Linhagens de Escherichia coli produtoras de β-lactamase de espectro estendido (ESβL) do tipo CTX-M são endêmicas no Brasil, sendo prevalentes em casos de infecções hospitalares e ambulatoriais. Atualmente, cepas produtoras de CTX-M têm sido recuperadas de ambientes urbanos, animais de companhia ou de produção e de alimentos de origem animal, inclusive afetando o agronegócio, o que aponta uma possível rota de disseminação em diferentes ecossistemas. Recentemente, nesta espécie, foi descoberto um novo gene, chamado de mcr-1, que confere resistência transferível à colistina, um dos últimos antibióticos eficazes para o tratamento de infecções causadas por bactérias produtoras de ESBL e carbapenemases. Deste modo, o presente estudo tem como objetivo elucidar os aspectos sobre a caracterização e a relação de plasmídeos que carregam genes do tipo blaCTX-M-8 e mcr- 1 em cepas de E. coli isoladas de seres humanos, animais, ambiente aquático e alimentos, no Brasil. Neste estudo são apresentados os resultados da análise plasmidial de 25 cepas de E. coli, das quais nove apresentaram o genótipo blaCTX-M-8/IncI1, 11 apresentaram o genótipo mcr-1/IncX4 e cinco apresentaram ambos os genótipos blaCTX-M-8/IncI1 e mcr-1/IncX4. Dos resultados, podemos observar que plasmídeos IncI1 (blaCTX-M-8) e IncX4 (mcr-1) estão circulando no Brasil desde o ano de 2009 entre diferentes clones (STs) de E. coli e em diferentes ambientes e hospedeiros. Os plasmídeos IncI1 foram conjugativos e pertencentes ao ST113, exceto o plasmídeo recuperado de um isolado humano, que foi pertencente ao ST131. Os plasmídeos IncI1 apresentaram sua arquitetura conservada, com a presença de genes de replicação, transferência e estabilidade. A partir do alinhamento, os plasmídeos IncI1 apresentaram 94-99% de similaridade genética entre eles. Dentre os plasmídeos IncX4, independente da fonte de isolamento, todos permaneceram com sua arquitetura altamente conservada. Entretanto, apenas dois plasmídeos (um encontrado em uma cepa de animal e outro encontrado em uma cepa de ambiente aquático) apresentaram uma IS1294, truncando o gene de mobilização. Na análise comparativa, todos os plasmídeos IncX4 apresentaram similaridade genética de 95-99,9% entre eles. No alinhamento de plasmídeos IncX4 brasileiros contra plasmídeos de outras regiões geográficas, foi observada similaridade genética > 99,9%, o que confirma a estabilidade e conservação desses plasmídeos. Neste estudo foram reportados dados inéditos da primeira identificação do gene mcr-1 em diferentes ecossistemas no Brasil, assim como a nova variante mcr-5.3. A análise filogenética dos plasmídeos IncI1 e IncX4, destacam que ambos compartilham uma arquitetura conservada, e a evolução é atribuída à aquisição de genes de resistência. Adicionalmente, um novo vetor de disseminação do gene mcr-1 no Brasil foi identificado - o plasmídeo IncHI2. Os resultados desse estudo demonstram o grave problema da resistência bacteriana dentro do conceito One-health e que, com o avanço de ferramentas moleculares, a identificação e a resolução desse problema poderá estar cada vez mais próxima de ser elucidada. / CTX-M-type extended-spectrum-β-lactamase (ESβL)-producing-Escherichia coli are endemic in Brazil and are prevalent in cases of nosocomial and ambulatory infections. Currently, CTXM-producing strains have been recovered from urban environments, companion/production animals and animal source foods, which indicates a possible route of dissemination in different ecosystems. Recently, in this species, a new gene, called mcr-1, has been discovered, conferring transferable resistance to colistin, one of the last effective antibiotics for the treatment of infections caused by ESBL- and carbapenemases -producing bacteria. Thus, the present study aims to elucidate unknown aspects of the pan-resistome and ancestral relationship of plasmids carrying blaCTX-M-8 and mcr-1 genes in strains of E. coli isolated from humans, animals, aquatic environment and food, in Brazil. In this study, we present results from the plasmidial analysis of 25 E. coli strains, from which nine presented the blaCTX-M-8/IncI1 genotype, 11 presented the mcr-1/IncX4, and five presented both blaCTX-M-8/IncI1 and mcr-1/IncX4 genotypes. Among these results, we can observe that IncI1 (blaCTX-M-8) and IncX4 (mcr-1) plasmids are circulating in Brazil since 2009, between different E. coli clones (STs) and different hosts and environments. IncI1 plasmids were conjugative and assigned to ST113, with exception of a plasmid recovered from a human isolate, which was assigned to ST131. IncI1 plasmids presented conserved architecture, with the presence of genes of replication, transference, and stability. From the alignment analysis, IncI1 plasmids presented 94-99% genetic similarity among them. Among the IncX4 plasmids, regardless the isolation source, their architecture remained highly conserved. However, only two plasmids (one detected in an animal\'s strain and another detected in an aquatic environment\'s strain) presented an IS1294, truncating