Clinical, epidemiological, and laboratory prognostic factors in patients with leprosy reactions: A 10-year retrospective cohort study.

Introduction: Leprosy reactions, the main cause of neural damage, can occur up to 7 years after starting multidrug therapy. We aimed to approach the prognostic factors that may influence the leprosy reactions over the follow-up time. Methods: Retrospective cohort study, encompassing 10 years of data collection, composed of 390 patients, divided into 201 affected by reactions and 189 reaction-free individuals. Epidemiological, clinical, and laboratory variables were approached as prognostic factors associated with leprosy reactions. The association among variables was analyzed by a binomial test and survival curves were compared by the Kaplan-Meier and Cox proportional-hazards regression. Results: 51.5% (201/390) of patients were affected by leprosy reactions. These immunological events were associated with lepromatous leprosy (16.2%; 63/390; p < 0.0001) and multibacillary group (43%; 169/390; p < 0.0001). This study showed that survival curves for the prognostic factor anti-PGL-I, comparing positive and negative cases at diagnosis, differed in relation to the follow-up time (Log Rank: p = 0.0760; Breslow: p = 0.0090; Tarone-Ware: p = 0.0110). The median survival times (time at which 50% of patients were affected by leprosy reactions) were 5 and 9 months for those reactional cases with negative (26/51) and positive serology (75/150), respectively. The time-dependent covariates in the cox proportional-hazards regression showed anti-PGL-I as the main prognostic factor to predict leprosy reactions (hazard ratio=1.91; p = 0.0110) throughout the follow-up time. Conclusions: Finally, these findings demonstrated that anti-PGL-I serology at diagnosis is the most important prognostic factor for leprosy reactions after starting multidrug therapy, thus enabling prediction of this immunological event.

Association between diabetes and food insecurity in an urban setting in Angola: a case-control study.

Diabetes is common in urban settings in Sub-Saharan Africa. Household food insecurity has been suggested to increase the chance of developing diabetes among adults. The relationship between diabetes and food insecurity has not been explored in Angolan urban settings so far. This case-control (1:2) study investigated the association between diabetes and food insecurity among adults attending six healthcare facilities in Luanda (Angola) between April 2019 and September 2019. All subjects with fasting blood glucose (FBG) levels ≥ 126 mg/dl were included as cases. For each case, the next two subjects with FBG levels < 110 mg/dl were included as controls, to warrant the achievement of the set 1:2 ratio. Food insecurity was assessed using the Food Insecurity Experience Scale (FIES). A total of 663 participants (221 cases and 442 controls) were enrolled in the study. Median FIES raw score was 7 (IQR 1-8) in cases and 5 (IQR 2-8) in controls (p = 0.09). The distribution of FIES levels (0-3; 4-6; 7-8) was different between cases and controls (p < 0.0001), with highest FIES scores (7-8) recorded in 53.0% of cases and 38.2% of controls. Our findings revealed an association between diabetes and severe food insecurity among adults attending healthcare facilities in the capital city of Angola.

Penicillin-resistant, ampicillin-susceptible Enterococcus faecalis isolates are uncommon in non-clinical sources.

This study aimed to investigate whether penicillin-resistant, ampicillin-susceptible E. faecalis (PRASEF) isolates are disseminated in non-clinical sources, and to compare the molecular characteristics and antimicrobial resistance (AMR) profile of clinical and non-clinical E. faecalis isolates. Non-clinical samples (n = 280) were collected and 101 E. faecalis isolates were recovered from food (n = 18), faeces of healthy animals (n = 24), water (n = 28) and sewage (n = 31). PRASEF (n = 68) and penicillin-susceptible, ampicillin-susceptible E. faecalis (n = 77) isolates of clinical origin were also evaluated. A significant variety of AMR profiles was observed among non-clinical isolates according to the source. No food isolate exhibited a multidrug resistance (MDR) phenotype different from those of isolates from animal faeces (50.0%) and sewage (38.7%). Overall, the MDR phenotype was more frequent among clinical (56.6%) than non-clinical isolates (22.8%) (p < 0.01). Non-clinical PRASEF isolates (n = 3) were only recovered from hospital sewage. Note that representative clinical and non-clinical PRASEF isolates were grouped in pulsotype A, and belonged to CC9 (clonal complex). In conclusion, E. faecalis isolates exhibiting the unusual penicillin-resistant but ampicillin-susceptible phenotype appeared to be restricted to the hospital environment. Our findings highlight the ability of PRASEF isolates to survive in sewage, which could enable these hospital-adapted lineages to spread to new ecological niches.

