?a de E. coli ou Salmonella spp. Dentre os Vibrios, houve predomin?ncia de Vibrio alginolyticus com 45% e Vibrio parahaemolyticus com 10,5%. Aeromonas hydrophila contribuiu com 30% dos isolados deste g?nero e 83,3% dos isolados de Plesiomonas shigelloides foram obtidos de camar?o de vida livre enquanto 16,7% foram obtidos de camar?o de cativeiro. Os resultados apresentam uma grande freq??ncia de cepas potencialmente patog?nicas ao homem presentes nestes camar?es; ressaltando a import?ncia do monitoramento destes organismos n?o s? para a ind?stria de carcinicultura como tamb?m para a sa?de p?blica.

This work will look at two factors that add to the diversity of carbapenem resistant bacteria. First, it focuses on the diversity of carbapenemase resistance plasmids. 446 plasmids were characterized by size, gene content and replicon groups. We identified that on average, over 30% of the encoded proteins on each plasmid have an unknown function. Plasmid sizes ranged from 1.6kb to 500kb, with an average of around 100kb and median of 80kb. Additionally, six replicon groups account for 80% of all the carbapenemase resistance plasmids. We also highlight the lack of data available for carbapenemase carrying plasmids from bacterial genera other than Escherichia and Klebsiella, and plasmids that carry the New Delhi metallo-β- lactamase or the Verona-integron encoded metallo-β-lactamase. Second, we characterized the β-lactamase diversity of a single carbapenemase resistant Klebsiella pneumoniae. This isolate encodes six distinct β-lactamases, all of which are functional, and three of which are redundant. Additionally, we determined that the CTX-M-15 cephalosporinase imparts a greater fitness when grown in aztreonam (a monobactam) than ceftazidime (a cephalosporin). Finally, we show that individually, these β-lactamases do not account for the elevated levels of resistance seen in the parent strain, indicating that the passive resistance mechanisms (i.e. efflux pumps, altered membrane porins) may play a larger role than originally thought.

We explain a new method of detecting non point source fecal contamination using a PCR based method called Touchdown Polymerase Chain Reaction (TD-PCR). Using genetic markers particular to general, ruminant and human Bacteroides- Prevotella genes, we identified presence in both fresh and salt water environments. Water samples from four sites were collected at approximate 2-week intervals for a year. Samples were analyzed for total coliforms, fecal coliforms, E. coli, and the presence of general, ruminant and human Bacteroides-Prevotella markers. We compared the odds of recovering each PCR marker between sites. We investigated the relationship between rainfall and recovery of PCR markers. Finally, we compared the sensitivity of the PCR methods to standard public health methods. / Graduation date: 2003

Der zeitnahe und möglichst sichere Nachweis bakterieller Krankheitserreger und deren Empfindlichkeit gegenüber verfügbaren antibakteriell wirksamen Chemotherapeutika (Antibiotika) stellt einen Hauptaufgabenbereich der medizinischen mikrobiologischen Routinediagnostik dar. Hierzu wurden im Laufe der Jahre unterschiedliche Methoden entwickelt, womit von der genauen Beschreibung der Kolonie- und mikroskopischen Morphologie, Anfärbbarkeit und Formation über die Charakterisierung der biochemischen Leistungsfähigkeit bis hin zur genauen Sequenzierung des gesamten Genoms ein enormer Fortschritt zu verzeichnen war. Seit Mitte der 1990er Jahre etablierte sich die Massenspektrometrie als phänotypisches Nachweisverfahren und gewann zunehmend an Bedeutung. Ebenso konnten Erfolge beim Nachweis Antibiotika resistenter Bakterien verzeichnet werden. Um das Potential dieser noch jungen Nachweismethode weiter zu erforschen, wurden in dieser Arbeit Spezies der Familie Enterobacteriaceae und der Nonfermenter in eine eigene massenspektrometrische Datenbank aufgenommen, um diese als Grundlage zur Validierung des Identifizierungspotentials der Methode mittels Blindstudie zu nutzen. Im selben Arbeitsschritt wurde der Versuch unternommen, Antibiotika resistente Stämme im Zuge der Speziesidentifizierung zu detektieren, um so Aussagen über eine mögliche Einschränkung der therapeutischen Möglichkeiten und gegebenenfalls notwendigen Hygienemaßnahmen treffen zu können.