In this work, an enantioselective HPLC method with UV and fluorimetric detection was developed and subsequently optimized for chiral separation of four aminoacids (D/L-alanine, D/L-valine, D/L-leucine, D/L-isoleucine) in native and particularly in derivatized form with an emphasis on enantioseparation of D-analogues. Retention and enantioseparation behavior of studied analytes was investigated on three chiral stationary phases based on teicoplanin (Chirobiotic T, Chirobiotic T2) and teicoplanin aglycone (Chirobiotic TAG). At the Chirobiotic T column, enantioseparations of underivatized aminoacids were performed with UV detection at 205 nm in the mobile phases methanol/water with different volume ratios. Baseline separation of L- and D-forms was achieved, however, the sensitivity of detection was very low. In order to increase detection sensitivity, derivatization of aminoacids was performed using 9-fluorenylmethyl chloroformate (FMOC-Cl) and the derivatization procedure was monitored on Chirobiotic T column with fluorimetric detection (λEx = 254 nm, λEm = 314 nm) in a buffered mobile phase methanol/0.5% TEAA buffer, pH 6.0 40/60 (v/v). In terms of derivatization, volume ratio D/L-aminoacid/derivatization agent 1/1 with ten times higher concentration of derivatization agent was found to be the most suitable....

Made available in DSpace on 2014-06-11T19:28:03Z (GMT). No. of bitstreams: 0 Previous issue date: 2009-03-30Bitstream added on 2014-06-13T20:17:46Z : No. of bitstreams: 1 passoni_mh_me_arafcf.pdf: 404173 bytes, checksum: 0602419a359e80c6739ffbcafd458c33 (MD5) / Universidade Estadual Paulista (UNESP) / A teicoplanina é um antibiótico glicopeptídico, cujo mecanismo de ação é inibir a síntese da parede celular bacteriana. Esse antibiótico vem sendo bastante utilizado no Brasil no combate a bactérias Gram-positivas multiresistente a fármacos. Em razão deste fármaco ser relativamente novo no mercado, não há metodologia de análise descrita em compêndios oficias. Este trabalho apresenta procedimentos para quantificação de teicoplanina em pó para solução injetável. O método espectrofotometrico na região ultravioleta a 279 nm, na faixa de concentração de 60,0 a 110,0 μg/mL (r2 = 0,999), apresentou linearidade, precisão e exatidão, com teor médio no pó para solução injetável de 97,45%. A cromatografia líquida de alta eficiência utilizou coluna C18 (4,6 x 250 mm, 5 mm) e a fase móvel constituída de metanol : acetonitrila (50:50, V/V), na faixa de concentração de 70,0 a 120,0 mg/mL (r2 = 0,999) e apresentou linearidade, precisão e exatidão, com teor médio no pó para solução injetável de 99,12%. Os dados foram calculados pela análise de variância (ANOVA), permitindo assim aplicação destes métodos no controle de qualidade. / Teicoplanin is a glycopeptide antibiotic, which inhibits the bacteria cellular membrane synthesis. This antibiotic is quite new and has been used in Brazil to combat Gram-positive bacteria that are multi-drug resistant. There is not described analytical methodology in official literature. This work reports procedures for the quantification of teicoplanin in pharmaceutical forms. In the UV-spectrophotometry at 279 nm, the Lambert-Beer law was obeyed in the concentration range from 60.0 to 110.0 μg/mL (r2 = 0,999), whose analysis presented linearity, precision and accuracy, with average in powder for injection of 97.45. In the second method, HPLC methods, the samples were injected into a Waters Symmetry C18 column (4.6 x 250 mm, 5 mm). The mobile phase was consisted of acetonitrile and methanol (50:50, V/V). UV detection was performed at 279 nm, and the samples and reference solutions were prepared in the mobile phase; the calibration curve for teicoplanin was linear from 70.0 to the 120.0 mg/mL range (r2 = 0.999). The procedure presented linearity, precision, accuracy, with average in powder for injection of 99.12%. The statistical data were calculated by analysis of variance (ANOVA), that it allows the application of the analytical methods in the quality control of pharmaceutical preparations.

