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Previous issue date: 2013-10-17 / Conselho Nacional de Pesquisa e Desenvolvimento Científico e Tecnológico - CNPq / The bacterial pharyngotonsillitis are infections of the upper airways that occurs predominantly in children and adolescents. Due to the composition of the oral microbiota is difficult to clarify the role of each organism in the etiology of the disease. The presence of bacteria that produce beta-lactamase interferes with the effectiveness of beta-lactam antibiotics, the most commonly drug used in treatment of these infections, promoting the recurrence of the disease. S. aureus is one of the most common pathogen in the etiology of tonsillitis and its relevance is due to the ability of antimicrobial resistance and persistence in the tissues of the tonsils. Tonsillectomy is indicated in cases of recurrent tonsillitis after several failures in the antibiotic terapy. The aim of this study was to determine the prevalence of S. aureus in the tonsils of patients undergoing tonsillectomy, in a teaching hospital in Goiânia, the antimicrobial susceptibility profile and the genetic characterization of isolates. Tonsils obtained from 123 patients were processed, the microorganisms identified and submitted to antibiogram by conventional techniques. The isolates that presented cefoxitin resistance were submitted to tests to determine the minimum inhibitory concentration - MIC for oxacillin and to detect the presence of the mecA gene. All isolates were subjected to PCR for detection of Panton-Valentine leukocidin gene and to PFGE to determine the genetic similarity among them. It was identified 60 S. aureus isolates from 49 patients (39.8%). There were no significant difference in prevalence by sex and, the average age of male patients was lower (8.2 years) (p<0.001) than the female patients (15.3 years). Nine out 49 patients(18.4%) presented two or more different S. aureus isolates. The isolates presented resistance of 85.0%, 10.0%, 15.0%, 3.3%, 10.0%, 3.3%, 18.3% and 8.3% to penicillin, amoxicillin + ácido clavulânico, cefoxitin, ceftriaxone, erythromycin, trimethoprim/sulfamethoxazole, ciprofloxacin and tetracycline, respectively. All isolates were sensitive to linezolid and rifampin. Six erythromycin-resistant isolates (10.0%) showed inducible resistance (MLSbi) to clindamycin and quinupristin/dalfopristin. Eight isolates (13.3%) were resistant to three or more classes of antimicrobials. Despite the resistance to cefoxitin be considered a marker of the presence of the mecA gene only in two resistant isolates it has been found,
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suggesting that the cefoxitin resistance should be mediated by other mechanisms, such as the overproduction of beta-lactamases. None of these isolates showed resistance to more than two classes of antimicrobials. Among the sixty S. aureus isolates, only carried the gene encoding the Panton-Valentine leukocidin. This isolate presented resistance to five classes of antimicrobials and phenotype D. PFGE analysis grouped 36 (60,0%) of 60 isolates in 10 clusters (>80% similarity), since no one specific clone was associated with colonization of the tonsils. It was observed different patients carrying S. aureus isolates genetically identical or with a high level of similarity (>80%), suggesting in these cases, a common origin. The high prevalence of S. aureus in tonsils suggests an ability to colonize the surface and/or the persistence in the tissues of the tonsils. The isolation of MDR bacteria can promote cross-resistance to other bacteria commonly associated with recurrent tonsillitis. The results point to change the paradigm of diagnosis and treatment of recurrent tonsillitis in order to enable the correct use of antimicrobials to reduce the recurrence which is the main cause of tonsillectomy. / As faringotonsilites bacterianas são infecções das vias aéreas superiores que ocorrem predominantemente em crianças e adolescentes. Devido à composição da microbiota oral é difícil o esclarecimento da participação de cada microrganismo na etiologia da doença. A presença de bactérias produtoras de β-lactamases interfere na eficácia de antimicrobianos β-lactâmicos, os mais utilizados no tratamento destas infecções, favorecendo a recorrência da doença. S. aureus é