Beta-lactams susceptibility testing of penicillin-resistant, ampicillin-susceptible Enterococcus faecalis isolates: a comparative assessment of Etest and disk diffusion methods against broth dilution.

This study aimed to evaluate the accuracy of disk diffusion and Etest methods, compared to that of the broth dilution reference method for identifying beta-lactam susceptibilities of Penicillin-Resistant, Ampicillin-Susceptible Enterococcus faecalis (PRASEF) isolates. Fifty-nine PRASEF and 15 Penicillin-Susceptible, Ampicillin-Susceptible E. faecalis (PSASEF) clinical nonrepetitive isolates were evaluated. The effectiveness of five beta-lactams (ampicillin, amoxicillin, imipenem, penicillin, and piperacillin) was tested. All antimicrobial susceptibility tests were performed and interpreted according to the Clinical and Laboratory Standards Institute guidelines. Interpretative discrepancies, such as essential agreement, categorical agreement, and errors, were assessed. The acceptability was ≥ 90% for both categorical agreement and essential agreement. Etest proved to be an accurate method for testing beta-lactam susceptibilities of the emerging PRASEF isolates, disk diffusion presented poor performance, particularly for imipenem and piperacillin.

Diabetes and pre-diabetes among adults reaching health centers in Luanda, Angola: prevalence and associated factors.

With the lack of surveys, surveillance program and/or statistical data, epidemiologic studies can provide a better understanding of diabetes in Sub-Saharan Africa. This was a cross-sectional survey to determine prevalence of diabetes and impaired fasting glucose (IFG) among adults attending six health centres in six different districts of Luanda (Angola) during August-November 2018, followed by a case-control study to assess the risk factors for IFG and diabetes in a subgroup of subjects not receiving treatment for diabetes. Factors associated with diabetes/IFG were assessed using a generalized ordered logit model and the effects were expressed as odds ratios (OR1 for IFG/diabetes vs. no IFG/diabetes; OR2 for diabetes vs. no diabetes) with 95% CI (confidence interval). Some 1,803 participants were included in the survey. Prevalence of diabetes was 12.0% (95%CI 10.5% to 13.5%) and prevalence of IFG was 9.0% (95%CI 7.7% to 10.4%). Older age (OR1 = OR2 1.03, 95%CI 1.02 to 1.04), higher weight (OR1 = OR2 1.01, 95%CI 1.01 to 1.03), having measured glycaemia before (OR2 2.07, 95%CI 1.29 to 3.31), feeling polyuria (OR1 1.93, 95%CI 1.13 to 3.28; OR2 2.18, 95%CI 1.32 to 3.59), feeling polydipsia (OR1 1.92, 95%CI 1.16 to 3.18), feeling weakness (OR1 = OR2 2.22, 95%CI 1.39 to 3.55), consumption of free-sugars food/beverages (OR1 = OR2 2.34, 95%CI 1.44 to 3.81) and time spent seated (OR1 1.80, 95%CI 1.17 to 2.76) were associated with increased likelihood of diabetes and/or IFG, while eating vegetables was associated with decreased likelihood of IFG or diabetes (OR1 = OR2 0.69, 95%CI 0.47 to 0.99). In conclusion, the high prevalence of diabetes and IFG, with common unawareness of the disease, calls for appropriate interventions in Angolan urban settings. Further research may evaluate the impact of context-specific factors to enhance intervention strategies and feed the results into local health policies. In addition, such information may be useful for selecting high-risk subjects to test.

By-Products of Camu-Camu [Myrciaria dubia (Kunth) McVaugh] as Promising Sources of Bioactive High Added-Value Food Ingredients: Functionalization of Yogurts.

Camu-camu (Myrciaria dubia (Kunth) McVaugh) is a fruit economically relevant to the Amazon region, mostly consumed in the form of processed pulp. Our aim was to perform an unprecedented comparative study on the chemical composition and bioactivities of the camu-camu pulp and industrial bio-residues (peel and seed), and then the most promising fruit part was further explored as a functionalized ingredient in yogurt. A total of twenty-three phenolic compounds were identified, with myricetin-O-pentoside and cyanindin-3-O-glucoside being the main compounds in peels, followed by p-coumaroyl hexoside in the pulp, and ellagic acid in the seeds. The peel displayed the richest phenolic profile among samples, as well as the most significant antibacterial (MICs = 0.625-10 mg/mL) and anti-proliferative (GI50 = 180 µg/mL against HeLa cells) activities. For this reason, it was selected to be introduced in a food system (yogurt). Taken together, our results suggest the possibility of using the camu-camu peel as a source of food additives.