the mobilization gene. In the comparative analysis, all IncX4 plasmids presented 95-99,9% genetic similarity among them. In the alignment of Brazilian IncX4 plasmids against plasmids from other geographic regions, >99.9% genetic similarity was observed, confirming the stability and conservation of these plasmids. In this study, unprecedented data from the first identification of the mcr-1 gene in different ecosystems in Brazil, as well as the new variant, mcr-5.3. Additionally, it was identified a new dissemination vector of the mcr-1 gene in Brazil - the IncHI2 plasmid. Phylogenetic analysis of IncI1and IncX4 plasmids highlight that both share a conserved backbone, and evolution is attributed to the acquisition of clinically relevant antimicrobial resistance genes. The results from this study demonstrate the serious problem of the bacterial resistance within the \"One-Health\" concept and that, with the advance of molecular tools, identification and resolution of this problem may be increasingly closer to being elucidate.

<p>Syftet med studien var att beskriva och jämföra vilka kunskaper sjuksköterskestudenter i slutet av utbildningen vid två lärosäten har gällande Methicillinresistent Staphylokock aureus (MRSA), Extended Spectrum Beta-Lactamase (ESBL) och basala hygienrutiner. Vidare var syftet att beskriva sjuksköterskestuderandes uppfattningar av utbildningens kvalitet gällande MRSA, ESBL och hygienrutiner. Studien hade en beskrivande och jämförande design. Undersökningsgruppen valdes ut genom bekvämlighetsurval. Data samlades in med ett frågeformulär som besvarades av 126 sjuksköterskestudenter.</p><p>Resultatet visade att sjuksköterskestudenterna hade bristande kunskaper gällande främst ESBL, men även gällande MRSA. Majoriteten av studenterna hade låg kunskap gällande riskfaktorer för ESBL samt vart på kroppen man vanligtvis finner mikroorganismen vid förekomst av MRSA. Däremot hade sjuksköterskestudenterna högre kunskap om basala hygienrutiner. Nästan alla studenter hade kunskap om betydelsen av god handhygien. Dock visade studenterna stora brister i kunskap gällande när munskydd bör användas. Signifikanta skillnader i kunskap gällande ESBL och hygienrutiner mellan de båda lärosätena fanns. Majoriteten av studenterna ansåg att undervisningen om MRSA och ESBL under sjuksköterskeutbildningen inte varit tillräcklig. Däremot ansåg huvudparten av studenterna att undervisningen om hygienrutiner varit tillräcklig.</p><p>Slutsatsen var att undervisningen om MRSA, ESBL och basala hygienrutiner i sjuksköterskeutbildningen behöver förbättras.</p> / <p>The aim of the study was to describe and compare nurse students knowledge regarding Methicillin-resistant Staphylococcus aureus (MRSA), Extended Spectrum Beta-Lactamase (ESBL) and basic hygiene routines. The students were in the end of their education and represented two Swedish universities. Further on, the aim was to describe the nurse students perceptions of the education's quality about MRSA, ESBL and hygiene routines. The study had a descriptive and comparing design. The survey group was chosen through convenience selection and data were collected with a questionnaire, responded by 126 nurse students.</p><p>The results showed that the nurse students had inadequate knowledge about ESBL as well as MRSA. The majority of the students had low knowledge about risk factors for ESBL, and where on the body one normally finds the micro-organism in occurrence of MRSA. However, the nurse students had higher knowledge about basic hygiene routines and almost all students had knowledge about the importance of proper hand hygiene. The students had deficit knowledge concerning when masks should be used in order to cover the mouth. Significant differences in knowledge about ESBL and hygiene routines was found between the universities. The majority of the students perceived that the education about MRSA and ESBL during the nurse education program were not sufficient. Although, most of the students perceived that the education about hygiene routines had been sufficient.</p><p>The conclusion was that the education about MRSA, ESBL and basic hygiene procedures in the nurse education program needs improvement.</p>

<p>Resistenta bakterier är ett växande problem inom den svenska sjukvården. Extended spectrum ß-lactamases (ESBL) är bakterier som kan bilda enzymer som bryter ned antibiotika så att den på så sätt blir resistent. En av de stora anledningarna till spridning av resistenta bakterier är personalens brist på korrekt utförande av basala hygienrutiner. Syftet med studien var att undersöka hur sjukvårdspersonal på en infektionsavdelning tillämpar de riktlinjer för basala hygienrutiner som finns fastställda för personal inom hälso- och sjukvården. Data samlades in genom observationer på en infektionsavdelning på ett sjukhus i Mellansverige. Resultatet visade att följsamheten till basala hygienrutiner var mindre än hälften bland de två jämförda personalgrupperna. Resultatet visade hög följsamhet till handskanvändning vid vård av patienter som inte var ESBL-bärare, medan följsamheten var sämre vid vård av patienter med ESBL. Detta resultat visade på en signifikant skillnad, dvs. att personalen var bättre på att använda handskar vid vård av patienter som inte var bärare av ESBL. Resultatet visade att nära hälften av de observerade inte spritar händerna innan patientkontakt, vare sig det rör sig om en patient som är bärare av ESBL-bakterier eller inte. Det tyder på stora brister i följsamheten till hygienrutiner på den observerade infektionsavdelningen.