Orientador: Hérida Regina Nunes Salgado / Banca: Hérida Regina Nunes Salgado / Banca: Márcia da Silva / Banca: Cristiane Masetto de Gaitani / Resumo: A teicoplanina é um antibiótico glicopeptídico, cujo mecanismo de ação é inibir a síntese da parede celular bacteriana. Esse antibiótico vem sendo bastante utilizado no Brasil no combate a bactérias Gram-positivas multiresistente a fármacos. Em razão deste fármaco ser relativamente novo no mercado, não há metodologia de análise descrita em compêndios oficias. Este trabalho apresenta procedimentos para quantificação de teicoplanina em pó para solução injetável. O método espectrofotometrico na região ultravioleta a 279 nm, na faixa de concentração de 60,0 a 110,0 μg/mL (r2 = 0,999), apresentou linearidade, precisão e exatidão, com teor médio no pó para solução injetável de 97,45%. A cromatografia líquida de alta eficiência utilizou coluna C18 (4,6 x 250 mm, 5 mm) e a fase móvel constituída de metanol : acetonitrila (50:50, V/V), na faixa de concentração de 70,0 a 120,0 mg/mL (r2 = 0,999) e apresentou linearidade, precisão e exatidão, com teor médio no pó para solução injetável de 99,12%. Os dados foram calculados pela análise de variância (ANOVA), permitindo assim aplicação destes métodos no controle de qualidade. / Abstract: Teicoplanin is a glycopeptide antibiotic, which inhibits the bacteria cellular membrane synthesis. This antibiotic is quite new and has been used in Brazil to combat Gram-positive bacteria that are multi-drug resistant. There is not described analytical methodology in official literature. This work reports procedures for the quantification of teicoplanin in pharmaceutical forms. In the UV-spectrophotometry at 279 nm, the Lambert-Beer law was obeyed in the concentration range from 60.0 to 110.0 μg/mL (r2 = 0,999), whose analysis presented linearity, precision and accuracy, with average in powder for injection of 97.45. In the second method, HPLC methods, the samples were injected into a Waters Symmetry C18 column (4.6 x 250 mm, 5 mm). The mobile phase was consisted of acetonitrile and methanol (50:50, V/V). UV detection was performed at 279 nm, and the samples and reference solutions were prepared in the mobile phase; the calibration curve for teicoplanin was linear from 70.0 to the 120.0 mg/mL range (r2 = 0.999). The procedure presented linearity, precision, accuracy, with average in powder for injection of 99.12%. The statistical data were calculated by analysis of variance (ANOVA), that it allows the application of the analytical methods in the quality control of pharmaceutical preparations. / Mestre

The aim of this work was to develop and to optimize HPLC method for enantioseparation of newly synthesized derivatives of amino acids. The set of these analytes contained four N- blocked derivatives of D,L-Phenylalanine, three N-unblocked derivatives of D,L- Phenylalanine, , one methylated derivative of D,L-Tyrosine and D,L-Tyrosine. Two separation modes i.e. reversed phase and polar-organic modes and two columns i.e. Chirobiotic® T and Chirobiotic® T2 were used. Chiral stationary phases of these columns were composed of macrocyclic antibiotic teicoplanin coated on silica gel support. As mobile phases in revesed phase mode, methanol and acetate buffer were used with Chirobiotic® T column. The most suitable concentration were 20 mM and the most suitable pH value were 4.00. Under the above mentioned conditions eight analytes of ten were separated and the optimal conditions were found. Polar-organic mode and Chirobiotic® T column were suitable only for enantioseparation of three N-blocked derivatives of D,L- Phenylalanine. Mobile phases were composed of methanol with small additions of triethylamine and acetic acid. Chirobiotic® T2 column in reversed phase mode was not suitable for tested set of analytes. Only partial separation of D,L-Tyrosine derivative and one N-unblocked D,L-Phenylalanine...