um dos patógenos mais frequentes na etiologia das tonsilites e sua relevância se deve à capacidade de resistência aos antimicrobianos e à persistência nos tecidos internos das tonsilas. A tonsilectomia é indicada nos casos de tonsilite recorrente após várias falhas na antibioticoterapia. O objetivo deste trabalho foi determinar a prevalência de S. aureus em tonsilas de pacientes submetidos à tonsilectomia, em um hospital escola de Goiânia; o perfil de suscetibilidade aos antimicrobianos e a caracterização genética dos isolados. Tonsilas obtidas de 123 pacientes foram processadas, os microrganismos identificados e submetidos ao antibiograma por técnicas convencionais. Nos isolados resistentes à cefoxitina, foi realizada a determinação da concentração inibitória mínima - CIM para oxacilina e a detecção da presença do gene mecA por PCR. Todos os isolados foram submetidos à PCR para detecção da leucocidina Panton-Valentine e ao PFGE para determinação da similaridade genética. Foram identificados 60 isolados de S. aureus de 49 pacientes (39,8%). Não houve diferença significativa da prevalência por sexo e a média de idade dos pacientes do sexo masculino foi menor (8,2 anos) (p<0,001) do que das pacientes (15,3 anos). Em nove (18,4%) dos 49 pacientes houve a identificação de dois ou mais isolados diferentes de S. aureus. Os isolados apresentaram resistência de 85,0%, 10,0%, 15,0%, 3,3%, 10,0%, 3,3%, 18,3% e 8,3% para penicilina, amoxacilina + ácido clavulânico, cefoxitina, ceftriaxona, eritromicina, sulfametoxazol/trimetoprim, ciprofloxacina e tetraciclina respectivamente. Todos os isolados foram sensíveis à linezolida e rifampicina. Seis isolados (10,0%) resistentes à eritromicina apresentaram fenótipo de resistência induzível (MLSbi) à clindamicina e quinupristina/dalfopristina. Oito isolados (13,3%) foram resistentes a três ou mais classes de antimicrobianos. Apesar da resistência à cefoxitina ser considerada o
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marcador da presença do gene mecA, somente em dois isolados resistentes, o mesmo foi detectado sugerindo que a resistência à cefoxitina pudesse ser mediada por outro mecanismo, como a hiperprodução de β-lactamases. Nenhum desses isolados apresentou resistência a mais de duas classes de antimicrobianos. Dos 60 S. aureus isolados, somente um apresentou o gene que codifica a leucocidina Panton-Valentine. Neste isolado ainda foi observada resistência a cinco classes de antimicrobianos e fenótipo D. A análise por PFGE agrupou 36 (60,0%) dos 60 isolados em 10 clusters (>80% similaridade), não sendo detectado um clone específico associado à colonização das tonsilas. Porém observamos pacientes diferentes portando S. aureus geneticamente idênticos ou com alto grau de similaridade (>80%), sugerindo nestes casos, uma origem comum. A alta prevalência de S. aureus nas tonsilas sugere uma capacidade de colonização da superfície e/ou persistência nos tecidos internos das tonsilas. O isolamento de bactérias MDR pode favorecer resistência cruzada de outras bactérias comumente associadas à tonsilite recorrente. Os resultados apontam para mudança no paradigma de diagnóstico e tratamento de tonsilites recorrentes com vistas a viabilizar o uso correto de antimicrobianos e diminuir a recorrência que é a principal causa de tonsilectomia
| Identifer | oai:union.ndltd.org:IBICT/oai:repositorio.bc.ufg.br:tede/3173 |
| Date | 17 October 2013 |
| Creators | Cavalcanti, Veraluce Paolini |
| Contributors | André, Maria Cláudia Dantas Porfirio Borges, Braga, Carla Afonso da Silva Bitencourt, André, Maria Cláudia Dantas Porfirio Borges, Cardoso, Juliana Lamaro, Cardoso, Alessandra Marques |
| Publisher | Universidade Federal de Goiás, Programa de Pós-graduação em Biologia das Interações PH (IPTSP), UFG, Brasil, Instituto de Patologia Tropical e Saúde Pública - IPTSP (RG) |
| Source Sets | IBICT Brazilian ETDs |
| Language | Portuguese |
| Detected Language | English |
| Type | info:eu-repo/semantics/publishedVersion, info:eu-repo/semantics/masterThesis |
| Format | application/pdf |
| Source | reponame:Biblioteca Digital de Teses e Dissertações da UFG, instname:Universidade Federal de Goiás, instacron:UFG |
| Rights | http://creativecommons.org/licenses/by-nc-nd/4.0/, info:eu-repo/semantics/openAccess |
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