No description available.

No description available.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-09-20T11:52:49Z No. of bitstreams: 1 vanessacordeirodias.pdf: 663329 bytes, checksum: a6ecc4c9fdb1483811c9adc9cb8fad2c (MD5) / Approved for entry into archive by Diamantino Mayra (mayra.diamantino@ufjf.edu.br) on 2016-09-26T20:23:46Z (GMT) No. of bitstreams: 1 vanessacordeirodias.pdf: 663329 bytes, checksum: a6ecc4c9fdb1483811c9adc9cb8fad2c (MD5) / Made available in DSpace on 2016-09-26T20:23:46Z (GMT). No. of bitstreams: 1 vanessacordeirodias.pdf: 663329 bytes, checksum: a6ecc4c9fdb1483811c9adc9cb8fad2c (MD5) Previous issue date: 2010-12-10 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / As infecções do trato urinário (ITU) são manifestações freqüentes na população, geralmente causadas por bacilos Gram-negativos. As β-lactamases são enzimas bacterianas que conferem resistência aos antimicrobianos do tipo β-lactâmicos (penicilinas, cefalosporinas, aztreonam e carbapenêmicos). A produção de β-lactamases de Espectro Estendido (ESBL) tem sido descrita como um importante mecanismo de resistência aos β-lactâmicos. De maneira geral, Escherichia coli e Klebsiella pneumoniae são as espécies bacterianas mais comumente encontradas produzindo ESBL, embora a detecção dessas enzimas já tenha sido observada em diversos gêneros dentro da família Enterobacteriaceae. O objetivo deste estudo foi avaliar os perfis de susceptibilidade a antimicrobianos e correlacionar os testes fenotípicos com a detecção de marcadores genéticos para produção de β-lactamases dos tipos ESBL, AmpC e KPC em enterobactérias associadas à etiologia de ITUs em pacientes atendidos em um Laboratório de Análises Clínicas da cidade de Juiz de Fora, MG. Para o estudo restrospectivo (20012008), 66.660 isolados de urina com suspeita de ITU foram analisadas, e após a identificação bioquímica, as linhagens de enterobactérias foram submetidas a testes de susceptibilidade aos antimicrobianos, pelo método de disco-difusão, de acordo com as normas do Clinical and Laboratory Standards Institute/CLSI. A detecção fenotípica da produção de ESBL foi feita através do teste de aproximação dos discos. Para o estudo prospectivo (2009), 12.304 amostras com suspeita de ITU foram avaliadas, e após a identificação bioquímica das linhagens, foram feitos os testes de susceptibilidade aos antimicrobianos e o teste de aproximação dos discos, para a detecção fenotípica da produção de ESBL. A identificação dos marcadores de β-lactamase (SHV, TEM, CTX-M, AMPc e KPC) foi feita por reação em cadeia da polimerase (PCR). De 416 linhagens produtoras de ESBL entre 2001- 2008, E. coli foi a mais freqüente (74,4%). Altos níveis de resistência foram obtidos para sulfazotrim, gentamicina e ciprofloxacina neste período. Todas as linhagens foram sensíveis ao imipenem. No estudo prospectivo, 105 linhagens produtoras de ESBL foram isoladas, sendo E. coli a mais freqüente (63%). Foi observado um alto índice de resistência a amoxacilina-clavulanato (80,8%), e aproximadamente 70% das amostras foram resistentes à associação trimetoprim/sulfametoxazol e as fluoroquionolonas (ciprofloxacina e ácido nalidíxico). Dentre as drogas utilizadas como substrato para detecção de ESBL, a cefotaxima foi o substrato com maior índice de resistência (86,6%), seguido de aztreonam (60,9%) e ceftazidima (55,2%). Entre as 105 linhagens recuperadas, todos os marcadores genéticos pesquisados para ESBL foram detectados. Considerando-se a freqüência de detecção dos marcadores genéticos, TEM foi o mais frequente (86,6%), seguido por SHV (59%), CTX-M (31,4%) e AMPc (27,6%). Em todas as linhagens bacterianas avaliadas, foi detectado pelo menos 1 dos marcadores genéticos associados à produção de β-lactamases (22,8%), 52,4% apresentaram 2 marcadores, 20% apresentaram 3 marcadores e 4,8% apresentaram 4 dos marcadores pesquisados. β-lactamases do tipo KPC não foram