</p> / <p>Resistant bacteria are an increasingly large problem within the Swedish health care system. Extended spectrum ß-lactamases (ESBL) are bacteria that produce enzymes capable of breaking down antibiotics, a characteristic which renders them resistant to antibiotics. One of the main causes for the spreading of resistant bacteria is low compliance to hand hygiene procedures.</p><p>The aim of this study was to examine how the health care workers of an infectious disease ward apply the hygiene guidelines that have been established for health care staff. Data was collected through observations in an infectious disease ward in Central Sweden. The results showed that compliance towards hand hygiene procedures was less than 50% within the two staff groups compared. It also showed good compliance to the guidelines for glove use when caring for patients not carrying ESBL, but less compliance when caring for patients with the infection. The difference was statistically significant, i.e. health care staff used gloves more often when caring for patients not carrying ESBL than they did with patients who were carriers. The results showed that that almost 50% of the observed health care workers did not use hand disinfection before contact with patients, whether these were ESBL carriers or not. This indicates that compliance to hand hygiene procedures is not as good as one could hope for.</p>

Syftet med studien var att beskriva och jämföra vilka kunskaper sjuksköterskestudenter i slutet av utbildningen vid två lärosäten har gällande Methicillinresistent Staphylokock aureus (MRSA), Extended Spectrum Beta-Lactamase (ESBL) och basala hygienrutiner. Vidare var syftet att beskriva sjuksköterskestuderandes uppfattningar av utbildningens kvalitet gällande MRSA, ESBL och hygienrutiner. Studien hade en beskrivande och jämförande design. Undersökningsgruppen valdes ut genom bekvämlighetsurval. Data samlades in med ett frågeformulär som besvarades av 126 sjuksköterskestudenter. Resultatet visade att sjuksköterskestudenterna hade bristande kunskaper gällande främst ESBL, men även gällande MRSA. Majoriteten av studenterna hade låg kunskap gällande riskfaktorer för ESBL samt vart på kroppen man vanligtvis finner mikroorganismen vid förekomst av MRSA. Däremot hade sjuksköterskestudenterna högre kunskap om basala hygienrutiner. Nästan alla studenter hade kunskap om betydelsen av god handhygien. Dock visade studenterna stora brister i kunskap gällande när munskydd bör användas. Signifikanta skillnader i kunskap gällande ESBL och hygienrutiner mellan de båda lärosätena fanns. Majoriteten av studenterna ansåg att undervisningen om MRSA och ESBL under sjuksköterskeutbildningen inte varit tillräcklig. Däremot ansåg huvudparten av studenterna att undervisningen om hygienrutiner varit tillräcklig. Slutsatsen var att undervisningen om MRSA, ESBL och basala hygienrutiner i sjuksköterskeutbildningen behöver förbättras. / The aim of the study was to describe and compare nurse students knowledge regarding Methicillin-resistant Staphylococcus aureus (MRSA), Extended Spectrum Beta-Lactamase (ESBL) and basic hygiene routines. The students were in the end of their education and represented two Swedish universities. Further on, the aim was to describe the nurse students perceptions of the education's quality about MRSA, ESBL and hygiene routines. The study had a descriptive and comparing design. The survey group was chosen through convenience selection and data were collected with a questionnaire, responded by 126 nurse students. The results showed that the nurse students had inadequate knowledge about ESBL as well as MRSA. The majority of the students had low knowledge about risk factors for ESBL, and where on the body one normally finds the micro-organism in occurrence of MRSA. However, the nurse students had higher knowledge about basic hygiene routines and almost all students had knowledge about the importance of proper hand hygiene. The students had deficit knowledge concerning when masks should be used in order to cover the mouth. Significant differences in knowledge about ESBL and hygiene routines was found between the universities. The majority of the students perceived that the education about MRSA and ESBL during the nurse education program were not sufficient. Although, most of the students perceived that the education about hygiene routines had been sufficient. The conclusion was that the education about MRSA, ESBL and basic hygiene procedures in the nurse education program needs improvement.