High Prevalence of the aac(6')-Ie-aph(2'')-Ia Gene in Hospital Isolates of Enterococcus faecalis Co-Resistant to Gentamicin and Penicillin.

Objectives: This study aimed to characterize the molecular mechanism of resistance to gentamicin among penicillin-resistant, ampicillin-susceptible Enterococcus faecalis (PRASEF) isolates by investigating the presence of the aac(6')-Ie-aph(2'')-Ia gene. The co-resistance to antimicrobials of other classes was also evaluated. Results: Among the 151 isolates evaluated, 70 were PRASEF and 81 were penicillin-susceptible and ampicillin-susceptible E. faecalis (PSASEF). No ß-lactamase producing isolate was detected. Eighty-three (55.0%) and 35 (23.2%) out of the 151 E. faecalis isolates showed high-level gentamicin resistance (HLGR) and high-level streptomycin resistance (HLSR) phenotypes. However, a significantly higher rate of PRASEF (88.6%) showed HLGR phenotype in comparison with PSASEF (23.5%) (p < 0.01). Conversely, a significantly lower rate of PRASEF (14.3%) showing HLSR was observed in comparison with PSASEF (30.9%) (p = 0.02). The prevalence of isolates displaying multidrug resistance (MDR) phenotype was significantly higher (p < 0.01) in the group of PRASEF (81.4%) than in PSASEF (18.6%). The majority of PSASEF (61.9%) and PRASEF (90.3%) isolates showing HLGR phenotype was harboring the aac(6')-Ie-aph(2'')-Ia gene, which encodes a bifunctional enzyme that inactivates all aminoglycosides except streptomycin. Conclusion: The aac(6')-Ie-aph(2'')-Ia gene was prevalent among the Brazilian PRASEF isolates that usually exhibit co-resistance to gentamicin and to multiple other drugs.

Potential of oxygen and nitrogen reactive intermediates to disperse Listeria monocytogenes from biofilms.

Studying biofilm dispersal is important to prevent Listeria monocytogenes persistence in food processing plants and to avoid finished product contamination. Reactive oxygen and nitrogen intermediates (ROI and RNI, respectively) may trigger cell detachment from many bacterial species biofilms, but their roles in L. monocytogenes biofilms have not been fully investigated. This study reports on ROI and RNI quantification in Listeria monocytogenes biofilms formed on stainless steel and glass surfaces; bacterial culture and microscopy combined with fluorescent staining were employed. Nitric oxide (NO) donor and inhibitor putative effects on L. monocytogenes dispersal from biofilms were evaluated, and transcription of genes (prfA, lmo 0990, lmo 0807, and lmo1485) involved in ROI and RNI stress responses were quantified by real-time PCR (qPCR). Microscopy detected the reactive intermediates NO, peroxynitrite, H2O2, and superoxide in L. monocytogenes biofilms. Neither NO donor nor inhibitors interfered in L. monocytogenes growth and gene expression, except for lmo0990, which was downregulated. In conclusion, ROI and RNI did not exert dispersive effects on L. monocytogenes biofilms, indicating that this pathogen has a tight control for protection against oxidative and nitrosative stresses.

Biofilm formation by Vibrio parahaemolyticus on different surfaces and its resistance to sodium hypochlorite / Formação de biofilme por Vibrio parahaemolyticus em diferentes superficies e resistência ao hipoclorito de sódio

