As exigências das condições higiênico-sanitárias na produção de animais de interesse zootécnico vêm aumentando progressivamente dada à necessidade de aliar-se produtividade a produtos de alta qualidade para atender a mercados consumidores cada vez mais exigentes. Nesse sentido, a utilização de antimicrobianos, tanto na profilaxia como na terapêutica, permanece como estratégia de controle para vários microrganismos patogênicos, de importância não apenas para a produção animal como também para a saúde humana, ainda que restrições ao uso indiscriminado desses produtos têm se intensificado. Não obstante, o uso excessivo desses produtos está associado à seleção de microrganismos resistentes nas áreas de produção. Por outro lado, investigações sobre circulação de cepas resistentes em rebanhos animais, até então restritas a populações humanas, ainda permanecem limitadas no Brasil. Bactérias do gênero Enterococcus, integrantes usuais da microbiota gastrointestinal animal e humana, são indicadoras ambientais de contaminação fecal e tem-se tornado objeto de preocupação em saúde pública e veterinária dada a ocorrência de cepas resistentes à vancomicina (VRE). O presente trabalho teve como objetivo isolar, quantificar e caracterizar VRE presentes em amostras fecais de ovinos oriundos de pequenas propriedades das regiões centro-leste e nordeste do estado de São Paulo. Para tanto, 132 amostras fecais foram coletadas diretamente do reto dos animais ou do piso das instalações. As amostras foram semeadas em ágar m-Enterococcus e subcultivadas em Ágar Bile Esculina acrescido de 6 µg/mL de vancomicina (ABEV), para confirmação de Enterococcus spp e detecção de cepas resistentes. Procedeu-se igualmente a observação da morfologia, características tintoriais, bioquímicas e moleculares. O número máximo de Enterococcus spp. encontrado foi de 2,6 × 105 e 1,70 × 105 UFC/g de fezes do ambiente e dos animais, respectivamente. Na caracterização bioquímica espécies mais prevalentes foram: Enterococcus faecalis e Vagococcus fluvialis. No ABEV, houve crescimento de colônias VRE em 33 das 84 amostras de ovinos-caprinos e em 21 das 48 amostras ambientais, representando, respectivamente 46,7% e 29,3% das amostras analisadas. A análise por multiplex PCR das 54 cepas VRE obtidas indicaram que 23 (43%), 22 (41%), 2 (3,5%) e 2 (3,5%) foram positivas, respectivamente, para os genes vanC2/C3, vanC1, vanA e vanB, sendo que para 5,3% dos isolados nenhum produto foi amplificado, sugerindo a possível ocorrência de genes dos demais grupos van conhecidos entre os isolados. Os resultados obtidos indicam, de forma inédita no país, a circulação de VRE em propriedades produtoras de ovinos e caprinos, sem ocorrência de manifestações clínicas aparentes nos animais, porém com possíveis riscos à saúde dos produtores e profissionais envolvidos, bem como a eventuais consumidores. / Demands for sanitary conditions in animal farming have been increasing progressively given the need to combine productivity and high quality products to support increasingly demanding consumer markets. In this context, antimicrobial drugs used in prevention as well as in therapy remain as the control strategy for several pathogenic microorganisms, not important only in animal production but also in human health, although restrictions for the indiscriminate use of these drugs have been intensified. However, the excessive use of these products has been associated to the selection of resistant microorganisms in production areas. On the other hand, investigation on strains of public health importance circulating in animal herds is still limited in Brazil. Enterococcus genus bacteria, usually present in animal and human gastrointestinal microbiota, are environmental indicators of fecal contamination and have become a concerning subject in public and veterinary health given the occurrence of strains resistant to vancomycin (VRE). The present study aimed to isolate, quantify and characterize VRE present in stool samples of sheep and goats from several farms in the center-east and northeast regions of São Paulo State. Swabs collected one hundred and thirty-two stool samples either directly from the animal\'s rectum or from the ground. Samples were plated onto m-Enterococcus agar plates and subcultivated in Bile esculin agar with 6 µg/mL of vancomycin (BEAV) to confirm Enterococcus spp and detect resistant samples. Colonies were identified by colonial morphology, Gram\'s staining, biochemical, and molecular profile. The highest colony count was equal to 2.6 × 105 and 1.7 × 105 CFU/g of feces from environmental and animal samples, respectively. Regarding biochemical characterization, Enterococcus faecalis e Vagococcus fluvialis were the most prevalent species. VRE was detected on BEAV in 33 out of 84 sheep-goat samples and in 21 out of 48 ambient samples, indicating a positivity rate of 46.7% and 29.3% respectively in the investigated samples. Analysis by multiplex PCR of the obtained 54 VRE strains indicated that 23 (43%), 22 (41%) 2 (3.5%) and 2 (3.5%) were positive, respectively, for the vanC2/C3, vanC1, vanA and vanB genes, and no product was amplified for 5.3% of the isolates, suggesting the possible occurrence of other known van gene groups among the isolates. The results obtained in this study indicate, for the first time in the studied areas, the circulation of VRE in sheep and goat farms, with no occurrence of apparent clinical signs in the animals, but with possible health risks to the farmers and workers involved, as well as potential consumers.