Resistenta bakterier är ett växande problem inom den svenska sjukvården. Extended spectrum ß-lactamases (ESBL) är bakterier som kan bilda enzymer som bryter ned antibiotika så att den på så sätt blir resistent. En av de stora anledningarna till spridning av resistenta bakterier är personalens brist på korrekt utförande av basala hygienrutiner. Syftet med studien var att undersöka hur sjukvårdspersonal på en infektionsavdelning tillämpar de riktlinjer för basala hygienrutiner som finns fastställda för personal inom hälso- och sjukvården. Data samlades in genom observationer på en infektionsavdelning på ett sjukhus i Mellansverige. Resultatet visade att följsamheten till basala hygienrutiner var mindre än hälften bland de två jämförda personalgrupperna. Resultatet visade hög följsamhet till handskanvändning vid vård av patienter som inte var ESBL-bärare, medan följsamheten var sämre vid vård av patienter med ESBL. Detta resultat visade på en signifikant skillnad, dvs. att personalen var bättre på att använda handskar vid vård av patienter som inte var bärare av ESBL. Resultatet visade att nära hälften av de observerade inte spritar händerna innan patientkontakt, vare sig det rör sig om en patient som är bärare av ESBL-bakterier eller inte. Det tyder på stora brister i följsamheten till hygienrutiner på den observerade infektionsavdelningen. / Resistant bacteria are an increasingly large problem within the Swedish health care system. Extended spectrum ß-lactamases (ESBL) are bacteria that produce enzymes capable of breaking down antibiotics, a characteristic which renders them resistant to antibiotics. One of the main causes for the spreading of resistant bacteria is low compliance to hand hygiene procedures. The aim of this study was to examine how the health care workers of an infectious disease ward apply the hygiene guidelines that have been established for health care staff. Data was collected through observations in an infectious disease ward in Central Sweden. The results showed that compliance towards hand hygiene procedures was less than 50% within the two staff groups compared. It also showed good compliance to the guidelines for glove use when caring for patients not carrying ESBL, but less compliance when caring for patients with the infection. The difference was statistically significant, i.e. health care staff used gloves more often when caring for patients not carrying ESBL than they did with patients who were carriers. The results showed that that almost 50% of the observed health care workers did not use hand disinfection before contact with patients, whether these were ESBL carriers or not. This indicates that compliance to hand hygiene procedures is not as good as one could hope for.

Ziel der vorliegenden Studie war es, den Einfluss einer therapeutischen Behandlung mit β Lactamantiobiotika auf die Resistenzlage der intestinalen Flora beim Schwein zu untersuchen. Im Anschluss an eine Behandlung mit Ceftiofur konnte die Entwicklung resistenter E. coli bei den behandelten Tieren, sowie unbehandelten Tieren, die sich mit im selben Stall befanden, beobachtet werden. Zusätzlich wurden mittels PCR Extended-Sprectrum-Lactamasen (ESBL)-codierende Gene bei diesen Keimen nachgewiesen. Da subtherapeutische Antibiotikadosen die Entwicklung von Resistenzen fördern können, wurden die Konzentrationen an Desfuroylceftiofur in Kot, Urin, Stallaerosole und Sedimentationsstäube im Anschluss an die Behandlung mit Ceftiofur untersucht. Die Bestimmung erfolgte mittels UPLC MS/MS. In allen Matrices konnten Wirkstoffrückstände detektiert werden und beweist den Eintrag von mikrobiologisch aktiven Substanzen in die Umgebung. Die Ergebnisse dieser Studie machen noch einmal deutlich, dass der Einsatz von Antibiotika zurückhaltend und in Kombination mit einer guten Stallhygiene erfolgen sollte.