ABSTRACT: Vibrio parahaemolyticus is an important pathogen for both fish industry and consumers. It forms biofilm which makes it difficult to eliminate this microorganism using sanitizers. This study aimed to assess biofilm formation on different surfaces and effect of biofilm on resistance to sanitizers. Eight isolates of biofilm-forming V. parahaemolyticus were tested for the ability to form biofilms on a number of surfaces including high density polyethylene, stainless steel, glass, exoskeleton of Farfantepenaeus paulensis (Pink Shrimp), and operculum of Micropogonias furnieri (Whitemouth Croaker). Efficiency of sanitizer sodium hypochlorite against the bacteria was evaluated in the biofilms formed on the surface of the materials used; out the eight strains analyzed four formed biofilm on different surfaces. The present study shows that there are variations between surfaces in terms of biofilm formation, with more than one bacterial strain being able to form biofilm on the surface of the operculum of M. furnieri and on high density polyethylene as well. One isolate formed biofilm on glass, and one isolate formed biofilm on stainless steel. Sanitizers reduced biofilm formation on all surfaces. Based on our findings, we concluded that V. parahaemolyticus isolates have different ability to form biofilm on different surfaces. No isolates formed biofilm on shrimp shells. Results of this study also showed that sodium hypochlorite eat a concentration of 20 parts per million (20ppm) of Cl2, albeit not able to eliminate bacteria reported in biofilms, is still capable of reducing bacterial populations.

RESUMO: Vibrio parahaemolyticus é uma bactéria patogênica importante tanto para a indústria como para os consumidores de pescados, uma vez que pode formar biofilme, dificultando a sua eliminação por sanitizantes. Este estudo teve como objetivo verificar a formação de biofilme em diferentes superfícies e o efeito do biofilme sobre a resistência a sanitizante. Oito isolados de V. parahaemolyticus formadores de biofilme foram testados quanto à capacidade de formar biofilme em superfícies de polietileno de alta densidade, aço inoxidável, vidro, exoesqueleto de Farfantepenaeus paulensis (Camarão-rosa) e opérculo de Micropogonias furnieri (Corvina). A eficiência do sanitizante hipoclorito de sódio foi avaliada frente às bactérias nos biofilmes formados sobre a superfície dos materiais utilizados. Das oito cepas analisadas, quatro foram consideradas formadoras de biofilme em diferentes superfícies. Os resultados mostraram variação entre as superfícies, sendo que mais de uma cepa formou biofilme na superfície do opérculo de M. furnieri e do polietileno de alta densidade. Um isolado formou biofilme em vidro e um em aço inoxidável. Nenhum isolado formou biofilme na carapaça de camarão. O sanitizante reduziu a formação do biofilme em todas as superfícies. Conclui-se que os isolados de V. parahaemolyticus apresentam distinta capacidade de formar biofilme em diferentes superfícies e que o hipoclorito de sódio na concentração de 20 partes por milhão (20ppm) de Cl2, embora não elimine as bactérias que se encontram em biofilme, reduz a sua população.

Formação de biofilme por Vibrio parahaemolyticus isolados de pescados / Biofilm formation by Vibrio parahaemolyticus isolated from fish

O pescado é um alimento altamente perecível, possui pH próximo a neutralidade, elevada atividade de água e alto teor de nutrientes facilmente utilizáveis por micro-organismos. Vibrio parahaemolyticus pode ser encontrado em ambientes com salinidade entre 3% e 8% e tem pH ideal para multiplicação entre 7,8 e 8,6. É um patógeno que pode causar gastrenterite aguda pelo consumo de frutos do mar contaminados, crus ou mal cozidos. Mesmo os processos de tratamento de água como cloração, adição de antibióticos e filtros apresentam dificuldade em reduzir a contaminação por Vibrio, sendo suposto que este gênero bacteriano pode formar biofilmes em diferentes superfícies. O objetivo do trabalho foi verificar a capacidade de V. parahaemolyticus isolados de pescados formarem biofilme após estresse subletal. No decorrer de um ano, foram realizadas 12 coletas mensais de amostras de peixes capturados no estuário da Lagoa dos Patos, as quais foram analisadas quanto à presença de V. parahaemolyticus. Concomitantemente, foram coletadas assepticamente amostras de água do estuário para análise de sanilidade e pH. Os isolados de Vibrio foram analisados pela reação em cadeia da polimerase (PCR) para identificação da espécie pela presença dos genes toxR. Além dos isolados obtidos no presente trabalho, também foram estudadas 15 outras cepas de V. parahaemolyticus previamente isoladas em outros trabalhos. As cepas foram avaliadas quanto à capacidade de produção de biofilme em placas de microtitulação. A capacidade de produção de biofilme após as cepas serem submetidas a diferentes tipos de estresse subletal (42ºC, 20ºC, 4ºC e pH ácido) também foi testada. Dentre os 120 peixes analisados, foram isolados V. parahaemolyticus de quatro (3,33%) pescados, sendo Mugil platanus a única espécie de peixe na qual o micro-organismo foi encontrado. Das 19 cepas analisadas, 89,5% foram capazes de formar biofilme, o que parece indicar que essa capacidade tem um papel importante na sobrevivência do micro-organismo nos pescados. Dessas, 25% das cepas aumentaram a capacidade de formar biofilme. Com base nos resultados, conclui-se que peixes da espécie M. platanus do estuário da Lagoa dos Patos são hospedeiros de V. parahaemolyticus e que a quase totalidade das cepas são formadoras de biofilme. A exposição a condições subletais de estresse tem efeito distinto sobre as diferentes cepas, induzindo aumento na capacidade de formar biofilme em algumas. Este foi o primeiro estudo realizado com V. parahaemolyticus, para avaliar o efeito de fatores de estresse sobre a formação de biofilme.(AU)