detectadas. O conhecimento da epidemiologia, dinâmica de disseminação e circulação destes marcadores genéticos de resistência a drogas constitui um dado clínico relevante, pois possibilita a instauração de uma terapia antimicrobiana mais adequada, bem como a construção de um banco de informações epidemiológicas, como ferramenta para contenção da expansão da disseminação dos genes de resistência aos antimicrobianos β-lactâmicos. / The urinary tract infections (UTI) are highly frequent within the population and usually caused by Gram-negative rods. The bacterial β-lactamases are enzymes which confer resistance against β-lactam antibiotics (penicillins, cephalosporins, aztreonam and carbapenems) amongst which Extended Spectrum β-Lactamases (ESBL) has been described as an important resistance mechanism to the β-lactam in Gram-negative bacteria. Generally, Escherichia coli and Klebsiella pneumoniae are the most frequent ESBL producing bacterial species, but its production by representatives of other bacterial genus within the Enterobacteriaceae family has already been documented. The aim of this study were to evaluate the antimicrobial susceptibility patterns and to correlate phenotypic tests with the detection of genetic markers for β-lactamases production such as ESBL, AmpC and KPC in enterobacteria associated to the UTI etiology in patients assisted at a Clinical Analyses Laboratory in Juiz de Fora, MG. From a retrospective study (2001-2008), 66.660 urine samples were analyzed, and the biochemically identified bacteria were submitted to antibiotic susceptibility testing by the disk-diffusion method, according to the Clinical Laboratory Standards Institute/CLSI guidelines. Further, phenotypic detection of the ESBL production was carried out through the disk approximation test. From a prospective study (2009), 12.304 samples were evaluated, and after the microbial identification, antibiotic susceptibility tests and disk approximation assays were performed, for ESBL phenotypic detection. Identification of β-lactamase genetic markers (SHV, TEM, CTX-M, AMPc and KPC) were performed through polymerase chain reaction (PCR). Out of 416 ESBL producing bacteria identified between 2001 and 2008, E. coli was the most frequent (74.4%). High resistance levels were obtained for trimethopim-sulfamethoxazole, gentamicin and ciprofloxacin in this period. All of the strains were sensitive to imipenem. Regarding the prospective study, 105 ESBL producing bacteria were isolated, being E. coli the most frequent (63%). A high resistance rate was observed against amoxacilin/clavulanic-acid (80.8%), and almost 70% of the samples were resistant to the association trimethopim-sulfamethoxazole and the fluoroquionolones (ciprofloxacin and nalidixic acid). Among the drugs for ESBL detection, the cefotaxime was the substrate with the highest resistance rate (86.6%), followed by aztreonam (60.9%) and ceftazidime (55.2%). Among these strains, all of the researched genetic markers for ESBL were detected. In regard to the frequency of detection of the genetic markers, TEM was the most frequent (86.6%), following by SHV (59%), CTX-M (31.4%) and AmpC (27.6%). In all of the bacterial strains it was detected at least 1 of the genetic markers associated to the production of β –lactamases. Two markers were detected in 52.4% and in 20% and 48%, at least 3 or 4 markers were detected, respectively. The KPC type β -lactamase was not detected. The knowledge about the epidemiology, spread dynamics and circulation of these resistance genetic markers to drugs among the different bacterial populations constitutes a relevant issue and makes possible the establishment of a more appropriated chemotherapy. Besides, the generation of basic epidemiological information may sustain for contention of the antimicrobial resistance and the spread of resistant genetic markers related to inactivation of β-lactam drugs.

