Cibele Massotti Magagnin

Antifungal susceptibilities and identification of species of the Sporothrix schenckii complex isolated in Brazil.

Sporotrichosis is a subacute or chronic mycosis caused worldwide by the dimorphic species complex, Sporothrix schenckii. We studied 85 isolates recovered in Brazil to verify their identification and evaluate their in vitro antifungal susceptibility patterns. Based on phenotypic tests (microscopic features, ability to grow at 30°C and 37°C, colony diameters, as well as assimilation of sucrose and raffinose) and molecular assays (amplification of a fragment of the calmodulin gene), the strains were identified as S. schenckii, S. brasiliensis and S. globosa, with a predominance of S. schenckii isolates. There was 37.7% disagreement between the phenotypic and genotypic identification methodologies. In general, terbinafine was the most active drug, followed by ketoconazole and itraconazole, and the less active fluconazole and voriconazole. Five isolates (one S. globosa and four S. schenckii) were found to be itraconazole-resistant strains but, in general, there were no differences in the in vitro antifungal susceptibility profiles among the Sporothrix species.

Emergence of NDM-1-producing Enterobacteriaceae in Porto Alegre, Brazil

OBJECTIVES To evaluate the emergence of New Delhi metallo-β-lactamase 1 (NDM-1)-producing Enterobacteriaceae isolates in Brazil. METHODS From April to October 2013, following the detection of the first NDM-1-producing isolate, a surveillance study was performed for the detection of blaNDM-1 among Enterobacteriaceae isolates with reduced susceptibility to carbapenems in 17 hospitals of Porto Alegre, Brazil. Real-time PCR was used to determine the presence of carbapenemase genes, which were further sequenced. Clonal relatedness was assessed by pulsed-field gel electrophoresis (PFGE). RESULTS A total of 1134 isolates were evaluated. blaNDM-1 was detected in 11 (0.97%) isolates: nine Enterobacter cloacae complex (eight belonging to a single clone recovered from two distinct hospitals and the other strain from a third hospital) and two Morganella morganii (belonging to a single clone recovered from one hospital). Most isolates presented high-level resistance to carbapenems. CONCLUSIONS NDM-1-producing Enterobacteriaceae have emerged rapidly in the hospitals of the Brazilian city where they were first detected. The emergence of NDM-1 in Brazil is of great concern, since it is a severe threat to antimicrobial therapy against Enterobacteriaceae in this country.

Detection of OXA-370, an OXA-48-related class D β-lactamase, in Enterobacter hormaechei from Brazil

Jorge L. M. Sampaio, Vanessa B. Ribeiro, Juliana Coutinho Campos, Franciéli P. Rozales, Cibele M. Magagnin, Diego R. Falci, Renato Cassol F. da Silva, Micheline G. Dalarosa, Daniela I. Luz, Fabiane J. Vieira, Laura C. Antochevis, Afonso Luis Barth, Alexandre P. Zavascki Departamento de Análises Clínicas e Toxicológicas—Faculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, Brazil; Microbiologia—Fleury Medicina e Saúde, São Paulo, Brazil; Laboratório de Pesquisa em Resistência Bacteriana—LABRESIS, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de PósGraduação em Ciências Farmacêuticas, Faculdade de Farmácia, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Infection Control Service, Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Medical School, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil

Characterization of Tn3000, a Transposon Responsible for blaNDM-1 Dissemination among Enterobacteriaceae in Brazil, Nepal, Morocco, and India

ABSTRACT In Enterobacteriaceae, the blaNDM genes have been found in many different genetic contexts, and a wide diversity of plasmid scaffolds bearing those genes has been found. In August 2013, we identified NDM-1-producing Escherichia coli and Enterobacter hormaechei strains from a single rectal swab sample from a patient hospitalized in Rio de Janeiro, Brazil, who had no history of travel abroad. Complete DNA sequencing using the Illumina platform and annotation of the two plasmids harboring the blaNDM-1 gene, one from each strain, showed that they belonged to incompatibility groups IncFIIK and IncX3 and harbored a novel transposon named Tn3000. Similar genetic structures have been identified among other isolates in Brazil but also on plasmids from other continents. Our findings suggest that the blaNDM-1 gene may be transmitted by Tn3000 in different parts of the world.

In vitro susceptibility of chromoblastomycosis agents to five antifungal drugs and to the combination of terbinafine and amphotericin B

Chromoblastomycosis is a chronic mycosis that affects the skin and subcutaneous tissues caused by several genera of dematiaceous fungi. There is not a treatment of choice. Thus, tools that help guide clinical practice are fundamental. In this sense, antifungal activity tests in vitro could be useful. However, trials with chromoblastomycosis agents are scarce. The aim of this study was to evaluate both the in vitro susceptibility of 60 chromoblastomycosis agents to five antifungals and the combination of amphotericin B (AMB) and terbinafine (TRB). TRB, itraconazole (ITZ) and ketoconazole (KTZ) were, in this order, the drugs which showed better activity against the chromoblastomycosis agents. The less active drugs were voriconazole (VRZ) and AMB. The more differentiated group was Exophiala spinifera. Cladophialophora carrionii and Fonsecaea spp. are significantly more susceptible to KTZ than Phialophora verrucosa, whereas C. carrionii is significantly more sensitive to VRZ than P. verrucosa and E. spinifera. Assays in this direction allow the knowledge of the susceptibility of the causative agents which may help the management of patients with this disease. This study includes the largest number of these agents and of genera found in the literature.