Fish is a highly perishable food, has a neutral pH, high water activity and high content nutrient, which makes it favorable to the microorganisms multiplication. Vibrio parahaemolyticus may be found in environments with a salinity of 3% and 8% and has optimal pH for multiplication between 7.8 and 8.6. This pathogen can cause acute gastroenteritis by consumption of contaminated raw or undercooked seafood. There is difficulty in reducing Vibrio contamination during fish processing, being supposed that this bacterial genus can form biofilm on different surfaces. The aim of this study was to verify the ability of V. parahaemlyticus isolated from fish from biofilm after sublethal stress. In the course of one year, 12 monthly samples of fish caught in the Lagoa dos Patos Estuary were analyzed for the presence of V. parahaemolyticus. Concurrently, water samples from estuary were collected aseptically for salinity analysis and pH. Vibrio isolates were analyzed by polymerase chain reaction (PCR) to identification of the species by presence of the toxR gene. In addition to the isolates obtained in this study were also studied 15 other strains of V. parahaemolyticus previously isolated in other works. The strains were evaluated for biofilm production capacity in microtiter plates. The biofilm production capacity after the strains had being subjected to different types of sublethal stress (42oC, 20°C, 4°C and acid pH) was also tested. Among the 120 analyzed fish, V. parahaemolyticus were isolated from four (3.33%) fishes, and Mugil platanus was the only species in which the microorganism was found. Among the 19 strains analyzed, 89.5% were able to form biofilm, which seems to indicate that this ability has an important role in the microorganism survival in the fish. Among these strains, 25% increased the ability to form biofilm after sublethal exposure. Based on the results, we concluded that fish of the species M. platanus of the Lagoa dos Patos Estuary are hosts of V. parahaemolyticus and that almost all of these strains are forming biofilm. Exposure to sublethal stress conditions has distinct effect on different strains, inducing an increase in the ability to form biofilm in some. This was the first study about the effects of stress on the V. parahaemolyticus biofilms formation.(AU)

Chromobacterium violaceum (Schröter 1872) isolated from the aquatic environment associated with the fish culture of Jaú, Zungaro jahu (Ihering, 1898) (Siluriformes, Pimelodidae) / Chromobacterium violaceum (Schröter 1872) isolado de ambiente aquático associado à piscicultura de Jaú, Zungaro jahu (Ihering, 1898) (Siluriformes, Pimelodidae) piscicultura

The jau, Zungaro jahu (Ihering, 1898) is an endangered species, rheophilic, reaching 1.5 m and more than 100 kg. During a work of microbiological monitoring of water quality, in the cultivation of Zungaro jahu, microorganisms that were isolated, were previously reported in other studies, as family members Enterobacteriaceae, Staphylococcus and non-fermenting bacilli. However, it was also isolated Chromobacterium violaceum, which despite being a bacterium found in such an environment, it was reported linked to the cultivation of fish. This paper describes the Chromobacterium violaceum founded in a psiculture, which has implications for national fish farming.

O jaú, Zungaro jahu (Ihering, 1898), é uma espécie em extinção, reofílica, atingindo 1,5 m e mais que 100 kg. Durante um trabalho de monitoramento microbiológico da qualidade da água, no cultivo da espécie em foco, foram isolados microrganismos previamente descritos em outros estudos, como membros da família Enterobacteriaceae, Staphylococcus e bacilos não fermentadores. Além desses microrganismos, foi isolada também a espécie Chromobacterium violaceum, que apesar de ser uma bactéria encontrada neste tipo de ambiente, não foi relatada associada ao cultivo de peixes. Este trabalho relata este importante achado, que pode trazer implicações à piscicultura nacional.