Membros da família Enterobacteriaceae podem causar meningite associada com infecções hospitalares e/ou secundárias. A terapia empírica utilizada em pacientes com suspeita de meningite é, às vezes, ineficiente, devido à produção de beta-lactamases de espectro estendido (ESBL), que é o mecanismo mais comum de resistência às cefalosporinas de amplo espectro em enterobactérias. O objetivo deste trabalho foi estudar a produção de ESBL e AmpC por enterobactérias isoladas de líquido céfalo-raquidiano e sangue de pacientes com suspeita de meningite da região de Ribeirão Preto, no período de 2000 a 2005. O teste do disco combinado foi utilizado para a detecção fenotípica e a PCR foi utilizada para amplificar genes codificadores de ESBL e AmpC. Três (6,52 %) das 46 enterobactérias isoladas no período estudado foram produtoras de ESBL e abrigavam o gene blaCTX-M-2. As enterobactérias produtoras de ESBL foram: S. marcescens IAL 19, (isolada em Araraquara, 2002), P. mirabilis IAL 29 e E. coli IAL 45 (isoladas em Franca, respectivamente, 2003 e 2004). O gene blaCTX-M-2 foi detectado em três gêneros diferentes, sugerindo que o gene blaCTX-M é endêmicos na região de Ribeirão Preto. Os dados obtidos por este trabalho são importantes porque existem poucos relatos sobre a produção de ESBL por enterobactérias isoladas de líquido céfalo-raquidiano e sangue de pacientes com suspeita de meningite. / Members of Enterobacteriaceae family are cause of cause meningitis associated with nosocomial or secondary infection. The empiric therapy used in patients with suspicion of meningitis is, sometimes, inefficient due to extended-spectrum beta-lactamases (ESBL)- producing, that is the most common mechanism of resistance to cephalosporins in enterobacteria. The main objective of this study was to evaluate ESBL and AmpC-producing Enterobacteriaceae isolated of cerebrospinal fluid and blood from patients with suspicion of meningitis from the region of Ribeirão Preto city, during 2000 to 2005. Combination disk method was used for phenotypic detection and PCR was used to amplify genes encoding ESBL and AmpC. Three (6.52 %) out of 46 enterobacteria isolated in the period studied were detected as ESBL-producing and harbored the blaCTX-M-2 gene. The ESBL-producing enterobacteria were: S. marcescens IAL 19, (isolated in Araraquara city SP - Brazil, 2002), P. mirabilis IAL 29 e E. coli IAL 45 (isolated in Franca city SP- Brazil, respectively, 2003 e 2004). The blaCTX-M-2 gene was detected in three different genera isolated for a long time, suggesting that the blaCTX-M-2 gene is endemic in the region of Ribeirão Preto city. The data generated by this study are important because there are low reports about ESBL-producing enterobacteria isolated of cerebrospinal fluid and blood from patients with suspicion of meningitis.