Submitted by Renata Lopes (renatasil82@gmail.com) on 2016-01-21T11:23:35Z No. of bitstreams: 1 ritosantopereira.pdf: 1611336 bytes, checksum: 8393e7d27377653e27c6bd1d9654130b (MD5) / Approved for entry into archive by Adriana Oliveira (adriana.oliveira@ufjf.edu.br) on 2016-01-25T18:43:36Z (GMT) No. of bitstreams: 1 ritosantopereira.pdf: 1611336 bytes, checksum: 8393e7d27377653e27c6bd1d9654130b (MD5) / Made available in DSpace on 2016-01-25T18:43:36Z (GMT). No. of bitstreams: 1 ritosantopereira.pdf: 1611336 bytes, checksum: 8393e7d27377653e27c6bd1d9654130b (MD5) Previous issue date: 2014-11-28 / FAPEMIG - Fundação de Amparo à Pesquisa do Estado de Minas Gerais / A resistência aos agentes antimicrobianos é um problema crescente, restringindo as opções de tratamento e resultando em falhas clinicas mais frequente. Carbapenemases são enzimas produzidas por bactérias Gram-negativas que conferem resistência aos β-lactâmicos. Klebsiella pneumoniae e Enterobacter aerogenes destacam-se pelo oportunismo e capacidade de produção destas enzimas e seu envolvimento nas infecções hospitalares. Nosso trabalho teve como objetivo avaliar os aspectos fisiológicos e moleculares relacionados à virulência e resistência aos carbapenêmicos em K. pneumoniae e E. aerogenes, isolados em um serviço de microbiologia clínica em um hospital terciário durante o ano de 2012. De maneira geral, 3437 espécimes clínicos coletados foram processados para isolamento microbiano. Amostras identificadas foram avaliadas quanto à susceptibilidade aos antimicrobianos e 42 enterobactérias resistentes aos carbapenêmicos foram consideradas. Foram realizados testes para avaliação da produção de carbapenemases, atividade hemolítica, estresse oxidativo, tolerância a biocidas e formação de biofilmes. Os microrganismos foram recuperados de urina, cateter, sangue e trato respiratório. Entre os pacientes, 61,9% eram de UTI. Os isolados apresentaram altos níveis de sensibilidade à amicacina e tigeciclina (>90%). Considerando-se a frequência dos marcadores genéticos, KPC foi a mais frequente (97,6%), seguido por TEM (95,2%), SHV (69,0%) e CTX-M (38,1%). Em todos os isolados avaliados, 2,4% apresentaram 1 marcador genético associado a resistência aos carbapenêmicos, 23,8% apresentaram 2 marcadores, 45,2% apresentaram 3 e 28,6% apresentaram 4. As espécies resistentes aos carbapenêmicos apresentaram características peculiares em relação às características fisiológicas avaliadas, sugerindo que essas bactérias possam apresentar comportamentos diferentes de microrganismos de mesma espécie sensíveis às drogas, com implicações não apenas para antibioticoterapia, mas também para sua virulência e persistência no ambiente nosocomial. Estes resultados confirmam a dificuldade de manejo terapêutico de pacientes com infecções associadas a microrganismos multi-resistentes e oportunistas com impactos diretos na mortalidade e no controle epidemiológico destes microrganismos nos centros de saúde. / The antimicrobial resistance is a growing problem, restricting treatment options and resulting in more frequent clinical failures. Carbapenemases are enzymes produced by Gram-negative bacteria which confer resistance to β-lactams. Klebsiella pneumoniae and Enterobacter aerogenes stand out by opportunism and production capacity of these enzymes and their involvement in nosocomial infections. Our study aimed to evaluate the virulence and related carbapenem resistance in K. pneumoniae and E. aerogenes physiological and molecular aspects, isolated from the Clinical Laboratory, in a tertiary hospital in the city of Juiz de Fora - Minas Gerais, during 2012. During the study period, 3437 clinical specimens were processed for microbial isolation. Identified samples were evaluated for antimicrobial susceptibility and 42 resistant Enterobacteriaceae to carbapenems were considered. Underwent tests for evaluation of carbapenemase production, hemolytic activity, biofilm formation, oxidative stress and biocides tolerance. The results showed that K. pneumoniae and E. aerogenes were recovered in urine, catheter, blood and respiratory tract. Among the patients, 61.9% were ICU. The isolates showed high levels of sensitivity to amikacin and tigecycline (>90%). Considering the frequency of genetic markers, KPC was the most common (97.6%), followed by TEM (95.2%), SHV (69.0%) and CTX-M (38.1%). In all isolates, 2.4% had one genetic marker associated with resistance to carbapenems, 23.8% had two markers, 45.2% had three and 28.6% had four. Carbapenemase producers showed particular characteristics regarding the assessed physiological characteristics, suggesting that these bacteria may exhibit different behaviors of microorganisms of the same species susceptible to carbapenem with implications not only for antibiotic therapy, but also for their virulence and persistence in the nosocomial environment. These results confirm the difficulty of therapeutic management of patients with infections associated with multi- resistant and opportunistic microorganisms with direct impacts on mortality and epidemiological control of these microorganisms in health centers.

