Alex Guerra Ferreira

Escherichia coli producing KPC-2 carbapenemase: first report in Brazil☆

Carbapenem resistance in Escherichia coli isolates is rare; resistance has usually been attributed to the presence of an AmpC β-lactamase in association with the loss of porins (Poirel et al., 2004). Klebsiella pneumoniae carbapenemase (KPC)-producing E. coli have been described in a few cases, involving KPC-2 and KPC-3 acquisition in the United States (Bratu et al., 2007; Deshpande et al., 2006; Hong et al, 2005) and KPC-2 in Israel (Navon-Venezia et al., 2006) and China (Cai et al., 2008). KPC enzymes have recently been described in Brazil in Klebsiella pneumoniae (Monteiro et al., 2009; Pavez et al., 2009; Peirano et al., 2009) and Enterobacter cloacae (Zavascki et al., 2009). This study is the first reported description of the presence of KPC-2 in E. coli isolates in Brazil. Since May 2008, in the University Hospital Pedro Ernesto, a 600-bed teaching hospital located in Rio de Janeiro City, Rio de Janeiro State, has isolated a KPC-2– producing K. pneumoniae clone from different patients hospitalized in different wards (personal communication). In an effort to curb this trend, we have begun routine screening of all Enterobacteriaceae isolates with carbapenem resistance or reduced carbapenem susceptibility for presence of carbapenemases by modified Hodge test (Anderson et al., 2007). From August 2008 to May 2009, we recovered 4 carbapenemase-positive E. coli isolates from postoperative fluid collection in nephrectomy (1 isolate), urine (1 isolate), and blood (2 isolates) from patients with different clinical backgrounds hospitalized in different wards. The isolates showed polymerase chain reactionpositive results by using blaKPC primers (Peirano et al., 2009), and amplicons sequencing revealed 100% of sequence identity with blaKPC-2. The main microbiologic findings for isolates are summarized in Table 1. According to the antimicrobial susceptibility testing by disk diffusion, all isolates exhibited resistance or reduced

Cystic Fibrosis Patient with Burkholderia pseudomallei Infection Acquired in Brazil

ABSTRACT Burkholderia pseudomallei is rarely isolated from cystic fibrosis patients outside known areas of endemicity. We report the recovery of B. pseudomallei from the sputum of a cystic fibrosis patient who lives in Brazil. We highlight the importance of careful attention to unusual nonfermentative gram-negative rods in cystic fibrosis patients.

First report of Paenibacillus cineris from a patient with cystic fibrosis

We describe the recovery of Paenibacillus cineris from a Brazilian cystic fibrosis (CF) patient. Paenibacillus spp. are mainly environmental organisms. Although the role that these species play in lung disease is not known, we highlight the importance of careful attention to unusual bacteria from respiratory secretions of CF patients.

Panton-Valentine leukocidin (PVL) gene carriage among Staphylococcus aureus strains with SCCmec types I, III, IV, and V recovered from cystic fibrosis pediatric patients in Brazil

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) is increasing in patients with cystic fibrosis (CF). We report a molecular characterization, antimicrobial resistance, and Panton-Valentine leukocidin (PVL) toxin gene detection of MRSA strains from 28 Brazilian pediatric CF patients (1 strain per patient). A significant proportion (50%) of MRSA SCCmec IV isolates was observed. Nearly half of MRSA strains harboring the PVL genes distributed in all SCCmec types detected. Multilocus sequence typing (MLST) analyses showed majority (57.1%) of the isolates belonged to known epidemic lineages, such as UK/EMRSA-3, Pediatric/USA 800, Southwest Pacific clone, and Brazilian/Hungarian clone. To our knowledge, this is the first Brazilian study of molecular epidemiology based on MLST and SCCmec typing and the first description of PVL genes in MRSA from CF patients.

Influence of biofilm formation in the susceptibility of Pseudomonas aeruginosa from Brazilian patients with cystic fibrosis.

Ferreira AG, Leão RS, Carvalho‐Assef APD, Folescu TW, Barth AL, Marques EA. Influence of biofilm formation in the susceptibility of Pseudomonas aeruginosa from Brazilian patients with cystic fibrosis. APMIS 2010; 118: 606–12.