O ensaio turbidimétrico tem como princípio a redução da densidade óptica em suspensões microbianas, decorrente o incremento na concentração do antibiótico. No ensaio convencional trabalha-se com tubos de ensaio que demandam longo tempo para visualização da resposta. Assim, o método empregando microplacas com leitura cinética para a dosagem de antibióticos é de interesse considerável, uma vez que possibilita reduzir quantidade de material e tempo de análise necessários e permite o ensaio de grande número de amostras simultaneamente, com leitura e cálculo automatizado. O objetivo deste trabalho é desenvolver o método de doseamento microbiológico de vancomicina empregando microplacas e modo de leitura cinético, assim como validar o método desenvolvido, através da avaliação dos parâmetros de especificidade e seletividade, linearidade, faixa ou intervalo linear, exatidão e precisão. Adicionalmente foi contemplado desenvolvimento paralelo entre o método convencional e o cinético, de forma a permitir respaldo positivo quanto à validação. Sendo assim, através do estudo dos parâmetros de validação do método cinético, trabalhou-se em condições estabelecidas abrangendo curva-padrão de vancomicina com concentrações entre 0,6 e 1,0 µg/mL, e emprego de meio de cultura caldo de caseína-soja inoculado com Bacillus subtilis (ATCC 6633) na proporção de 5%. Foram obtidos resultados satisfatórios em 5 horas de incubação. Conclui-se que o ensaio em microplacas permite avaliar, com vantagens, a atividade do antibiótico frente ao microrganismo-teste, permitindo facilidade operacional e maior rapidez na obtenção dos resultados. / The principle of the turbidimetric assay is to reduce the optical density of microbial suspensions, due to the increase in the concentration of antibiotic. In the conventional test works with tubes that require long time to display the answer. Thus, the method using microplates with kinetic reading for the dosage of antibiotics is of considerable interest, since it allows possible to reduce the amount of material and analysis time required and allows for testing of large numbers of samples simultaneously, with automated reading and calculating. The aim of this work is to develop the method of microbiological assay of vancomycin using microplates and kinetic reading mode, and to validate the method developed by evaluating the parameters of specificity and selectivity, linearity, linear range, accuracy and precision. Also included was the parallel development between the conventional method and the kinetic, to enable positive support for the validation. Thus, by studying the validation parameters of the kinetic method, worked under conditions laid down covering vancomycin standard curve with concentrations between 0.6 and 1.0 mg / mL, and soybean-casein broth inoculated with 5% of Bacillus subtilis (ATCC 6633). Satisfactory results were obtained with 5 hours incubation. In conclusion, the microplate assay allows to evaluate, with advantages, the activity of the antibiotic against the microorganism, allowing greater operational ease and rapidity of obtaining results.

