<p>Due to long time of overconsumption of antibiotic, the possibility of an effective infection treatment is now threatened. Bacteria have begun develop resistant against antibiotic, witch is most due to bacteria that do not normally develop resistant. These kinds of bacteria produce ESBL, and have made the healthcare costs increase around twice as much, as for bacteria that do not produce ESBL.</p>

<p>Syftet med studien var att beskriva och jämföra vårdpersonalens kunskaper om MRSA och ESBL samt kunskaper om hygienrutiner inom primärvården före och efter en hygienutbildning.</p>

Due to long time of overconsumption of antibiotic, the possibility of an effective infection treatment is now threatened. Bacteria have begun develop resistant against antibiotic, witch is most due to bacteria that do not normally develop resistant. These kinds of bacteria produce ESBL, and have made the healthcare costs increase around twice as much, as for bacteria that do not produce ESBL.

Syftet med studien var att beskriva och jämföra vårdpersonalens kunskaper om MRSA och ESBL samt kunskaper om hygienrutiner inom primärvården före och efter en hygienutbildning.

Submitted by TIAGO CASELLA null (tiago_casella@yahoo.com.br) on 2016-11-23T17:21:44Z No. of bitstreams: 1 Tese - biblioteca.pdf: 2980158 bytes, checksum: 5d23fec311f66bb459c291f4a63a4749 (MD5) / Approved for entry into archive by Felipe Augusto Arakaki (arakaki@reitoria.unesp.br) on 2016-11-29T11:28:25Z (GMT) No. of bitstreams: 1 casella_t_dr_sjrp.pdf: 2980158 bytes, checksum: 5d23fec311f66bb459c291f4a63a4749 (MD5) / Made available in DSpace on 2016-11-29T11:28:25Z (GMT). No. of bitstreams: 1 casella_t_dr_sjrp.pdf: 2980158 bytes, checksum: 5d23fec311f66bb459c291f4a63a4749 (MD5) Previous issue date: 2016-11-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / A resistência a cefalosporinas de espectro estendido (ESC) mediada pela produção de β-lactamases de espectro estendido (ESBL) por Enterobacteriaceae é um problema de saúde pública global. Neste contexto, o aumento da resistência a ESC entre Escherichia coli isoladas de animais de produção é uma questão importante, uma vez que bactérias comensais de animais de produção podem contaminar os produtos alimentícios e chegar ao intestino humano via cadeia alimentar. O Brasil é um importante produtor e o maior exportador de carne de frango no mundo. Assim, é de extrema importância monitorar a presença dessas bactérias neste setor alimentar. No presente estudo, foi realizada uma comparação do genótipo de resistência a ESC em E. coli isoladas a partir de carnes de frango no Brasil e na França, considerando que não há relação comercial de carne de frango entre esses dois países. Esta abordagem pode ser útil para compreender as dinâmicas dos fatores de resistência na cadeia de produção de frangos. Além disso, linhagens isoladas do trato gastrointestinal de frangos no Brasil foram também estudadas. Para isso, amostras de carnes de frango de diferentes pontos do varejo e swabs de cloaca de frangos de três diferentes fazendas foram coletadas no Estado de São Paulo, Brasil. Também, amostras de carnes de frango de diferentes pontos do varejo de Lyon, França, foram amostradas. As amostras de carne e os swabs de cloaca de frangos foram inoculados em ágar MacConkey acrescido com ESC. As colônias foram identificadas por sistema automatizado, e a suscetibilidade aos antimicrobianos foi testada por disco-difusão. PCR para detecção de genes blaESBL e blapAmpC e para a determinação dos grupos filogenéticos de E. coli foram realizadas. Os genes bla foram sequenciados e os plasmídeos foram caracterizados pelo esquema PBRT e por southern blot/hibridação de géis de PFGE-S1. Quase todas as carnes de frango apresentaram, ao menos, uma linhagem de E. coli resistente a ESC, e 53,8% dos frangos analisados também estavam colonizados por E. coli resistente a ESC. Resistência a aminoglicosídeos, fenicóis, quinolonas, sulfonamidas, tetraciclina e trimetoprim também foi detectada. Um total de 60 linhagens isoladas de amostras do Brasil foram estudadas, e o gene blaCTX-M-2 foi o principal responsável pela resistência a ESC, mas blaCTX-M-55, blaCMY-2, blaCTX-M-15 e blaCTX-M-8 também foram detectados. De 77 linhagens isoladas de amostras de carne de frango da França, o gene blaCTX-M-1 foi o principal responsável pela resistência a ESC, mas blaTEM-52, blaCMY-2 e blaSHV-12 também foram detectados. A maioria dos blaCTX-M-2 estão associados à ISCR1 e a integrons complexos de classe 1, e