Trichosporon asahii superinfections in critically ill COVID-19 patients overexposed to antimicrobials and corticosteroids.

OBJECTIVES: To investigate the occurrence of Trichosporon asahii fungemia among critically ill COVID-19 patients. METHODS: From 1 July to 30 September 2020, cases of T asahii fungemia (TAF) in a Brazilian COVID-19 referral centre were investigated. The epidemiology and clinical courses were detailed, along with a mycological investigation that included molecular species identification, haplotype diversity analysis and antifungal susceptibility testing. RESULTS: Five critically ill COVID-19 patients developed TAF in the period. All five patients had common risk conditions for TAF: central venous catheter at fungemia, previous exposure to broad-spectrum antibiotics, prior echinocandin therapy and previous prolonged corticosteroid therapy. The average time of intensive care unit hospitalisation previous to the TAF episode was 23 days. All but one patient had voriconazole therapy, and TAF 30-day mortality was 80%. The five T asahii strains from the COVID-19 patients belonged to 4 different haplotypes, mitigating the possibility of skin origin and cross-transmission linking the 5 reported episodes. The antifungal susceptibility testing revealed low minimal inhibitory concentrations for azole derivatives. CONCLUSIONS: Judicious prescription of antibiotics, corticosteroids and antifungals needs to be discussed in critically ill COVID-19 patients to prevent infections by hard-to-treat fungi like T asahii.

Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features.

BACKGROUND: Bloodstream infections (BSI) are associated with high morbidity and mortality. This scenario worsens with the emergence of drug-resistant pathogens, resulting in infections which are difficult to treat or even untreatable with conventional antimicrobials. The aim of this study is to describe the epidemiological aspects of BSI caused by multiresistant gram-negative bacilli (MDR-GNB). METHODS: We conducted a laboratory-based surveillance for gram-negative bacteremia over a 1-year period. The bacterial isolates were identified by MALDI-TOF/MS and the antimicrobial susceptibility testing was performed by VITEK®2. Resistance genes were identified through PCR assays. RESULTS: Of the 143 patients, 28.7% had infections caused by MDR-GNB. The risk factors for MDR bacteremia were male sex, age ≥ 60, previous antimicrobial use, liver disease and bacteremia caused by K. pneumoniae. K. pneumoniae was the most frequently observed causative agent and had the highest resistance level. Regarding the resistance determinants, SHV, TEM, OXA-1-like and CTX-M-gp1 were predominant enzymatic variants, whereas CTX-M-gp9, CTX-M-gp2, KPC, VIM, GES, OXA-48-like, NDM and OXA-23-like were considered emerging enzymes. CONCLUSIONS: Here we demonstrate that clinically relevant antibiotic resistance genes are prevalent in this setting. We hope our findings support the development of intervention measures by policy makers and healthcare professionals to face antibiotic resistance.

Is there concordance between bone and tendon cultures in patients with foot tissue loss?

BACKGROUND: Deep infections of the extremities are a challenge that threaten limb salvage. OBJECTIVES: To investigate whether the results of bone and deep tissue cultures from patients with trophic limb ulcers coincide. METHODS: A retrospective study was conducted with data from 54 patients with deep trophic limb ulcers admitted to the Complexo Hospitalar Universitário Professor Edgard Santos, Salvador (BA), Brazil. The study analyzed all patients for whom cultures of material from foot wounds in patients with tissue loss had been performed using two specimen types: bone and fragments of deep tendon. The study analyzed concordance between the two sample types and total number of microorganisms and numbers of microorganisms by Gram staining in both samples. RESULTS: The mean age of the 54 patients in the sample was 63.6 years, 80% had PAOD, 70% were diabetic, and 72% were hypertensive. Analysis of the cultures showed that 28 (52%) pairs of samples from the 54 patients exhibited complete concordance, with the same microorganisms grown from fragments of deep tendon and bone. There was partial disagreement in 13 samples (24%) and total disagreement in 13 (24%). On average, 1.62 microorganisms were isolated from deep tendon fragments and 1.72 were isolated from bone samples. Analyzing Gram-positive microorganisms separately, the mean number of species grown was 0.48 for tendon cultures and 0.44 for bone cultures. In contrast, the mean number of Gram-negative microorganisms isolated was 1.14 for tendon samples and 1.27 for bone samples. CONCLUSIONS: Around half of the patients with foot tissue loss had bone and tendon cultures that coincided exactly.