Estima-se que 30% da população mundial esteja colonizada por Staphylococcus aureus. Indivíduos portadores de HIV/AIDS possuem maiores riscos de colonização e infecções causadas por S. aureus resistente à meticilina (MRSA), devido a seu estado imunológico comprometido, frequente uso de antibióticos e reinternações hospitalares. Linhagens de MRSA emergiram na década de 60, logo após a introdução da meticilina, devido a aquisição de genes que codificam proteínas ligadoras de penicilinas modificadas, mecA e mecC, contidos no elemento genético móvel SCCmec (do inglês, Staphylococcal Cassete Chromossome). Este estudo buscou caracterizar amostras de MRSA de pacientes com HIV/AIDS, isoladas no primeiro e sétimo dia de internação no hospital, e de seus profissionais de saúde, do Hospital das Clínicas de Ribeirão Preto, no período de abril de 2011 a maio de 2013. Os objetivos foram caracterizar fenotípica e genotipicamente os isolados de MRSA e comparar as linhagens, a fim de observar se havia disseminação entre os pacientes ou entre estes e profissionais de saúde relacionados. Foi realizada caracterização por perfil de sensibilidade, determinação do elemento SCCmec, eletroforese em campos pulsados (PFGE, do inglês, Pulsed Field Gel Electrophoresis) e tipagem por sequenciamento de Multilocus (MLST). Foram pesquisados os tipos de hemólise produzidos e a presença de gene para produção da Leucocidina Panton Valentine (PVL). Vinte pacientes encontravam-se colonizados no primeiro dia de internação, treze após uma semana e três profissionais da saúde estavam colonizados durante o estudo. Quando excluídas as amostras consideradas duplicatas, SCCmecIV foi o elemento predominante. Grande variedade clonal de MRSA foi encontrada nos pacientes, totalizando 11 pulsotipos. ST239-SCCmecIII, relacionado ao Clone Endêmico Brasileiro (BEC), foi isolado de pacientes logo no primeiro dia de internação, provavelmente devido à prévia internação. O profissional de saúde P1 apresentou colonização por MRSA caracterizado como pulsotipo E, que persistiu após o tratamento para descolonização. P1 foi tratado novamente e posteriormente foi observado isolado com pulsotipo J, sugerindo ser um clone diferente dos anteriores, mas ainda com linhagem ST105-SCCmecII. Apenas um isolado, do paciente 5, apresentou grande similaridade (92,3%) com um isolado do profissional de saúde (P1). Entretanto, houve intervalo de 10 meses entre as coletas e não há indício de transmissão direta de uma pessoa para outra. Presença do gene da PVL foi encontrada em apenas dois isolados. Três amostras de MRSA foram caracterizadas como hVISA (do inglês, heterogeneous Vancomycin Intermediate Staphylococcus aureus) e dois deles possuíam resistência intermediária à teicoplanina. Um isolado apresentou resistência à daptomicina em 48h de incubação com uma população heterogênea detectada. Todos foram sensíveis a quinupristina-dalfopristina, linezolida e tigeciclina. Concluímos que não houve disseminação de uma linhagem específica entre os pacientes, ou entre profissionais de saúde e pacientes e não foi observada relação entre o tempo de estadia no hospital e aquisição de uma linhagem em específico. No entanto, algumas linhagens com perfis de resistência muito preocupantes, como hVISA e com heterorresistência à daptomicina, foram isoladas e requerem atenção e monitoramento, com programas de vigilância e adoção de práticas de segurança e higiene no trabalho por parte dos profissionais de saúde. / It is estimated that 30 % of the world population is colonized by Staphylococcus aureus. Individuals with HIV/AIDS have a higher risk of colonization and infection caused by methicillin-resistant S. aureus (MRSA), due to their compromised immune system, frequent use of antibiotics and hospital readmissions. Strains of MRSA emerged in the 60s, shortly after the introduction of methicillin. Such resistance is caused by acquisition of genes encoding modified penicillin binding proteins, mecA and mecC, contained in the mobile genetic element SCCmec (Staphylococcal Cassette Chromosome). This study aimed to characterize MRSA isolated from patients with HIV/AIDS, in the first and seventh day of hospitalization, and their health care professionals, at the Clinical Hospital of Ribeirão Preto, in the period of April 2011 to May 2013. The objectives were to characterize phenotypic and genotypically MRSA isolates in order to observe if there was some lineage spread among patients or between