Evaluation of polymorphisms in pbp4 gene and genetic diversity in penicillin-resistant, ampicillin-susceptible Enterococcus faecalis from hospitals in different states in Brazil.

The aim of the present study was to verify whether penicillin-resistant, ampicillin-susceptible Enterococcus faecalis (PRASEF) occurred in Brazil prior to the beginning of the 21st century, and to verify whether ampicillin susceptibility can predict susceptibility to other ß-lactams in E. faecalis with this inconsistent phenotype. The presence of polymorphisms in the pbp4 gene and genetic diversity among the isolates were investigated. Of 21 PRASEF analyzed, 5 (23.8%) and 4 (19.0%) were imipenem and piperacillin resistant simultaneously by disk diffusion and broth dilution respectively, contradicting the current internationally accepted standards of susceptibility testing. Sequencing of pbp4 gene revealed an amino acid substitution (Asp-573→Glu) in all PRASEF isolates but not in the penicillin-susceptible, ampicillin-susceptible E. faecalis. Most PRASEF (90.5%) had related pulsed-field gel electrophoresis profiles, but were different from other PRASEF described to date. Results demonstrate that penicillin-resistant, ampicillin-susceptible phenotype was already a reality in the 1990s in E. faecalis isolates in different Brazilian states, and some of these isolates were also imipenem- and piperacillin-resistant; therefore, internationally accepted susceptibility criteria cannot be applied to these isolates. According to pbp4 gene sequencing, this study suggests that a specific amino acid substitution in pbp4 gene found in all PRASEF analyzed is associated with penicillin resistance.

Penicillin-resistant, ampicillin-susceptible Enterococcus faecalis of hospital origin: pbp4 gene polymorphism and genetic diversity.

Despite the spread of penicillin-resistant, ampicillin-susceptible Enterococcus faecalis (PRASEF) isolates in diverse countries, the mechanisms leading to this unusual resistance phenotype have not yet been investigated. The aim of this study was to evaluate whether polymorphism in the pbp4 gene is associated with penicillin resistance in PRASEF isolates and to determine their genetic diversity. E. faecalis isolates were recovered from different clinical specimens of hospitalized patients from February 2006 to June 2010. The ß-lactam minimal inhibitory concentrations (MICs) were determined by E-test®. The PCR-amplified pbp4 gene was sequenced with an automated sequencer. The genetic diversities of the isolates were established by PFGE (pulsed-field gel electrophoresis) and MLST (multilocus sequencing typing). Seventeen non-producing ß-lactamase PRASEF and 10 penicillin-susceptible, ampicillin-susceptible E. faecalis (PSASEF) strains were analyzed. A single-amino-acid substitution (Asp-573→Glu) in the penicillin-binding domain was significantly found in all PRASEF isolates by sequencing of the pbp4 gene but not in the penicillin-susceptible isolates. In contrast to the PSASEF isolates, a majority of the PRASEFs had similar PFGE profiles. Six representative PRASEF isolates were resolved by MLST into ST9 and ST524 and belong to the globally dispersed clonal complex 9 (CC9). In conclusion, it appears quite likely that the amino acid alteration (Asp-573→Glu) found in the PBP4 of the Brazilian PRASEF isolates may account for their reduced susceptibility to penicillin, although other resistance mechanisms remain to be investigated.

Ampicillin susceptibility can predict in vitro susceptibility of penicillin-resistant, ampicillin-susceptible Enterococcus faecalis Isolates to amoxicillin but not to imipenem and piperacillin.

Our findings demonstrated that the results obtained for ampicillin may accurately predict the in vitro susceptibility to amoxicillin but not to imipenem and piperacillin among isolates of Enterococcus faecalis resistant to penicillin but susceptible to ampicillin, which have emerged recently, in contrast to penicillin- and ampicillin-susceptible isolates.