Submitted by Biblioteca da Faculdade de Farmácia (bff@ndc.uff.br) on 2017-03-30T17:56:53Z No. of bitstreams: 1 Porto, Daniele Ferreira [Dissertação, 2014].pdf: 1240957 bytes, checksum: 014bd9c8587ee46053ae0e4023717210 (MD5) / Made available in DSpace on 2017-03-30T17:56:53Z (GMT). No. of bitstreams: 1 Porto, Daniele Ferreira [Dissertação, 2014].pdf: 1240957 bytes, checksum: 014bd9c8587ee46053ae0e4023717210 (MD5) / Complicações por doenças infecciosas têm sido relacionadas ao uso excessivo de antibióticos. A Nanotecnologia apresenta avançadas estratégias no tratamento de diferentes enfermidades, devido ao tamanho nanométrico, capaz de atravessar diversas membranas biológicas anteriormente impermeáveis realizando a entrega direcionada de agentes antimicrobianos. Polímeros biodegradáveis a base de poli (ε-caprolactona) (PCL) e poli (ácido lático-co-glicolídeo) (PLGA) têm sido amplamente empregados na preparação de nanosistemas carreadores de fármacos. Este estudo objetivou desenvolver nanopartículas poliméricas carreadoras de vancomicina (VAN) e avaliar sua atividade antibacteriana. Para tal foi empregado um planejamento experimental que permitiu combinar diferentes condições de preparação utilizando PCL como material de parede. Foi delineado um planejamento fatorial fracionado (2k-1 + 3), o qual avaliou a influência de variáveis independentes – razão polímero/ativo (PCL/VAN), tempo de ultrassom e volume de solvente orgânico – sobre as respostas – tamanho de partícula, polidispersão, concentração de VAN encapsulada e eficiência de encapsulação. As NP foram preparadas de acordo com o método de múltipla emulsificação com difusão do solvente e analisadas com base nas respostas obtidas, bem como através da avaliação de ensaios in vitro, tais como cinética de liberação e determinação da atividade antimicrobiana. A caracterização física foi realizada através das análises de calorimetria exploratória diferencial (DSC) e espectroscopia do infravermelho (IV-TF). Os resultados mostraram que o terceiro ensaio do planejamento (2k-1 +3) reuniu condições experimentais para produzir PCL-NP otimizadas e que somente a variável PCL/VAN apresentou efeito significativo, influenciando o aumento da concentração de VAN encapsulada. As condições identificadas para a otimização das NP de PCL foram reproduzidas utilizando-se PLGA a fim de realizar um estudo comparativo. Além disso, foi possível observar que houve diferença significativa entre os parâmetros avaliados com ambos os polímeros (p-valor< 0,05, ANOVA). Os espectros de IV-TF gerados pela VAN e NP poliméricas sugeriram que o antimicrobiano foi encapsulado na matriz das NP. Estes resultados foram confirmados pelos termogramas de DSC, além de indicar ausência de interação significativa entre VAN e PLGA. O perfil de liberação in vitro da VAN encapsulada com PLGA, apresentou padrão bifásico de liberação. Os valores das concentrações inibitórias mínimas da VAN e das NP poliméricas observados sugerem que a capacidade de inibição do crescimento bacteriano da VAN foi preservada, independente das condições de produção e da encapsulação nas diferentes NP. Deste modo, conclui-se que o PLGA apresenta vantagens no processo de nanoencapsulação em relação ao PCL, o que o torna um polímero promissor no desenvolvimento de novos sistemas de liberação controlada de VAN / Complications from infectious diseases have been related to overuse of antibiotics. Nanotechnology has advanced strategies in the treatment of different diseases due its nanoscale size able to cross different impermeable biological membranes performing targeted delivery of antimicrobial agents. Biodegradable polymers based in poly (ε-caprolactone) (PCL) and poly(lactide-co-glycolide) (PLGA) have been widely employed in the preparation of Drug Carriers Nanosystems. This study aimed to develop polymeric nanoparticle carrier of vancomycin (VAN) and evaluate its antibacterial activity. In this sense it was employed an experimental design to combine different preparation conditions using PCL as wall material. It was outlined a fractional factorial design (2k-1 + 3), which evaluated the influence of independent variables polymer/active ratio (PCL/VAN), ultrasound time and organic solvent volume on the particle size, polydispersity, VAN loaded concentration and the encapsulation efficiency responses. NP were prepared according to the emulsification multiple with solvent diffusion method and analyzed based on the obtained responses, and by evaluating in vitro assays, such as release kinetics and antimicrobial activity determination. Physical characterization was performed by Differential Scanning Calorimetry (DSC) and infrared spectroscopy (FT-IR). The results showed the third test (2k-1 +3) gathered experimental conditions to produce optimized PCL-NP and only PCL/VAN variable presented