these and related health professionals. MRSA isolates were characterized by susceptibility profile, SCCmec element typing, pulsed field gel electrophoresis (PFGE) and multilocus sequencing typing (MLST). Pattern of hemolysis and the presence of the gene for production of Leukocidin Panton Valentine (PVL) were determined. Twenty patients were colonized on the first day of hospitalization, thirteen patients in a week and only three health care professionals were colonized during the study. SCCmecIV was the predominant element when samples considered duplicates were excluded. Large variety of MRSA clones was found in patients with 11 pulsotypes. ST239-SCCmecIII, related to Brazilian Endemic Clone (BEC), was isolated from patients on the first day of hospitalization, probably due to previous hospital admission. Professional P1 was colonized by MRSA isolate characterized as pulsotype E which persisted after treatment for decolonization. P1 was treated again and was observed with a pulsotype J isolate, which suggests being a different clone of the same lineage ST105-SCCmecII. Only one sample, from patient 5, showed high similarity (92.3 %) with this health professional isolate (P1). However, there was an interval of 10 months between the collections and there is no evidence of direct transmission from one person to another. Presence of the PVL gene was found in only two isolates. Three MRSA isolates were characterized as hVISA (heterogeneous Vancomycin Intermediate S. aureus) and two of them were also intermediate resistant to teicoplanin. One isolate showed resistance to daptomycin in 48h incubation and heterogeneous population was detected. All isolates were susceptible to quinupristin-dalfopristin, linezolid and tigecycline. We conclude that no spread of a particular strain was found among patients or between health care professionals and patients, and no relationship between duration of hospital stay and acquisition of a specific lineage was observed. However, some strains with resistance profiles very threatening, as hVISA and heteroresistant to daptomycin, were isolated and require attention and monitoring, with surveillance programs and use of safety practices and hygiene by health professionals.

Estima-se que 30% da população mundial esteja colonizada por Staphylococcus aureus. Indivíduos portadores de HIV/AIDS possuem maiores riscos de colonização e infecções causadas por S. aureus resistente à meticilina (MRSA), devido a seu estado imunológico comprometido, frequente uso de antibióticos e reinternações hospitalares. Linhagens de MRSA emergiram na década de 60, logo após a introdução da meticilina, devido a aquisição de genes que codificam proteínas ligadoras de penicilinas modificadas, mecA e mecC, contidos no elemento genético móvel SCCmec (do inglês, Staphylococcal Cassete Chromossome). Este estudo buscou caracterizar amostras de MRSA de pacientes com HIV/AIDS, isoladas no primeiro e sétimo dia de internação no hospital, e de seus profissionais de saúde, do Hospital das Clínicas de Ribeirão Preto, no período de abril de 2011 a maio de 2013. Os objetivos foram caracterizar fenotípica e genotipicamente os isolados de MRSA e comparar as linhagens, a fim de observar se havia disseminação entre os pacientes ou entre estes e profissionais de saúde relacionados. Foi realizada caracterização por perfil de sensibilidade, determinação do elemento SCCmec, eletroforese em campos pulsados (PFGE, do inglês, Pulsed Field Gel Electrophoresis) e tipagem por sequenciamento de Multilocus (MLST). Foram pesquisados os tipos de hemólise produzidos e a presença de gene para produção da Leucocidina Panton Valentine (PVL). Vinte pacientes encontravam-se colonizados no primeiro dia de internação, treze após uma semana e três profissionais da saúde estavam colonizados durante o estudo. Quando excluídas as amostras consideradas duplicatas, SCCmecIV foi o elemento predominante. Grande variedade clonal de MRSA foi encontrada nos pacientes, totalizando 11 pulsotipos. ST239-SCCmecIII, relacionado ao Clone Endêmico Brasileiro (BEC), foi isolado de pacientes logo no primeiro dia de internação, provavelmente devido à prévia internação. O profissional de saúde P1 apresentou colonização por MRSA caracterizado como pulsotipo E, que persistiu após o tratamento para descolonização. P1 foi tratado novamente e posteriormente foi observado isolado com pulsotipo J, sugerindo ser um clone diferente dos anteriores, mas ainda com