Variação espacial e sazonal de microrganismos associados ao cultivo do Zungaro jahu (Ihering, 1898), na Estação Ambiental de Volta Grande no Estado de Minas Gerais / Spatial and seazonal variations of microorganisms associated with cultivation Zungaro jahu (Ihering,1898), at Estação Ambiental de Volta Grande in the State of Minas Gerais

Objetivo - Identificar a variação espacial e a sazonal de microrganismos associados ao cultivo semi-intensivo do Zungaro jahu. Métodos - As amostras de água foram coletadas ao longo de um eixo longitudinal em uma piscicultura, no município de Conceição das Alagoas/MG e semeadas em diferentes meios de cultura. Os microrganismos foram isolados e identificados. Resultados - Foram identificados10 gêneros de bactérias. Para os cinco pontos de coleta analisados, obteve-se uma diversidade de 11 espécies de bactérias Gram-negativas e 3 espécies de bactérias Gram-positivas. Conclusão - A análise de variação sazonal apontou para uma redução das categorias taxonômicas em julho, o que pode estar relacionado às baixas temperaturas observadas neste período. A análise da variação espacial mostrou que o tanque que recebe a água de toda a piscicultura apresenta maior diversidade microbiana provavelmente decorrente da adição de matéria orgânica utilizada como insumo.

Objective - To identify the spatial and seasonal variation of microorganisms associated with Zungaro jahu cultivation semi-intensive. Methods - Water samples were collected along a longitudinal axis in a fish farming Conceição das Alagoas county, Minas Gerais-Brazil, and seeded in different culture medium. Results - Ten bacteria genus were isolated and identified 11 of microorganisms and 3 species of Gram-negative and Gram-positive bacteria, respectively was obtained in the five collected points analyzed. The seasonal variation analysis indicated a reduction of taxonomic categories in July, must be directly associated with the low temperatures. Conclusion - The analysis showed that space variation of the tank which receives water from the whole farm-fish has a higher microbial diversity; probably due to the addition of organic matter used in fish feed.

Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients.

Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1%) were found to be colonised with vanC VRE and only one patient (0.3%) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1%) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.

Risk factors for vancomycin-resistant enterococci colonisation in critically ill patients

Vancomycin-resistant enterococci (VRE) are important hospital pathogens and have become increasingly common in patients admitted to the intensive care unit (ICU). To determine the incidence and the risk factors associated with VRE colonisation among ICU patients, active surveillance cultures for VRE faecal carriages were carried out in patients admitted to the ICU of the University Hospital of Uberlândia, Minas Gerais, Brazil. Risk factors were assessed using a case-control study. Seventy-seven patients (23.1 percent) were found to be colonised with vanC VRE and only one patient (0.3 percent) was colonised with vanA VRE. Independent risk factors for VRE colonisation included nephropathy [odds ratio (OR) = 13.6, p < 0.001], prior antibiotic use (OR = 5.5, p < 0.03) and carbapenem use (OR = 17.3, p < 0.001). Our results showed a higher frequency (23.1 percent) of Enterococcus gallinarum and Enterococcus casseliflavus, species that are intrinsically resistant to low levels of vancomycin (vanC), without an associated infection, associated with prior antibiotic use, carbapenem use and nephropathy as comorbidity. This study is the first to demonstrate the risk factors associated with vanC VRE colonisation in ICU hospitalised patients. Although vanA and vanB enterococci are of great importance, the epidemiology of vanC VRE needs to be better understood. Even though the clinical relevance of vanC VRE is uncertain, these species are opportunistic pathogens and vanC VRE-colonised patients are a potential epidemiologic reservoir of resistance genes.

Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study.

INTRODUCTION: In the past two decades members of the genus Enterococcus have emerged as important nosocomial pathogens worldwide. This study prospectively analyzed the distribution of species and trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital from 2006-2009. METHODS: Enterococcal species were identified by conventional biochemical tests. The antimicrobial susceptibility profile was performed by disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI). A screening test for vancomycin was also performed. Minimal inhibitory concentration (MIC) for vancomycin was determined using the broth dilution method. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). RESULTS: A total of 324 non-repetitive enterococcal isolates were recovered, of which 87% were E. faecalis and 10.8% E. faecium. The incidence of E. faecium per 1,000 admissions increased significantly (p < 0.001) from 0.3 in 2006 to 2.3 in 2009. The VRE rate also increased over time from 2.5% to 15.5% (p < 0.001). All VRE expressed high-level resistance to vancomycin (MIC >256 µg/ mL) and harbored vanA genes. The majority (89.5%) of VRE belonged to E. faecium species, which were characteristically resistant to ampicillin and quinolones. Overall, ampicillin resistance rate increased significantly from 2.5% to 21.4% from 2006-2009. Resistance rates for gentamicin, chloramphenicol, tetracycline, and erythromycin significantly decreased over time, although they remained high. Quinolones resistance rates were high and did not change significantly over time. CONCLUSIONS: The data obtained show a significant increasing trend in the incidence of E. faecium resistant to ampicillin and vancomycin.

Trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital: a 4-year study / Evolução da resistência aos antimicrobianos entre isolados clínicos de enterococos em um hospital terciário brasileiro: um estudo de 4 anos

INTRODUCTION: In the past two decades members of the genus Enterococcus have emerged as important nosocomial pathogens worldwide. This study prospectively analyzed the distribution of species and trends in antimicrobial resistance among clinical isolates of enterococci in a Brazilian tertiary hospital from 2006-2009. METHODS: Enterococcal species were identified by conventional biochemical tests. The antimicrobial susceptibility profile was performed by disk diffusion in accordance with the Clinical and Laboratory Standards Institute (CLSI). A screening test for vancomycin was also performed. Minimal inhibitory concentration (MIC) for vancomycin was determined using the broth dilution method. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). RESULTS: A total of 324 non-repetitive enterococcal isolates were recovered, of which 87 percent were E. faecalis and 10.8 percent E. faecium. The incidence of E. faecium per 1,000 admissions increased significantly (p < 0.001) from 0.3 in 2006 to 2.3 in 2009. The VRE rate also increased over time from 2.5 percent to 15.5 percent (p < 0.001). All VRE expressed high-level resistance to vancomycin (MIC >256µg/ mL) and harbored vanA genes. The majority (89.5 percent) of VRE belonged to E. faecium species, which were characteristically resistant to ampicillin and quinolones. Overall, ampicillin resistance rate increased significantly from 2.5 percent to 21.4 percent from 2006-2009. Resistance rates for gentamicin, chloramphenicol, tetracycline, and erythromycin significantly decreased over time, although they remained high. Quinolones resistance rates were high and did not change significantly over time. CONCLUSIONS: The data obtained show a significant increasing trend in the incidence of E. faecium resistant to ampicillin and vancomycin.

INTRODUÇÃO: Nas últimas duas décadas, os enterococos emergiram como importantes patógenos nosocomiais no mundo inteiro. Neste estudo, foi analisada a distribuição das espécies e a evolução da resistência aos antimicrobianos entre isolados clínicos de enterococos obtidos em um hospital terciário, no período de 2006 a 2009. MÉTODOS: As espécies foram identificadas por testes bioquímicos convencionais e o perfil de sensibilidade foi determinado pelo método de disco difusão. A sensibilidade à vancomicina foi também determinada pela triagem em agar e pela concentração inibitória mínima (CIM). Testes moleculares foram utilizados para confirmar as espécies e determinar os genótipos dos enterococos resistentes à vancomicina (VRE). RESULTADOS: Foram analisadas 324 amostras de enterococos, sendo 87 por cento E. faecalis e 10,8 por cento E. faecium. A incidência de E. faecium por 1.000 pacientes internados aumentou significativamente (p < 0,001) de 0,3 em 2006 para 2,3 em 2009. A taxa de VRE também aumentou significativamente de 2,5 por cento para 15,5 por cento (p < 0,001). Todos os VRE apresentaram genótipo VanA e CIM >256µg/mL para vancomicina. A maioria (89,5 por cento) dos VRE pertencia à espécie E. faecium e foram resistentes à ampicilina e quinolonas. Foi observado um aumento significativo na taxa de resistência à ampicilina, de 2,5 por cento (2006) para 21,4 por cento (2009). As taxas de resistência para gentamicina, cloranfenicol, tetraciclina e eritromicina diminuíram significativamente no período do estudo. Para as quinolonas, as taxas de resistência foram elevadas não alteraram significativamente, no período do estudo. CONCLUSÕES: Os resultados do presente estudo mostram um aumento significativo na incidência de E. faecium resistentes à ampicilina e vancomicina.

First report of vancomycin-resistant Enterococcus faecalis in Uberaba, Minas Gerais state

In this study we report the first isolation of VanA-type vancomycin-resistant Enterococcus faecalis strains from two different patients hospitalized in the same intensive care unit at the hospital of Universidade Federal do Triângulo Mineiro (UFTM), Uberaba, Minas Gerais, Brazil.