SOUZA, Germana Conrado de. Detecção de betalactamases de espectro expandido (ESBL) em cepas de coliformes isoladas de carne de frango comercializada na cidade de Fortaleza, Ceará. 2007. 118 f. : Dissertação (mestrado) - Universidade Federal do Ceará, Departamento de Tecnologia de Alimentos, Curso de Mestrado em Tecnologia de Alimentos, Fortaleza-CE, 2007 / Submitted by Nádja Goes (nmoraissoares@gmail.com) on 2016-06-08T12:16:01Z No. of bitstreams: 1 2007_dis_gcsouza.pdf: 591918 bytes, checksum: d21477fb14b177c756c5c364cea58315 (MD5) / Approved for entry into archive by Nádja Goes (nmoraissoares@gmail.com) on 2016-06-08T12:16:16Z (GMT) No. of bitstreams: 1 2007_dis_gcsouza.pdf: 591918 bytes, checksum: d21477fb14b177c756c5c364cea58315 (MD5) / Made available in DSpace on 2016-06-08T12:16:16Z (GMT). No. of bitstreams: 1 2007_dis_gcsouza.pdf: 591918 bytes, checksum: d21477fb14b177c756c5c364cea58315 (MD5) Previous issue date: 2007 / The poultry processing industry depends on the biosafety and quality of the products offered to the population, and is the cheapest and more affordable source of proteins. The intensive production process of poultry products requires constant microbiological controls. This study was aimed to assess the microbiological conditions of this product and to perform an antimicrobial susceptibility test and the screening of ESBL-producing bacteria on the strains isolated from the collected samples. Between April and November 2006, 80 samples of fresh and freezed poultry meat marketed in the city of Fortaleza were collected. The microbiological protocol included an aerobic mesophile bacterial count, and the determination of the coliform MPN at 35oC and 45oC, according to the ANVISA (National Sanitary Surveillance Agency) resolution RDC 12 of January 02, 2001. The susceptibility test was carried out according to the disk diffusion technique (KIRBY-BAUER), and the screening for ESBL-producing strains was performed by CLSI. The used antibiotics were amikacine (30µg), ampicillin (10µg), ciprofloxacin (5µg), ceftazidime (30µg), streptomycin (10µg), doxycycline (30µg), gentamicin (10µg), imipenem (10µg), sulphonamide (300µg) and sulfamethoxazol/trimetroprim (25µg). The mesophile bacterial count in the 80 tested strains ranged from <1.0 x 10 CFU/g to 6.3 x 10 CFU/g. 34 (43%) of the samples were positive for coliforms at 35oC and 17 (21%) for coliforms at 45oC. In the 11 E. coli strains, the highest resistance was found against doxycycline (91%), while 27% of the strains were 100% sensitive to amikacin, gentamicin and imipenem. Within the 22 Klebsiella pneumonia isolated strains, the highest resistance was against ampicillin (94.5%), with the highest sensitivity to gentamicin, sulfamethoxazol/trimetroprim and amikacin (94.5%, 94.5%, and 90%, respectively). Of the 19 Enterobacter aerogenes strains, 90.1% were resistant to ampicillin and 95.4% showed to be sensitive to ciprofloxacin. Of the 11 strains of Escherichia coli, 22 of Klebsiella pneumoniae and 19 of Enterobacter aerogenes, only 4, 9 and 5 strains, respectively, showed to have an ESBL-producing phenotype, and only 3 (33%) of the K. pneumoniae strains and 3 (60%) of the E. aerogenes strains were confirmed as being ESBL producers. We verified the poultry meat to be microbiologically flawed, as shown by the high number of mesophile aerobic bacteria and coliforms grown at 35oC and at 45oC, being a warning sign for the occurrence of DTA, even by microorganisms resistant to multipleantibiotics and ESBL producers. The implementation of a Hazard Analysis and Critical Control Points (HACCP) system involving all the processing stages can be an effective measure in order to improve the quality and safety of this product. / A cadeia produtiva do frango de corte depende da biossegurança e da qualidade dos produtos que são ofertados à população, visto ser essa a fonte de proteína mais acessível e barata. O intenso processamento de produtos avícolas necessita de constantes averiguações a respeito da sua qualidade microbiológica. Diante do exposto, este trabalho teve como objetivo avaliar as condições microbiológicas e de realizar o teste de susceptibilidade antimicrobiana e detecção de bactérias produtoras