linhagem ST105-SCCmecII. Apenas um isolado, do paciente 5, apresentou grande similaridade (92,3%) com um isolado do profissional de saúde (P1). Entretanto, houve intervalo de 10 meses entre as coletas e não há indício de transmissão direta de uma pessoa para outra. Presença do gene da PVL foi encontrada em apenas dois isolados. Três amostras de MRSA foram caracterizadas como hVISA (do inglês, heterogeneous Vancomycin Intermediate Staphylococcus aureus) e dois deles possuíam resistência intermediária à teicoplanina. Um isolado apresentou resistência à daptomicina em 48h de incubação com uma população heterogênea detectada. Todos foram sensíveis a quinupristina-dalfopristina, linezolida e tigeciclina. Concluímos que não houve disseminação de uma linhagem específica entre os pacientes, ou entre profissionais de saúde e pacientes e não foi observada relação entre o tempo de estadia no hospital e aquisição de uma linhagem em específico. No entanto, algumas linhagens com perfis de resistência muito preocupantes, como hVISA e com heterorresistência à daptomicina, foram isoladas e requerem atenção e monitoramento, com programas de vigilância e adoção de práticas de segurança e higiene no trabalho por parte dos profissionais de saúde. / It is estimated that 30 % of the world population is colonized by Staphylococcus aureus. Individuals with HIV/AIDS have a higher risk of colonization and infection caused by methicillin-resistant S. aureus (MRSA), due to their compromised immune system, frequent use of antibiotics and hospital readmissions. Strains of MRSA emerged in the 60s, shortly after the introduction of methicillin. Such resistance is caused by acquisition of genes encoding modified penicillin binding proteins, mecA and mecC, contained in the mobile genetic element SCCmec (Staphylococcal Cassette Chromosome). This study aimed to characterize MRSA isolated from patients with HIV/AIDS, in the first and seventh day of hospitalization, and their health care professionals, at the Clinical Hospital of Ribeirão Preto, in the period of April 2011 to May 2013. The objectives were to characterize phenotypic and genotypically MRSA isolates in order to observe if there was some lineage spread among patients or between these and related health professionals. MRSA isolates were characterized by susceptibility profile, SCCmec element typing, pulsed field gel electrophoresis (PFGE) and multilocus sequencing typing (MLST). Pattern of hemolysis and the presence of the gene for production of Leukocidin Panton Valentine (PVL) were determined. Twenty patients were colonized on the first day of hospitalization, thirteen patients in a week and only three health care professionals were colonized during the study. SCCmecIV was the predominant element when samples considered duplicates were excluded. Large variety of MRSA clones was found in patients with 11 pulsotypes. ST239-SCCmecIII, related to Brazilian Endemic Clone (BEC), was isolated from patients on the first day of hospitalization, probably due to previous hospital admission. Professional P1 was colonized by MRSA isolate characterized as pulsotype E which persisted after treatment for decolonization. P1 was treated again and was observed with a pulsotype J isolate, which suggests being a different clone of the same lineage ST105-SCCmecII. Only one sample, from patient 5, showed high similarity (92.3 %) with this health professional isolate (P1). However, there was an interval of 10 months between the collections and there is no evidence of direct transmission from one person to another. Presence of the PVL gene was found in only two isolates. Three MRSA isolates were characterized as hVISA (heterogeneous Vancomycin Intermediate S. aureus) and two of them were also intermediate resistant to teicoplanin. One isolate showed resistance to daptomycin in 48h incubation and heterogeneous population was detected. All isolates were susceptible to quinupristin-dalfopristin, linezolid and tigecycline. We conclude that no spread of a particular strain was found among patients or between health care professionals and patients, and no relationship between duration of hospital stay and acquisition of a specific lineage was observed. However, some strains with resistance profiles very threatening, as hVISA and heteroresistant to daptomycin, were isolated and require attention and monitoring, with surveillance programs and use of safety practices and hygiene by health professionals.