No description available.

No description available.

No description available.

TEM and SHV β-lactamases are the most prevalent β-lactamases among Gram-negative bacteria. The introduction and widespread use of expanded-spectrum antibiotics, particularly third generation cephalosporins, has led to the evolution of bacterial strains expressing extended spectrum β-lactamases (ESBLs). ESBLs emerge by genetic point mutation from non-extended spectrum precursors. It was found that multiple β-lactamase families within single isolates complicate the process of detecting the resistance status of isolate using non-quantitative DNA diagnostic methods. Preliminary phenotypic characterisation of probable β-lactamase enzyme family types present in 100 isolates from the Asia-Pacific and South African locales showed that single isolates frequently contained multiple β-lactamase families. SHV, TEM, AMPC and CTX-M β-lactamase families were detected in these isolates using PCR detection methods. Ninety-eight percent of all isolates tested contained as least one β-lactamase gene, with up to four to β-lactamase gene families found to co-exist in single isolates. Kinetic PCR methods for interrogating the polymorphic sites at blaSHV codons 238 & 240 and blaTEM codons 164, 238, 240 as well as promoter polymorphism were developed. A high proportion of blaSHV 238 and 240 mutant alleles was found to correlate with cefotaxime, ceftazidime and aztreonam resistance levels. In an attempt to understand the molecular basis for the co-existence of multiple blaSHV alleles within single isolates, the blaSHV promoter region was cloned from one ESBL expressing isolate. Experimental results showed that blaSHV can exist downstream of two different promoters within a single isolate. Both promoters have previously been reported, and differ by the presence or absence of IS26, which results in a change in the transcription initiation site. The blaSHV gene copy numbers in cis with the different promoters were measured, and it was found that the copy number of the IS26::blaSHV promoter was positively correlated with resistance levels. Cloning and analysis of PCR products showed that different blaSHV variants existed in cis with promoters in individual isolates. However, mutant genes were more abundant downstream of the IS26 promoter. There were no ESBL+ isolates without this promoter. It was concluded that blaSHV in cis with the IS26 promoter is located on an amplifiable replicon, and the presence of the IS26 insertion may facilitate the acquisition of an ESBL+ phenotype. To further confirm the role of IS26 in resistance acquisition, ESBL negative isolates were subjected to serial passage in vitro evolution experiments and fluctuation assays. Results confirm that the insertion of the IS26 element upstream of blaSHV is positively correlated with the ability to exhibit an ESBL phenotype, when such isolates also contain the critical G238S substitution. It was also found that IS26 can catalyse the duplication and mobilisation of blaSHV within an isolate. Fluctuation experiments have shown that the frequency at which such genomic events occur resulting in ESBL phenotypes is extremely low and requires many generations of selection under sub-lethal conditions. A survey of a geographically diverse set of isolates has shown that IS26-blaSHV was found in all of the bacterial populations surveyed. However, it does not appear to be exclusively associated with SHV-mediated ESBL production.