de ESBL das cepas de microrganismos isoladas das amostras coletadas. No período de abril a novembro de 2006 foram coletadas 80 amostras de carne de frango resfriada e congelada comercializada na cidade de Fortaleza, Ceará. O protocolo microbiológico incluiu a contagem de bactérias aeróbias mesófilas, determinação do NMP de coliformes a 35°C e a 45°C, de acordo com a RDC n° 12 de 02 de janeiro de 2001 da ANVISA. Para o teste de susceptibilidade a antimicrobianos foi utilizada a técnica de difusão em placas segundo KIRBY-BAUER e CLSI, para detecção de cepas produtoras de ESBL. Os antibióticos usados foram: amicacina (30µg), ampicilina (10µg), ciprofloxacina (05µg), ceftazidima (30µg), estreptomicina (10µg), doxiciclina (30µg), gentamicina (10µg), imipenem (10µg), sulfonamida (300µg) e sulfametoxazol/trimetroprim (25µg). Das 80 amostras analisadas, a contagem de mesófilos variou de <1,0 x 10 UFC/g a 6,3 x 105 UFC/g, 34 (43%) das amostras foram positivas para coliformes a 35°C e 17 (21%) para coliformes a 45°C. Quanto ao teste de susceptibilidade antimicrobiana, o maior percentual de resistência encontrado nas 11 cepas de Escherichia coli foi à doxiciclina (91%); 27% das cepas foram 100% sensíveis a amicacina, gentamicina e imipenem. Das 22 cepas de Klebsiella pneumoniae isoladas, a maior resistência foi à ampicilina (94,5%); maior sensibilidade a gentamicina, sulfametoxazol/trimetroprim e amicacina, 94,5%, 94,5% e 90%, respectivamente. Das 19 cepas de Enterobacter aerogenes, 90,1% foram resistentes a ampicilina e 95,4% apresentaram sensibilidade a ciprofloxacina. Das 11 cepas de Escherichia coli, 22 de Klebsiella pneumoniae e 19 de Enterobacter aerogenes, apenas 4, 9 e 5 cepas apresentaram o fenótipo produtor de ESBL, respectivamente, e destas somente 3 (33%) das cepas de Klebsiella pneumoniae e 3 (60%) das cepas de Enterobacter aerogenes foram confirmadas como produtoras de ESBL. Foi possível constatar que a carne de frango apresentaram falhas em relação a qualidade microbiológica, como demonstrado pela presença de elevado número de bactérias aeróbias mesófilas, coliformes a 35°C e coliformes a 45°C, sinalizando para o risco potencial de ocorrência de DTA, inclusive por microrganismos multi-resistentes à antimicrobianos e produtores de ESBL. A implementação de um sistema de Análise de Perigos e Pontos Críticos de Controle (APPCC), envolvendo todas as etapas do processamento, pode constituir uma medida eficaz para a melhoria da qualidade e segurança do produto

Background: Hospital acquired infections belong to the most important aspects of patient safety in Swedish healthcare. The problem is increasing and some ESBL producing bacteria have become resistant to virtually all antibiotics and constitute a severe threat to patient’s health. The tasks of nurses are in collaboration with other healthcare professionals to suggest and implement suitable infection control actions and to monitor compliance with these. Aim: The aim was to describe the prophylactic measures, and the effect of those, performed by nurses to control spread of ESBL producing GNB. Method: A general literature search was performed in PubMed and CINAHL databases to identify original articles published between 2012 and 2017. Results: The prophylactic measures demonstrated to prevent spread of ESBL are to always comply with basic hygiene routines where good hand hygiene is the most important one. In the case of more extensive spread, more comprehensive bundle care programs may become necessary. Actions such as surveillance cultures, prevention of contact spread, strict routines for hand hygiene, education of staff and inspections of compliance with hygiene routines, and more intense environmental cleaning and disinfection may become relevant. Knowledge of ESBL producing GNB and compliance with hygiene routines are sometimes insufficient among Swedish healthcare staff. Conclusion: Measures that need to be implemented to prevent spread of ESBL producing bacteria need to be decided on a case-by- case basis. Collaboration with other healthcare professionals and ensuring staff´s compliance with hygiene routines and guidelines through education and training are important factors for success.