La teicoplanine est utilisée par voie intraveineuse (IV) dans le traitement de la pneumonie acquise sous ventilation mécanique (PAVM) à Staphylocoque aureus méticilline résistant. Nous avons évalué la faisabilité et les bénéfices de la nébulisation de teicoplanine en ventilation mécanique (VM) par rapport à la voie IV. L’administration d’un aérosol de teicoplanine chez le rat a permis d’obtenir des concentrations pulmonaires 48 fois supérieures à celles après IV et des concentrations plasmatiques inférieures à celles après IV. Après avoir mesuré l’influence des nébuliseurs sur les paramètres ventilatoires du respirateur, nous avons sélectionné le nébuliseur Aeroneb Pro®. Les propriétés bactériologiques de l’antibiotique ne sont pas altérées par le nébuliseur et l’exposition d’un modèle d’épithélium pulmonaire in vitro à des doses 100 fois supérieures à celles utilisées en IV n’a pas montré de cytotoxicité. L’étude réalisée sur la nébulisation de teicoplanine chez le porc en VM a montré un dépôt pulmonaire moyen de 18,1%. En conclusion, la nébulisation de teicoplanine pourrait etre envisagée comme une nouvelle arme thérapeutique dans la PAVM. / Nebulization of teicoplanin should be an alternative way of administration in Ventilator-associated pneumonia (VAP) caused by Methicillin-resistant staphylococcus aureus. We assessed the faisibility and advantages of nebulization of teicoplanin in mechanical ventilation. After a nebulization of teicoplanin in a rat model, the lung concentrations were more than 48 times higher than the lung concentrations following intravenous administration. In the next study, we used an Aeroneb Pro® nebulizer selected according to its safe properties with ventilator which was evaluated in a bench study. Any cytotoxicity was observed with high doses of teicoplanin and nebulization did not affect its pharmacological properties. In mechanically ventilated piglets, teicoplanin was administered efficiently by nebulization wih an aerosol delivery of 18.1% [16.3-27.0]. Pharmacokinetic parameters are particularly consistent with this time-dependent antibiotic and emphasize the potential of airways delivery of teicoplanin. In conclusion, nebulization of teicoplanin adds a further challenge to the development of aerosol therapy of antibiotics in VAP.

Glycopeptides are the so-called last-resort antibiotics in clinical practice used to treat heavier, predominantly nosocomial infections caused by multi-resistant coagulase-negative staphylococci. The origin and genetic basis of resistance to glycopeptide antibiotics has not yet been elucidated within coagulase-negative staphylococci. Research on Staphylococcus aureus has shown, that intermediate resistance to glycopeptide antibiotics is associated with the presence of one or more mutations, rather than being conditioned by the support of a particular genetic element, such as in enterococci. By using various types of in vitro resistant mutant selection, we were able to obtain isogenic pairs of glycopeptide sensitive and resistant strains of Staphylococcus epidermidis and Staphylococcus haemolyticus. By sequencing the genomes of these pairs, one nucleotide polymorphisms were identified and predominantly found in metabolic and cell wall control systems. Phenotypic analysis did not reveal a direct association of glycopeptide resistance with increased biofilm formation. In clinical practice, the cross-resistance of glycopeptides and other antibiotics is problematic. For the non-glycopeptide antibiotics imipenem and rifampicin, the incidence of cross-resistance with glycopeptide antibiotics in S. aureus...