blaCTX-M-1, blaCTX-M-15, blaCTX-M-55, e os oito blaCMY-2 do Brasil estão precedidos pela ISEcp1. O gene blaCTX-M-8 está associado à IS10. Nas amostras do Brasil, um gene blaCTX-M-2 é carreado por um plasmídeo IncHI2/P, blaCTX-M-8 por um plasmídeo IncI1, um gene blaCTX-M-15 por um plasmídeo IncX1, e os genes blaCTX-M-55 por plasmídeos IncFII ou IncN/FII. Nas amostras de carnes de frango da França, os genes blaCTX-M-1 são carreados por plasmídeos IncI1 ou IncFII, blaTEM-52 por plasmídeos IncI1 ou IncX1, blaCMY-2 por plasmídeos IncA/C ou IncK, e o gene blaSHV-12 por um plasmídeo IncI1. Todos os quatro principais grupos filogenéticos de E. coli (A, B1, B2, D) foram detectados, porém o filogrupo D foi predominante entre as linhagens do Brasil, e os filogrupos D, A e B1 foram igualmente distribuídos nas linhagens recuperadas na França. Em resumo, E. coli presentes na cadeia de produção de frangos carreiam genes de ESBL e de AmpC plasmideal, e genes, plasmídeos e linhagens resistentes a antimicrobianos parecem ser específicos em cada região geográfica. / Resistance to extended spectrum cephalosporins (ESC) mediated by the production of extended-spectrum β-lactamases (ESBL) by Enterobacteriaceae is a global public health concern. In this context, the raise in ESC-resistance among Escherichia coli isolated from food-producing animals is an important issue, since commensal bacteria from producing animals may contaminate food products and reach the human gut through the food chain. Brazil is an important producer and the greatest exporter of chicken meat in the world, so, it is of utmost importance to monitor the presence of these bacteria in this food sector. In this study, a comparison of the resistance genotype to ESC in E. coli isolated from chicken meat produced in Brazil and France was performed, considering that there is no commercial relationship of chicken meats between these countries. This approach may be useful to understand the dynamics of the resistance factors in chicken production chain. Also, isolates from cloacal swabs collected in Brazil were studied. For this, samples of chicken meat from different markets and chicken cloacal swabs from three separate farms were sampled in the State of São Paulo, Brazil. In addition, chicken meat samples were acquired from markets in Lyon, France. Meat samples and cloacal swabs were inoculated on MacConkey agar supplemented with ESC. Colonies were identified by an automated system, and antimicrobial susceptibility was tested by disc diffusion. PCRs for detection of blaESBL and blapAmpC genes were performed and phylogenetic groups were determined. The bla genes were sequenced, and plasmids were characterized by rep-typing and southern blot/hybridization on S1-PFGE gels. Almost all pieces of chicken meat presented at least one ESC-resistant E. coli, and 53.8% of chickens were also colonized by ESC-resistant E. coli. Resistance to phenicols, quinolones, aminoglycoside and sulphonamides was also detected. A total of 60 strains isolated from Brazilian samples was studied and the blaCTX-M-2 gene was the main responsible for the ESC-resistance, but blaCTX-M-55, blaCMY-2, blaCTX-M-15 and blaCTX-M-8 were also detected. From 77 strains isolated from chicken meat samples from France, the blaCTX-M-1 gene was the main responsible for ESC-resistance, but blaTEM-52, blaCMY-2 and blaSHV-12 were also detected. Most of blaCTX-M-2 were associated to ISCR1 and complex class 1 integrons, and blaCTX-M-1, blaCTX-M-15, blaCTX-M-55, and the eight blaCMY-2 from Brazil were preceded by ISEcp1. The blaCTX-M-8 gene was associated to IS10. In samples from Brazil, one blaCTX-M-2 gene was harbored by an IncHI2/P plasmid, blaCTX-M-8 was carried by an IncI1 plasmid, one blaCTX-M-15 was carried by an IncX1 plasmid, and the blaCTX-M-55 genes were harbored by IncFII or IncN/FII plasmids. In chicken meats from France, the blaCTX-M-1 genes were harbored by IncI1 or IncFII plasmids, blaTEM-52 were carried by IncI1 or IncX1 plasmids, blaCMY-2 were carried by IncA/C or IncK plasmids, and the blaSHV-12 gene was harbored by an IncI1 plasmid. All four major phylogenetic groups (A, B1, B2, D) were present, but phylogroup D was predominant among strains from Brazil, and phylogroups D, A and B1 were equally distributed in strains recovered in France. In summary, E. coli in the chicken production chain carry genes for ESBL and plasmidic AmpC, and genes, plasmids and antimicrobial resistant strains seem to be specific for each geographic region.