significant effect, influencing the VAN loaded concentration. The identified conditions for PCL-NP optimization were reproduced using PLGA in order to perform a comparative study. Furthermore, it was observed significant difference between polymers parameters (p-value < 0.05, ANOVA). The FT-IR spectra generated by the VAN and polymeric NP suggested the encapsulation of antimicrobial in the NP matrix. These results were confirmed by DSC thermograms, besides indicating absence of significant interaction between VAN and PLGA. The in vitro release profile of VAN encapsulated with PLGA showed a biphasic release pattern. The minimum inhibitory concentration results suggested the ability of bacterial growth inhibition of VAN was preserved, regardless of production conditions and encapsulation in different NP. It was able to conclude that PLGA has advantages in the nanoencapsulation process to the PCL, which makes it a promising polymer to develop new VAN sustained release systems

No presenta presenta resumen. / Revisión por pares

What is known and objective: Treatment of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia is a long-standing challenge to health care, often complicated by metastatic infections, treatment failure and mortality. When MRSA bacteraemia persists despite adequate initial treatment, current Infectious Diseases Society of America guidelines recommend evaluation and removal of possible sources of infection. In addition, a change in therapy may be considered. The objective of this review was to explore the therapeutic options for the treatment of persistent MRSA bacteraemia. Methods: A literature search of PubMed, MEDLINE and Google Scholar was performed using the following search terms: [methicillin-resistant Staphylococcus aureus OR MRSA] AND [bacteraemia OR bloodstream infection] AND [persistent OR persistence OR refractory OR treatment failure OR salvage] AND treatment. We evaluated relevant, adult, English-language, peer-reviewed studies published between 1985 and May 2018. In vitro and animal studies were considered as supportive of in vivo data. Results and discussion: Randomized, controlled trials are lacking. However, case series and case reports support multiple treatment options including high-dose daptomycin in combination with an antistaphylococcal β-lactam, ceftaroline, trimethoprim-sulfamethoxazole (TMP-SMX) or fosfomycin; ceftaroline alone or in combination with vancomycin or TMP-SMX; linezolid alone or in combination with a carbapenem, or telavancin. What is new and conclusion: Given the heterogeneity of the data, a preferred regimen has not emerged. Prescribers must take into consideration recent exposure, source control, and available synergy and clinical data. Further comparative trials are needed to establish a preferred regimen and the creation of a universal treatment algorithm.

Background Vancomycin dosing strategies targeting trough concentrations of 15–20 mg/L are no longer supported due to lack of efficacy evidence and increased risk of nephrotoxicity. Area-under-the-curve (AUC24) nomograms have demonstrated adequate attainment of AUC24 goals ≥ 400 mg h/L with more conservative troughs (10–15 mg/L). Objective The purpose of this study is to clinically validate a vancomycin AUC24 dosing nomogram compared to conventional dosing methods with regards to therapeutic failure and rates of acute kidney injury. Setting This study was conducted at a tertiary, community, teaching hospital in the United States. Method This retrospective, cohort study compared the rates of therapeutic failures between AUC24-extrapolated dosing and conventional dosing methods. Main outcome measure Primary outcome was treatment failure, defined as all-cause mortality within 30 days, persistent positive methicillin-resistant Staphylococcus aureus blood culture, or clinical failure. Rates of acute kidney injury in non-dialysis patients was a secondary endpoint. Results There were 96 participants in the extrapolated-AUC24 cohort and 60 participants in the conventional cohort. Baseline characteristics were similar between cohorts. Failure rates were 11.5% (11/96) in the extrapolated-AUC24 group compared to 18.3% (11/60) in the conventional group (p = 0.245). Reasons for failure were 6 deaths and 5 clinical failures in the extrapolated-AUC24 cohort and 10 deaths and 1 clinical failure in the conventional group. Acute kidney injury rates were 2.7% (2/73) and 16.4% (9/55) in the extrapolated-AUC24 and conventional cohorts, respectively (p = 0.009). Conclusion Extrapolated-AUC24 dosing was associated with less nephrotoxicity without an increase in treatment failures for bloodstream infections compared to conventional dosing. Further investigation is warranted to determine the relationship between extrapolated-AUC24 dosing and clinical failures.