A membrane protein VanZTei which is encoded by the gene vanZ from the vanA glycopeptide resistance gene cluster is a part of the large family of VanZ proteins. VanZTei confers resistance to teicoplanin in Enterococcus faecalis without the presence of other proteins encoded by the cluster. The aim of my work was to compare the ability of two orthologous proteins VanZTei and VanZg (from the genome of Enterococcus faecium) to confer resistance to glycopeptides in Staphylococcus aureus RN4220 and Enterococcus faecium. We have shown that VanZg increases resistance to teicoplanin (Tei) 8 to 16 times the and also to dalbavancin (Dalb) 8 times. VanZTei also confers resistance to Tei and Dalb, but the increase is only twofold. Conversely VanZTei confers resistance to newly synthetized glycopeptides more effectively than VanZg (fourfold increase of resistance confered by VanZTei and two to fourfold increase of resistance confered by VanZg). It suggests that both proteins have different specificity to antibiotics. In despite the mutants of S. aureus RN4220 VanZTei pRMC2 with increased resistance to teicoplanin (MICTei> 8 µg/ml) in which the resistance is dependent on vanZTei expression were selected. These resistant mutants do not carry mutation in a gene vanZTei or in its ribosomal binding site. Neither of the...

Introdução: O Clostridium difficile é um bacilo Gram-positivo, anaeróbio estrito, formador de esporos, que produz toxinas que podem causar diarreia, colite pseudomembranosa, dilatação do cólon, sepse e até morte. Nos últimos anos o quadro clínico e epidemiológico das infecções por Clostridium difficile tem se modificado e as limitações das opções terapêuticas tornaram-se mais evidentes. Objetivo Primário: Comparar as metodologias de disco-difusão e ágar-diluição na detecção de sensibilidade/resistência de isolados de Clostridium difficile. Objetivos Secundários: Avaliar prospectivamente o perfil de sensibilidade/resistência de isolados clínicos hospitalares de Clostridium difficile provenientes de seis hospitais terciários da cidade de São Paulo e fornecer evidências para fundamentar o diagnóstico e o tratamento empírico das diarreias causadas por Clostridium difficile. Métodos: utilizamos os métodos de disco-difusão e ágar-diluição, de acordo com os critérios estabelecidos pelo CLSI e EUCAST. Resultados: Os coeficientes de correlação observados entre os diâmetros dos halos de inibição e Concentração Inibitória Mínima foram abaixo do esperado tornando inviável o método de disco-difusão para determinação de sensibilidade aos antimicrobianos nitazoxanida, teicoplanina e tigeciclina. Todas as 50 cepas deste estudo foram sensíveis ao metronidazol (MIC50 foi de 1 ?g/mL a MIC90 foi de 2 ug/mL). Para o método de disco-difusão, sugerimos que halos de inibição >= 33mm possam ser interpretados como sensíveis. Devido à moderada correlação, significância estatística e distribuição de halos de inibição das amostras próximos aos valores encontrados utilizando a cepa ATTC, sugere-se a utilização do método de disco-difusão para vancomicina, onde halos com diâmetro >= 22mm possam ser considerados como sensíveis pelo método. Para o moxifloxacino houve uma boa correlação entre as duas metodologias: discodifusão e de ágar-diluição (O coeficiente de Pearson foi de -0,84, e o valor de p foi menor que 0,00001), sugerindo que halos de inibição >= 18mm possam ser interpretados como sensíveis pela metodologia de disco-difusão. A nitazoxanida foi à droga que mostrou melhor atividade in vitro (MIC50 foi 0,06 ?g/mL e a MIC90 de 0,12 ug/mL). Por se mostrar uma droga com potente atividade in vitro (MIC50 e a MIC90 foi de 0,12 ug/mL), a tigeciclina poderia ser mais uma opção terapêutica em infecções por Clostridium difficile, dependendo de mais estudos para avaliar sua real eficácia clínica e segurança. Conclusão: Os resultados verificados neste estudo indicam a necessidade de mais estudos in vitro e clínicos para definir os limites de sensibilidade/resistência para a teicoplanina e a nitazoxanida, pois