Antibiotic resistance is a growing threat to human health and is defined by the World Health Organization as a crisis that must be managed with the utmost urgency. Antibiotic resistant bacteria increase both mortality and morbidity and have a great impact on the global economy. Resistance is not confined to human health care, but is present also among animals and in our environment at large. Indeed, resistant bacterial strains have now been found in virtually all parts of the world, even in locations without direct human contact. The human gastrointestinal tract is populated by a complex, dynamic, diverse and highly interactive collection of microorganisms, including bacteria, archaea, fungi, yeasts and viruses, which constitutes our gastrointestinal microbiota. This microbiota is an important reservoir of resistance genes (our gastrointestinal resistome) and a “melting pot” for transfer of resistance genes between microbes, including potential pathogens. In this thesis I investigated the prevalences of two clinically important kinds of antibiotic resistance: extended-spectrum β-lactamases (ESBL) and vancomycin-resistant enterococci (VRE), as well as asymptomatic carriage of potential enteropathogens among healthy preschool children in Uppsala. Fecal samples from unidentified, individual diapers were collected in 2010 (125+313 samples) and in 2016 (334 samples). In addition, 204 environmental samples from the children’s preschools were collected in autumn 2016. A prevalence of 2.9% ESBL-producing Enterobactericeae was demonstrated in the first samples from 2010. No VRE were found and the occurrence of enteropathogens were reassuringly low. Results on ESBL prevalence in 2016 and transmission of resistance between children will be presented when the manuscript is published and at the dissertation.

Ökning av multiresistenta bakterier som MRSA och ESBL kan ses i Sverige. För att förebygga att dessa mikroorganismer sprids är det viktigt att basala hygienrutiner följs samt att personalen har kunskap om MRSA och ESBL.   Studiens syfte var att se vilken kunskap det fanns hos läkare och sjuksköterskor inom primärvården, gällande MRSA och ESBL, samt att undersöka följsamhet hos personalen gällande hygienrutiner. En tvärsnittsstudie gjordes där tre vårdcentraler valdes ut. 45 enkäter delades ut totalt. Fyra personer valde att inte delta.   Skiftande kunskaper kunde ses gällande smittspridning, mikrobiologiska egenskaper och behandling av bärarskap av MRSA och ESBL.   Kunskaper om hygienförebyggande åtgärder var goda och deltagarna svarade att engångsförkläde ska användas vid patientnära vård samt att noggrann handhygien ska utföras för att minska smittspridningen. Trots kunskap om vikten av noggrann handhygien var det cirka 25 % av deltagarna som utförde handdesinfektionen felaktigt. För övrigt var följsamheten god.   Studiens slutsats är att kunskaper i hygienförebyggande åtgärder samt följsamhet av basala hygienrutiner är relativt goda.