Bacillus popilliae and B. lentimorbus, causative agents of milky disease in Japanese beetles and related scarab larvae, have been differentiated based upon a small number of phenotypic characteristics, but they have not previously been examined at the molecular level. Thirty-four isolates of these bacteria were examined for DNA similarity. Three distinct but related similarity groups were identified; the first contained strains of B. popilliae, the second contained strains of B. lentimorbus, and the third contained two strains distinct from but related to B. popilliae. Some strains received as B. popilliae were found to be most closely related to B. lentimorbus and some received as B. lentimorbus were found to be most closely related to B. popilliae." Geographically distinct strains of B. popilliae and B. lentimorbus were analyzed using RAPD. Eight decamer primers were tested against nineteen new and seventeen isolates previously described by randomly amplified polymorphic DNA (RAPD) analysis (M. Tran). Of the new isolates, ten were found to be B. popilliae while nine isolates were more related to the B. lentimorbus species. Paraspore formation, believed to be a characteristic unique to B. popilliae, was found to occur among a subgroup of B. lentimorbus strains. Using a combination of two PCR primer pairs, the cry18Aa1 gene was detected in 31 of 35 B. popilliae isolates and in 1 of 18 B. lentimorbus isolates. When hemolymph smears were examined microscopically, a parasporal crystal was seen in three of the four B. popilliae strains where the PCR primers could not amplify the paraspore gene. The fourth strain was not tested due to the unavailability of infected hemolymph. A paraspore was also detected by microscopic examination in a subgroup of 14 B. lentimorbus strains. In combination, the primer pairs CryBp1 and CryBp2 are effective at detecting the paraspore gene in B. popilliae isolates, but not in the B. lentimorbus isolates. Growth in media supplemented with 2% NaCl was found to be less reliable in distinguishing the species than was vancomycin resistance, the latter present only in B. popilliae. The basis for vancomycin resistance in all isolates was investigated using a polymerase chain reaction assay designed to amplify the vanB gene in enterococci. An amplicon was identified and sequenced. The amplified portion of the putative ligase gene in B. popilliae had 77% and 68-69% nucleotide identity to the sequences of the vanA gene and the vanB genes, respectively. There was 75% and 69-70% identity between the deduced amino acid sequence of the putative ligase gene in B. popilliae and the deduced amino acid sequence of the vanA gene and the vanB genes, respectively. It has been determined that the vanE gene is located either on a plasmid greater than 16 kb in size or on the chromosome. The gene in B. popilliae may have had an ancestral gene in common with vancomycin resistance genes in enterococci. Bacillus sphaericus strains isolated on the basis of pathogenicity for mosquito larvae and strains isolated on the basis of a reaction with a B. sphaericus DNA homology group IIA 16S rRNA probe were analyzed for DNA similarity. All of the pathogens belonged to homology group IIA, but this group also contained nonpathogens. It appears inappropriate to designate this homology group a species based solely upon pathogenicity. / Ph. D.

This thesis investigates the supply chain of Vancomycin and Piperacillin/Tazobactam in order to understand why the two antibiotics have been exposed to back orders during recent years in Sweden. The health economical consequences due to these back orders of the two antibiotics was also examined. The used methods were literature search and elementary calculation methods. The supply chains for the two antibiotics consists of multiple manufacturing actors, both primary and secondary. The manufacturing actors are mostly located in low and middle income countries, which increases risks for the supply chains. The Swedish market is unattractive due to its small size and ineffective purchasing system, which also increases risks of shortages. The unattractive market is a probable cause of the lower amount of market authorisation holders which sell the antibiotics in Sweden. Furthermore, a financial model was created to assess the health economic impacts of shortages. The costs were calculated as the sum of the additional labor required to deal with shortages along with the costs of the alternative medicines. It was estimated that a shortage of Vancomycin can cost up to SEK 1 600 000 in fixed costs followed by up to SEK 202 997 per additional day of shortage and that a shortage of Pipetazo can cost up to SEK 1 600 000 in fixed costs followed by up to SEK 923 650 per day. There are also other negative aspects of these consequences, such as worsening of patient health and contributions to increased AMR.