faltam critérios de interpretação tanto para disco-difusão quanto para ágar-diluição. Os resultados deste trabalho in vitro confirmaram a utilidade do metronidazol como uma droga eficaz no tratamento de infecção por Clostridium difficile. A nitazoxanida foi à droga que mostrou melhor atividade in vitro por método dilucional. Sugerimos a utilização do método de disco-difusão para: metronidazol, vancomicina e moxifloxacino. Os resultados desse trabalho sugerem que halos de inibição para metronidazol ( >= 33mm), moxifloxacino ( >= 18mm) e vancomicina ( >= 22mm) poderiam ser considerados como sensíveis pelo método de disco-difusão. O método de ágardiluição é um método de boa acurácia, porém trabalhoso para ser executado na rotina laboratorial / Introduction: Clostridium difficile is a Gram-positive bacillus, strictly anaerobic, spore-forming, which produces toxins that can cause diarrhea, colitis pseudomembranous, colon expansion, sepsis and even death. In recent years the clinical and epidemiological picture of infection by Clostridium difficile has been modified and limitations of therapeutic options have become more evident. Primary Objective: Comparing the methods of disk diffusion and agar dilution in the detection sensitivity/resistance isolates of Clostridium difficile. Secondary Objectives: Prospectively evaluate the profile of sensitivity/resistance of hospital clinical isolates of Clostridium difficile from six tertiary hospitals in São Paulo city and provide evidence to support the diagnosis and empirical treatment of diarrhea caused by Clostridium difficile. Methods: We use the disk diffusion method and agar dilution method, according to the established criteria by CLSI and EUCAST. Results: The observed correlation coefficients between the inhibitions diameter zone of the and Minimum Inhibitory Concentration were under expectations impeding the disk diffusion method for determining sensitivity to nitazoxanide antimicrobial, teicoplanin and tigecycline. All 50 strains of this study were sensitive to metronidazole (MIC50 was 1 Ug/ml to MIC90 was 2 ug/ml). For the method disk diffusion, we suggest that inhibition zones >= 33mm can be interpreted as sensitive. Due to the moderate correlation, statistical significance and distribution of zones of inhibition on samples of the next found values using the strain ATTC, we suggest using the disk diffusion method for vancomycin where halos diameter >= 22mm can be considered as sensitive by the method. There was a good correlation to moxifloxacin between the two methodologies: disk diffusion and agar dilution (Pearson\'s coefficient was -0.84 , and the \"p\" value was less than 0.00001), suggesting that inhibition zones >= 18mm can be interpreted as sensitive by disk diffusion method. Nitazoxanide was the drug that showed a better performance in vitro activity (MIC50 was 0.06 ?g/ml and MIC90 0.12 ug/ml). For a drug that shows potent activity in vitro (MIC50 and MIC90 was 0.12 ug/ml), the tigecycline could be a therapeutic option in infection by Clostridium difficile, depending on further studies to evaluate their real clinical efficacy and security. Conclusion: Obtained results in this study indicate the need for further studies in vitro and clinicians to define the limits of sensitivity/resistance to teicoplanin and nitazoxanide, so there is no interpretation criteria for both disk diffusion and for agar dilution. Results of this work in vitro study confirmed the utility of metronidazole as an effective drug in the treatment of infection by Clostridium difficile. Nitazoxanide was the drug that showed better performance in vitro by dilutional method. We suggest the use of disk diffusion method: metronidazole, vancomycin and moxifloxacin. This work suggest that inhibition zones for metronidazole ( >= 33mm), moxifloxacin ( >= 18mm) and vancomycin ( >= 22mm) could be considered as sensitive by disk diffusion method. The agar dilution method is a method to be accurate, but laborious to run in the laboratory routine