Coincident with human activity in recent decades, human-associated microorganisms have arrived to the Antarctic region, possibly linked to increasing presence of scientific bases and ship-borne tourists. In the Arctic, humans have been present for a very long time, and the few parts of the Arctic without human activities is decreasing with time. The studies in this thesis investigate the occurrence of different pathogens in Antarctic and Arctic wildlife, especially in birds. The first study shows the existence of Enteropatogenic Escherichia coli (EPEC) in Antarctic fur seals. The EPEC isolates were so called atypical EPECs, carrying the eae gene but lacking the bfp gene. This is the first record of a diarrheogenic E. coli in wild animals in the Antarctic. The second study displays that spreading of antibiotic resistance mechanisms appears to be much more efficient than previously was known. Enterococcus faecium isolated from Alaskan birds showed high resistance to vancomycin and teicoplanin, but also to ampicillin and ciprofloxacin. These isolates also carried vanA genes and the virulent esp gene, which places the isolates in the clinical clone CC17 and indicates the isolates had a human origin. Bacteria from birds that reside in the Bering Strait region in the third study, demonstrates that only six of 145 E. coli from 532 birds had reduced antibiotic susceptibility. Despite this, selective screen on E. coli showed only four ESBL-producing isolates. The four E. coli isolates carried CTX-M genes. One isolate belonged to the E. coli O25b - ST131 genotype, which is a successful clone with a global spread. In the fourth study, 123 seawater samples and 400 fresh penguin feces were analyzed. From these, 71 E. coli strains were isolated and only one E. coli from penguins was resistant to one antibiotic (cloramfenicol), whereas in E. coli from seawater, resistance against ampicillin, tetracycline, streptomycin and trim-sulfa were detected. E. coli carrying ESBL type CTX -M genes were also detected and Multilocus Sequencing Typing (MLST) showed six different sequence types (ST) previously reported in humans: ST131, ST227, ST401, ST410, ST685 and ST937. In the short time interval between the second study (2005) and the third study (2010) in relation to the fifth study (2012) we found a dramatic increase in antibiotic-resistant genes in the Arctic region. Enterococci, E. coli, and Kl. pneumoniae carried antibiotic resistance genes to an extent and variety not previously reported. E. coli from Arctic birds showed resistant to 1, 2, 3, 4, and 5 different antibiotics. Resistant gene type vanA was confirmed in enterococci and ESBL genes type TEM, SHV and CTX-M in E. coli and Kl. pneumoniae was detected. Multilocus Sequencing typing (MLST), indicating that both E. coli and Kl. pneumoniae carrying ESBL markers that connects them to the humans. In summary, the combined studies strengthen that bacteria that cause infections in humans could spread to relatively pristine environments. We concluded that human and associated antibiotic-resistant bacteria has reached a global level, then we showed that ESBL- carrying bacteria circulating nowadays also in the last ESBL-free continent, Antarctica.

Made available in DSpace on 2014-06-12T15:53:47Z (GMT). No. of bitstreams: 2 arquivo4868_1.pdf: 953580 bytes, checksum: 30f8d7e6ee8c034d2c9fd4e760ecf3e3 (MD5) license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) Previous issue date: 2006 / As beta-lactamases de espectro estendido estão em expansão mundial, conferindo em isolados clínicos importantes fenótipos de multi-resistencia em bactérias que abrigam estas enzimas. Pacientes com infecção urinária (ITU) são principalmente infetados pelas E. coli e K. pneumoniae, que são as principais produtoras das ESBLs (beta-lactamases de espectro estendido). Neste trabalho, nós analisamos a presença de ESBL produzidas pela E. coli e K. pneumoniae em isolados de ITU de origem nosocomial e em comunidade. Padrões de suscetibilidade e a presença de genes de ESBL para SHV, TEM e CTX foram estudados em amostras de ESBL positivas. Os resultados mostraram que as cepas produtoras de ESBL estavam presentes em 25% das amostras de ITU nosocomiais e 9.3% nas de comunidade. As ESBLs esteve presente em 12.2 e 18.2% dos isolados de E. coli e de K.pneumoniae, respectivamente. Foram descobertos genes de ESBL em isolados de origem nosocomial e em comunidade. Todos os isolados que carregam os genes de ESBL apresentaram fenótipos de multi-resistência que alertam à necessidade de vigilância contínua nas ITU