Extended spectrum β-lactamases or ESBLs, which are derived from non-ESBL precursors by point mutation of β-lactamase genes (bla), are spreading rapidly all over the world and have caused considerable problems in the treatment of infections caused by bacteria which harbour them. The mechanism of this resistance is not fully understood and a better understanding of these mechanisms might significantly impact on choosing proper diagnostic and treatment strategies. Previous work on SHV β-lactamase gene, blaSHV, has shown that only Klebsiella pneumoniae strains which contain plasmid-borne blaSHV are able to mutate to phenotypically ESBL-positive strains and there was also evidence of an increase in blaSHV copy number. Therefore, it was hypothesised that although specific point mutation is essential for acquisition of ESBL activity, it is not yet enough, and blaSHV copy number amplification is also essential for an ESBL-positive phenotype, with homologous recombination being the likely mechanism of blaSHV copy number expansion. In this study, we investigated the mutation rate of non-ESBL expressing K. pneumoniae isolates to an ESBL-positive status by using the MSS-maximum likelihood method. Our data showed that blaSHV mutation rate of a non-ESBL expressing isolate is lower than the mutation rate of the other single base changes on the chromosome, even with a plasmid-borne blaSHV gene. On the other hand, mutation rate from a low MIC ESBL-positive (≤ 8 µg/mL for cefotaxime) to high MIC ESBL-positive (≥16 µg/mL for cefotaxime) is very high. This is because only gene copy number increase is needed which is probably mediated by homologous recombination that typically takes place at a much higher frequencies than point mutations. Using a subinhibitory concentration of novobiocin, as a homologous recombination inhibitor, revealed that this is the case.

Extended-spectrum β-lactamases (ESBLs) are plasmid-mediated bacterial enzymes that confer resistance for most β-lactams antibiotics. These enzymes are widespread in microorganisms in hospital settings worldwide. This study estimated the distribution and prevalence of the main ESBLs families among samples of Escherichia coli and Klebsiella spp. in the university hospital of Santa Maria (HUSM), Rio Grande do Sul. During a period of 14 months 90 microorganisms were selected as probable ESBL producers according to the recommendations of Clinical and Laboratory Standards Institute (CLSI). The isolated microorganisms were submitted to phenotypic confirmatory tests for the presence of ESBL. Samples that showed negative results were tested against their susceptibility to cefoxitin. The ESBLs types found in each organism were determined by the research of the genes bla TEM, bla SHV e bla CTX-M by polymerase chain reaction (PCR). Fifty-five (61.1%) samples were confirmed as ESBL positive by the combined disc method and fifty-seven (63.3%) by the double disc method. In the cefoxitin susceptibility test 16 of the 39 samples presented resistance to this agent. Based on PCR, 74 (82,2%) samples harbored TEM-type ESBL gens, 61 (67,8%) SHV-type and 19 (21,1%) CTX-M-type. Only one Escherichia coli isolate appeared harboring genes for the CTX-M family of ESBLs. The distribution of TEM, SHV and CTX-M ESBL families from HUSM presented some similarities and differences compared with ESBLs of other hospital settings. / As β-lactamases de Espectro Estendido (ESBLs) são enzimas bacterianas mediadas por plasmídeos que conferem resistência à maioria dos antibióticos β-lactâmicos. Estas enzimas estão amplamente disseminadas em microrganismos nos ambientes hospitalares do mundo. Este estudo estimou a distribuição e prevalência das principais famílias de ESBLs entre amostras de Escherichia coli e Klebsiella spp. no Hospital Universitário de Santa Maria (HUSM), Rio Grande do Sul. Durante um período de 14 meses, 90 microrganismos foram selecionados como prováveis produtores de ESBLs de acordo com os critérios estabelecidos pelo Clinical and Laboratory Standards Institute (CLSI). Os microrganismos isolados foram submetidos a testes fenotípicos confirmatórios para a presença de ESBL. As amostras que apresentaram resultado negativo nestes testes tiveram sua susceptibilidade testada frente à cefoxitina. Os tipos de ESBLs presentes em cada microrganismo foram determinados pela pesquisa dos genes bla TEM, bla SHV e bla CTX-M através da reação em cadeia da polimerase (PCR). Empregando-se o método do disco combinado, a presença de ESBLs foi confirmada em 55 (61,1%) amostras; quando o método do duplo disco foi utilizado, 57 (63,3%) amostras foram confirmadas. No teste de susceptibilidade à cefoxitina, 16 das 39 amostras testadas apresentaram resistência a este substrato. Com base na PCR, 74 (82,2%) amostras possuíam genes para a família TEM de ESBLs, 61 (67,8%) para a família SHV e 19 (21,1%) para a família CTX-M. Apenas um isolado de Escherichia coli demonstrou possuir genes para a família CTX-M de ESBLs. A distribuição de ESBLs das famílias TEM, SHV e CTX-M no HUSM apresentou semelhanças e diferenças em comparação com ESBLs de outros ambientes hospitalares.