Comparison of the worldwide transmissible Pseudomonas aeruginosa with isolates from brazilian cystic fibrosis patients

Cross-infection with Pseudomonas aeruginosa among cystic fibrosis (CF) patients is a rare occurrence. However, the emergence of transmissible strains has been reported between unrelated individuals. We analyzed the genetic relationship among P. aeruginosa isolates from Brazilian CF patients and transmissible clones which are worldwide spread. The data does not indicate the presence of closely related variant clones.

Characterization of Achromobacter Species in Cystic Fibrosis Patients: Comparison of bla OXA-114 PCR Amplification, Multilocus Sequence Typing, and Matrix-Assisted Laser Desorption Ionization–Time of Flight Mass Spectrometry

ABSTRACT Molecular methodologies were used to identify 28 Achromobacter spp. from patients with cystic fibrosis (CF). Multilocus sequence typing (MLST) identified 17 Achromobacter xylosoxidans isolates (all bla OXA-114 positive), nine Achromobacter ruhlandii isolates (all bla OXA-114 positive), one Achromobacter dolens isolate, and one Achromobacter insuavis isolate. All less common species were misidentified as A. xylosoxidans by matrix-assisted laser desorption ionization–time of flight mass spectrometry (MALDI-TOF MS). Chronic colonization by clonally related A. ruhlandii isolates was demonstrated.

Low‐level resistance and clonal diversity of Pseudomonas aeruginosa among chronically colonized cystic fibrosis patients

A prospective study was conducted in Brazil to evaluate antimicrobial resistance patterns and molecular epidemiology of Pseudomonas aeruginosa isolates from cystic fibrosis (CF) patients with chronic lung infection. All isolates were obtained between May 2009 and June 2010 from 75 patients seen in four reference centers in Brazil: HCPA (20 patients) and HEOM (15 patients), located in southern and northeastern Brazil, respectively; IFF (20 patients) and HUPE (20 patients), both in southwestern Brazil. Antimicrobial susceptibility testing, PCR for detection of carpapenemases, and pulsed‐field gel electrophoresis (PFGE) were performed in 274 isolates. A total of 224 PFGE types were identified and no clones were found circulating among the centers or within the same center. Despite the chronic infection, most patients were colonized by intermittent clones. Only three patients (4%) maintained the same clone during the study. The resistance rates were lower than 30% for the majority of antimicrobials tested in all centers and only 17% of isolates were multiresistant. Isolates (n = 54) with reduced susceptibility to imipenem and/or meropenem presented negative results for blaSPM‐1, blaIMP−1, blaVIM, and blaKPCgenes. Our results indicate an unexpected low level of antimicrobial resistance and a high genotypic diversity among P. aeruginosa from Brazilian chronic CF patients.

Hypermutable Pseudomonas aeruginosa in Cystic fibrosis patients from two Brazilian cities.

ABSTRACT Hypermutable (HPM) strains of Pseudomonas aeruginosa have been found at high frequencies in cystic fibrosis (CF) patients in Europe. We report the results of testing for HPM frequencies, mutator genotype, and antimicrobial resistance of P. aeruginosa strains from Brazilian CF patients. A modified disk diffusion technique was used to quantify antibiotic-resistant subpopulations of an isolate, and estimations of the frequency of mutation to rifampin resistance were determined for 705 isolates from 149 patients attending clinics in two Brazilian cities. Mutations in the mutS gene were detected by sequencing assays. We found 194 (27.5%) HPM isolates in samples from 99 (66.4%) patients. Thirty-five HPM isolates (18.0%) from 31 (31.3%) patients exhibited a high increased spontaneous mutation rate compared with controls, and eight isolates from six patients displayed a defective mutS gene. The dominant HPM population was associated with very low antibiotic resistance levels, while HPM subpopulations were generally more resistant to antimicrobials. A relatively high prevalence of HPM P. aeruginosa in CF patients was associated with surprisingly low antibiotic resistance levels, in contrast to some earlier studies.

Draft genome sequence of Acinetobacter pittii ST643 shared by cystic fibrosis patients.

Acinetobacter pittii has emerged as an important hospital pathogen that is associated with outbreaks and drug resistance. In cystic fibrosis (CF) patients, the detection of Acinetobacter spp. is rare; however, we isolated the A. pittii sequence type ST643 in several Brazilian CF patients treated in the same centre. The current study describes the draft genome of A. pittii ST643.