303 gesunde, deutsche Freiwillige, die in 53 verschiedene Länder (meist nach Asien, Afrika und Südamerika) reisten, wurden in eine prospektive Kohortenstudie aufgenommen. Stuhlproben und Daten über potenzielle reiseassoziierte Risikofaktoren (wie Reisestil, Essgewohnheiten, Auftreten von Gastroenteritis, Hygienemaßnahmen) wurden vor und nach der Reise mittels Fragebogen gesammelt. Mittels Selektivmedien (CHROMagar™ ESBL/KPC-Platten) wurden eine Untersuchung der Stuhlproben auf extended-spectrum beta-lactamase bildende Enterobacteriaceae (ESBL-PE) und Carbapenemase bildende Enterobacteriaceae (CPE) durchgeführt. Isolate mit bestätigtem ESBL-Phänotyp wurden auf das Vorhandensein von blaCTX-M-, blaTEM-, blaSHV-, blaVIM-, blaNDM-, blaKPC- und blaOXA-48-Genen mit Hilfe von PCR-Amplifikation und -Sequenzierung getestet. Bei den Antibiotikaempfindlichkeitstests wurde mit konventioneller Mikrobouillonverdünnung gearbeitet. Die Auswertung von 205 kompletten Teilnahmen zeigte vor Reiseantritt eine ESBL-PE Prävalenzrate von 6,8% (14/205). Unter den 191 Teilnehmern, die vor der Reise ESBL-negativ getestet wurden, waren nach Reiserückkehr 58 (30,4%) mit ESBL-bildenden Escherichia coli kolonisiert und 5 Reisende (8,6%) waren zusätzlich mit ESBL-produzierenden Klebsiella pneumoniae besiedelt. Carbapenem-resistente Enterobacteriaceae wurden nicht nachgewiesen. Die molekulargenetische ESBL-Typisierung zeigte, dass 52/54 (96,6%) der E. coli und 4/4 (100%) der K. pneumoniae-Stämme, die für die Sequenzierung verfügbar waren, CTX-M-Enzyme produzierten, und zwar überwiegend CTX-M-15 (33/56, 58,9%), und 2/54 (3,7%) der E. coli-Stämme SHV-12-Enzyme bildeten. Die Reisenden nach Indien wiesen die höchste Kolonisationsrate mit ESBL-PE (11/15, 73,3%: p=0.015) auf, gefolgt von Reisenden nach Südostasien (22/46, 47,8%; p=0.038). Die Auswertung der reiseassoziierten Risikofaktoren ergab allein für das Auftreten einer Gastroenteritis eine statistische Signifikanz (p=0.011). Strikte Händehygiene und ausschließliches Konsumieren abgepackter Getränke zeigten keinen protektiven Effekt. Die ESBL-PE-Persistenzrate nach 6 Monaten lag bei 8,6% (3/35). Daraus schlossen wir, dass weltweite Anstrengungen notwendig sind, um die weitere Ausbreitung von ESBL-PE in der Bevölkerung anzugehen. Eine aktive Überwachung und Kontaktisolation ist bei Aufnahme in eine medizinische Einrichtung speziell für Patienten, die innerhalb der letzten 6 Monate nach Indien und Südostasien gereist waren, empfehlenswert.