Emergence of Trichosporon mycotoxinivorans (Apiotrichum mycotoxinivorans) invasive infections in Latin America.

We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. A review of the relevant literature revealed that deep-seated infections were related to immunosuppression or invasive devices, while most of the CF patients showed a decline in lung function after positive cultures. Phylogenetic analyses revealed three distinct circulating genotypes. MALDI-TOF mass spectrometry analysis showed similar spectral profiles and correctly identified all strains/isolates. Biofilm production was documented in a bloodstream isolate and biofilm-producing cells showed high minimum inhibitory concentrations against antifungals.

Distribution of strain type and antimicrobial susceptibility of Escherichia coli isolates causing meningitis in a large urban setting in Brazil.

The clinical management of meningitis caused by Escherichia coli is greatly complicated when the organism becomes resistant to broad-spectrum antibiotics. We sought to characterize the antimicrobial susceptibilities, sequence types (ST), and presence of known drug resistance genes of E. coli isolates that caused meningitis between 1996 and 2011 in Salvador, Brazil. We then compared these findings to those for E. coli isolates from community-acquired urinary tract infections (UTI) that occurred during the same time period and in the same city. We found that 19% of E. coli isolates from cases of meningitis and less than 1% of isolates from UTI were resistant to third-generation cephalosporins. The sequence types of E. coli isolates from cases of meningitis included ST131, ST69, ST405, and ST62, which were also found among isolates from UTI. Additionally, among the E. coli isolates that were resistant to third-generation cephalosporins, we found genes that encode the extended-spectrum beta-lactamases CTX-M-2, CTX-M-14, and CTX-M-15. These observations demonstrate that compared to E. coli strains isolated from cases of community-acquired UTI, those isolated from cases of meningitis are more resistant to third-generation cephalosporins, even though the same sequence types are shared between the two forms of extraintestinal infections.

Incidence, aetiology and serotype coverage for pneumococcal vaccines of community-acquired pneumonia in adults: a population-based prospective active surveillance study in Brazil.

OBJECTIVES: To determine the incidence, aetiology and pneumococcal serotype distribution of community-acquired pneumonia (CAP) in Brazilian adults during a 2-year period. DESIGN: Prospective population-based surveillance study. SETTING: Patients from two emergency hospitals in Brazil were consecutively included in this study. PARTICIPANTS: A total of 111 adults aged 50 years and older with radiographically-confirmed CAP requiring an emergency department visit were prospectively enrolled between January 2018 and January 2020. MAIN OUTCOME MEASURES: Incidence rates of CAP were calculated according to age and pathogen. Pathogens were identified by conventional microbiological methods. Additionally, a novel, Luminex-based serotype specific urinary antigen detection assay was used to detect serotypes included in pneumococcal vaccines. RESULTS: Mean age of participants was 64 years and 31% were aged ≥70 years. Aetiology was established in 61 (57%) patients; among identified cases, the most common pathogens were Streptococcus pneumoniae (42/61, 69%) and influenza (4/61, 7%). Among serotypes identified from the 42 cases of pneumococcal CAP, estimated coverage ranged by pneumococcal vaccine formulations from 47.6% (13-valent), 59.5% (20-valent, licenced in the USA only) and 71.4% (23-valent). In patients with CAP, 20-valent pneumococcal vaccine serotypes were identified 2.5 times more frequently than 10-valent pneumococcal vaccine serotypes (22.5% vs 9.0%). The incidence rate for CAP in adults aged ≥50 years was 20.1 per 10 000 person-years. In general, the incidence of CAP increased consistently with age, reaching 54.4 (95% CI 36.8 to -76.6) per 10 000 in adults 80 years or older. CONCLUSIONS: We observed a high burden of pneumococcal CAP among adults in Brazil. Despite the routine immunisation of children and high-risk adults against pneumococcal disease in the Brazilian national vaccination programme, a persistent burden of pneumococcal CAP caused by vaccine serotypes remains in this population.