Perfil de suscetibilidade a antifúngicos de dermatófitos isolados de pacientes com insuficiência renal crônica

BACKGROUND The prevalence of dermatophytosis in the general population is high, particularly in patients with chronic renal failure. Treatment requires the use of topical and/or systemic antifungal drugs. The efficacy of antifungal agents for the treatment of dermatophytosis has yet to be evaluated. Studies evaluating the in vitro activity of antifungal agents are rare, particularly in filamentous fungi. OBJECTIVE To evaluate the susceptibility profile of different species of dermatophytes isolated from patients with chronic renal failure to nine antifungal drugs available on the market for the treatment of dermatophytosis. METHODS Twenty-six isolates of dermatophytes obtained from patients with chronic renal failure were analyzed with respect to their susceptibility to nine antifungal agents (ketoconazole, ciclopirox olamine, fluconazole, griseofulvin, itraconazole, miconazole, piroctone olamine, terbinafine and tioconazole), using the broth microdilution method proposed by the Clinical and Laboratory Standards Institute (CLSI) and adapted for dermatophytes. RESULTS Of the antifungal agents tested, the best results in terms of sensitivity were found with terbinafine and tioconazole, while the antifungal activity of fluconazole was found to be weak, particularly against strains of M. gypseum. Ciclopirox olamine, although less effective than terbinafine, also yielded satisfactory results. CONCLUSIONS In general, the sensitivity profile of the antifungal agents tested in this study was similar to results obtained in previous studies, confirming the need to determine which species is causing the dermatophytosis given that antifungal susceptibility varies from one species to another. Furthermore, the present findings show the importance of conducting in vitro sensitivity tests, since the sensitivity profile may differ among isolates of the same species.

Detection of blaGES-5 in Carbapenem-Resistant Kluyvera intermedia Isolates Recovered from the Hospital Environment

Vanessa B. Ribeiro, Alexandre P. Zavascki, Franciéli P. Rozales, Mariana Pagano, Cibele M. Magagnin, Carolina S. Nodari, Renato Cassol Ferreira da Silva, Micheline G. Dalarosa, Diego R. Falci, Afonso L. Barth ‹Laboratório de Pesquisa em Resistência Bacteriana, Centro de Pesquisa Experimental, Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Farmacêuticas; Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil; Programa de Pós-Graduação em Ciências Médicas, UFRGS, Porto Alegre, Brazil; Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil

A case of Exophiala spinifera infection in Southern Brazil: Molecular identification and antifungal susceptibility

We report a case of an 80-year-old Brazilian man, farmer, with lesions on the dorsum of the hand. A direct mycological examination, cultivation and microculture slide observation was performed. The sequencing of ITS1-5.8S rDNA-ITS2 region was carried out and the etiological agent confirmed as Exophiala spinifera. The in vitro susceptibility of this isolate to antifungal agents alone and in combination was evaluated. This is the third case of phaeohyphomycosis caused by Exophiala spinifera in Brazil.

Dermatophytosis: a 16-year retrospective study in a metropolitan area in southern Brazil

INTRODUCTION Dermatophytoses are considered a public health problem. The objectives of this study were to determine the evolution of their prevalence in the metropolitan area of Porto Alegre, Brazil, and to analyze the dermatophyte species distribution according to body site and demographic characteristics of the patients. METHODOLOGY This work was a retrospective analysis of data from patients attending a tertiary care hospital during 1996-2011. RESULTS There were 9,048 cases with cultures positive for dermatophytes. Trichophyton rubrum occurred in 59.6% of the cases, followed by Trichophyton interdigitale (34%), Microsporum canis (2.6%), Epidermophyton floccosum (1.5%), Microsporum gypseum (1.3%), and Trichophyton tonsurans (0.9%). The angular coefficients for T. interdigitale, E. floccosum, T. rubrum, and M. canis were +1.119, +0.211, -0.826 and -0.324% per year, respectively. Males presented higher prevalence of infection (79.3% versus 53.9%). Tinea unguium occurred in 48.5% of the cases, followed by tinea pedis (33.1%). T. rubrum was the predominant species in all regions of the body except the scalp, where M. canis was responsible for 75% of the cases. CONCLUSION Monitoring of the evolution of dermatophytosis tracks changes in prevalence over the years and may assist practical measures for the public health control of this disease.

Detection of OXA-370 directly from rectal swabs and blood culture vials using an immunochromatographic assay☆

We evaluated the performance of OXA-48 K-SeT assay for detecting OXA-370 directly from spiked rectal swabs and blood culture vials. The limit of detection of this test was 104UFC/mL for rectal swabs. Detection of the OXA-370-producing isolates was successfully achieved directly from positive blood culture vials independent of growing conditions.