Background Vancomycin dosing strategies targeting trough concentrations of 15–20 mg/L are no longer supported due to lack of efficacy evidence and increased risk of nephrotoxicity. Area-under-the-curve (AUC24) nomograms have demonstrated adequate attainment of AUC24 goals ≥ 400 mg h/L with more conservative troughs (10–15 mg/L). Objective The purpose of this study is to clinically validate a vancomycin AUC24 dosing nomogram compared to conventional dosing methods with regards to therapeutic failure and rates of acute kidney injury. Setting This study was conducted at a tertiary, community, teaching hospital in the United States. Method This retrospective, cohort study compared the rates of therapeutic failures between AUC24-extrapolated dosing and conventional dosing methods. Main outcome measure Primary outcome was treatment failure, defined as all-cause mortality within 30 days, persistent positive methicillin-resistant Staphylococcus aureus blood culture, or clinical failure. Rates of acute kidney injury in non-dialysis patients was a secondary endpoint. Results There were 96 participants in the extrapolated-AUC24 cohort and 60 participants in the conventional cohort. Baseline characteristics were similar between cohorts. Failure rates were 11.5% (11/96) in the extrapolated-AUC24 group compared to 18.3% (11/60) in the conventional group (p = 0.245). Reasons for failure were 6 deaths and 5 clinical failures in the extrapolated-AUC24 cohort and 10 deaths and 1 clinical failure in the conventional group. Acute kidney injury rates were 2.7% (2/73) and 16.4% (9/55) in the extrapolated-AUC24 and conventional cohorts, respectively (p = 0.009). Conclusion Extrapolated-AUC24 dosing was associated with less nephrotoxicity without an increase in treatment failures for bloodstream infections compared to conventional dosing. Further investigation is warranted to determine the relationship between extrapolated-AUC24 dosing and clinical failures.

De grampositiva bakterierna enterokocker tillhör normalfloran i tarmen hos människor samt djur. I detta arbete studeras vancomycin-variabla enterokocker (VVE) som är vanA positiva enterokocker, känsliga för vancomycin och kan utveckla resistens in vivo. Vancomycin-resistenta enterokocker (VRE) består av två arter bakterier Entrococcus faecalis och Enterococcus faecium. VVE består av Enterococcus faecium och är svåra att detektera med odlingsbaserad diagnostik och kan därför leda till att bakterien är underdiagnostiserad, samt att den tyst kan sprida sig inom sjukhusmiljön. VVE har en förmåga att kunna övergå från vancomycin-variabla till att vara vancomycin-resistenta fenotyper. Därför undersöks i denna studie vid vilken vancomycinkoncentration (5, 4, 3, 2 mg/L) som VVE kan anrikas i buljongerna inför amplifiering med hjälp av real-time polymerase chain reaction (real-time PCR). Resultatet visade att vancomycinkoncentrationen skulle behövas sänkas till 2 mg/L, dock kan bakgrundsfloran vara för hög vid denna koncentration av antibiotika. / The Gram-positive bacteria Enterococci, belong to the normal intestinal flora in humans and in animals. In the following study, vancomycin-variable enterococci (VVE) are investigated. VVE is a vanA-positive bacteria, meaning that they are sensitive to vancomycin and can develop a resistance in vivo. Vancomycin-resistant enterococci (VRE) consists of two different species of bacteria, Enterococcus faecalis and Enterococcus faecium. Furthermore, VVE consists of E. faecium and can be difficult to detect with a culture-based diagnostic andcan therefore lead to the bacterium being underdiagnosed. This in turn means that the bacteria can be quietly spread within the hospital. VVE has a unique ability, it can transition from vancomycin-variables to having vancomycin-resistant phenotypes. Therefore, this study investigates at what vancomycin concentration the VVE broths can be enriched in the broths before the qPCR. The results show that the vancomycin concentration is optimal at 2 mg/L. However, for the background flora this might be a too high concentration.