Conselho Nacional de Desenvolvimento CientÃfico e TecnolÃgico / Klebsiella pneumoniae à um bacilo gram-negativo responsÃvel por uma parcela significativa de infecÃÃes do trato urinÃrio, respiratÃrio e corrente sanguÃnea de adultos em hospitais, alÃm de infecÃÃes em recÃm-nascidos em unidades de terapia intensiva. Sua importÃncia tem aumentado devido ao surgimento de cepas produtoras de beta-lactamases de espectro estendido (ESBL). Estas enzimas medeiam resistÃncia aos oxyimino-&#946;-lactÃmicos. Em K. pneumoniae, a maioria das ESBL identificadas sÃo dos tipos TEM, SHV e CTX-M. Em adiÃÃo, &#946;-lactamases que hidrolisam carbapenÃmicos dos tipos KPC e GES tem sido detectadas nestes isolados. Surtos de infecÃÃo hospitalar causados por clones de K. pneumoniae multiressistentes tem sido descritos em vÃrias regiÃes do paÃs. No entanto, este à o primeiro relato de caracterizaÃÃo genÃtica de isolados de K. pneumoniae produtores de ESBL no estado do CearÃ, Brasil. Este estudo teve como objetivo, em primeiro lugar, detectar os principais genes responsÃveis pela produÃÃo de ESBL em cepas de K. pneumoniae obtidas a partir de pacientes que desenvolveram infecÃÃes hospitalares em um hospital de cuidados terciÃrios na regiÃo norte do estado do CearÃ, de novembro de 2013 a agosto de 2014 e, em segundo lugar, analisar a similaridade genÃtica destes isolados. Trinta e seis isolados clÃnicos de K. pneumoniae produtores de ESBL foram avaliados. A detecÃÃo dos genes blaCTX-M dos grupos 1 e 2, blaSHV-like, blaTEM-like, blaKPC-like e blaGES-like foi realizada por PCR. A tipagem molecular dos isolados foi realizada por Pulsed-Field Gel Electrophoresis (PFGE). Os genes blaCTX-M dos grupos 1 ou 2 e blaSHV-like foram detectados em 100% dos isolados e os genes blaTEM-like em 55,6%. Em adiÃÃo, 55,6% dos produtores de CTX-M tambÃm produziram SHV e TEM. Nenhum gene blaKPC-like e blaGES-like foi detectado. A tipagem molecular por PFGE mostrou grande diversidade entre os isolados, contudo dois isolados coletados em diferentes clÃnicas mostraram o mesmo perfil de bandas e tinham os mesmos genes bla e, entÃo, foram considerados como pertencentes a uma Ãnica cepa. A detecÃÃo dos genes blaCTX-M em 100% dos isolados sugere que as enzimas CTX-M sÃo as principais ESBL responsÃveis pelo fenÃtipo de resistÃncia aos beta-lactÃmicos nos isolados estudados. Dados apresentados neste estudo chamam atenÃÃo para um problema de resistÃncia endÃmico causado por cepas multiclonais de K. pneumoniae multirresistentes cujo controle passa essencialmente pelo aprimoramento das polÃticas de prescriÃÃo de antimicrobianos e pela implantaÃÃo de programas de prevenÃÃo e controle da disseminaÃÃo destes patÃgenos no hospital pesquisado. / Klebsiella pneumoniae is a Gram-negative bacillus responsible for a significant portion of urinary tract infections, respiratory, and bloodstream of adults in hospitals, besides infections in neonates in intensive care units. Its importance has increased due the emergence of extended-spectrum beta-lactamase-producing strains (ESBLs). These enzymes mediate resistance to oxyimino-&#946;-lactams. In K. pneumoniae, most of the identified ESBLs are of the TEM, SHV, and CTX-M types. In addition, carbapenem-hydrolyzing beta-lactamases of KPC and GES types has been detected in these isolates. Outbreaks of nosocomial infections caused by multidrug-resistant K. pneumoniae clones have been described in various regions of the country. However, this is the first report of the genetic characterization of ESBL-producing K. pneumoniae in the state of CearÃ, Brazil. This study aimed firstly to detect the main genes responsible for ESBL production in K. pneumoniae strains obtained from patients who developed nosocomial infections in a tertiary support hospital in the northern region of the Cearà state, from November 2013 to August 2014 and, secondly, to analyze the genetic similarity of these isolates. Thirty-six clinical isolates of ESBL-producing K. pneumoniae were evaluated. The detection of blaCTX-M groups 1 and 2, blaSHV-like, blaTEM-like, blaKPC-like, and blaGES-like genes was performed by PCR. Molecular typing of isolates was performed by pulsed-field gel electrophoresis PFGE. Groups 1 or 2 blaCTX-M and blaSHV-like genes were detected in 100% of the isolates and blaTEM-like genes in 55.6%. In addition, 55.6% of CTX-M-producers also produced SHV and TEM. No blaKPC-like and blaGES-like genes were detected. Molecular typing by PFGE showed great diversity between the isolates, although two isolates collected in different wards showed the same banding profile and had the same bla genes and so were considered to belong to a single strain. Detection of blaCTX-M genes in 100% of the isolates suggests that CTX-M enzymes are the major ESBLs responsible for the beta-lactam resistance phenotypes of the studied isolates. Data presented in this study call attention to an endemic resistance problem caused by multiclonal strains of multidrug-resistant K. pneumoniae whose control passes essentially the improvement of antimicrobial prescription policies and the implementation of prevention and control programs the spread of these pathogens in the studied hospital.