Deaths and hospitalizations of victims of non-drug toxicological events in Brazil, 2009 to 2018. / Óbitos e internações de vítimas de eventos toxicológicos não medicamentosos no Brasil, 2009 a 2018.

OBJECTIVE: to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. METHODS: this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for "treatment of intoxication or poisoning due to exposure to non-drug substances" held on the Hospital Information System. RESULTS: there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. CONCLUSIONS: there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.

Resistance to methicillin and other antimicrobials among community-acquired and nosocomial Staphylococcus aureus strains in a pediatric teaching hospital in Salvador, Northeast Brazil.

To report the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infection and to compare the antimicrobial resistance patterns between community-acquired (CA) and nosocomial (NI) strains stratified for resistance to methicillin, this retrospective study on patients under 20 years of age was conducted from April 1995 to December 2005 in a pediatric teaching hospital in Salvador, Brazil. Of 308 S. aureus strains isolated, 185 (60.1%) were reviewed, out of which 125 (67.6%) and 55 (29.7%) had CA or NI infection, respectively, and 5 were defined as colonization. Out of the nine patients with MRSA initially diagnosed as CA, three were excluded from the analysis because of report of hospitalization during the previous year. Resistance to methicillin was more frequent among NI (30.9% vs. 4.9%, p<0.001). Resistance to other antimicrobials was more common among NI-MRSA compared with CA-MRSA. Although at a low rate, CA-MRSA has occurred among children, in this region.

Isolation of blaNDM-producing Enterobacteriaceae in a public hospital in Salvador, Bahia, Brazil.

Carbapenemases have great importance in the global epidemiological scenario since infections with carbapenemase-producing bacteria are associated with high mortality, especially in hospitalized patients in intensive care units. This study describes two microorganisms producers of the New Delhi Metallo-b-lactamase, Klebsiella pneumoniae and Citrobacter freundii, from two patients admitted to a public hospital in Salvador, Bahia. These are the first clinical cases of New Delhi Metallo-b-lactamase described in microorganisms in the north and northeast Brazil. The isolates were characterized by antimicrobial susceptibility test, with resistance to all ß-lactams including carbapenems, negative Modified Hodge Test and the synergy test with Ethylenediaminetetraacetic acid, Phenylboronic Acid and Cloxacillin was positive only with Ethylenediaminetetraacetic acid (difference of >5mm in the inhibition zone between the disk without and with the inhibitor). Analysis by multiplex PCR for blaIMP, blaVIM, blaNDM, blaKPC and blaOXA-48 enzymes confirmed the presence of blaNDM gene. This report of two different New Delhi Metallo-b-lactamase-producing microorganisms in a different region of Brazil confirms the risk of spreading resistance genes between different species and emphasizes the need for prevention and control of infections caused by these pathogens, which have limited treatment options and have been linked to high mortality rates.

Direct identification from positive blood broth culture by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS).

Bloodstream infections (BSIs) are among the most concerning bacterial infections. They are one of the leading causes of morbidity and mortality, and occur in 30-70% of critical care patients. The prompt identification of the causative microorganism can help choosing the appropriate antimicrobial therapy that will lead to better clinical outcomes. Blood culture is one of the most relevant tests for microbiological diagnosis of bacterial infections. The introduction of the MALDI-TOF microbiological diagnosis significantly decreased the time of identifying microorganisms. However, it depends on the growth on solid culture medium. In this study, 538 bottles of positive blood cultures were evaluated to test the accuracy of an in house modified protocol. The study sample consisted of 198 Gram-negative and 350 Gram-positive bacteria. In all, 460 (83.94%) species were identified based on the direct plate findings. The protocol allowed the identification of 185/198 (93.43%) of the Gram-negative bacteria, including aerobes, anaerobes, and non-fermenters, and 275/350 (78.85%) of the Gram-positive bacteria. The proposed method has the potential to provide accurate results in comparison to the traditional method with the potential to reduce the turnaround time for the results and optimize antimicrobial therapy in BSI.

Óbitos e internações de vítimas de eventos toxicológicos não medicamentosos no Brasil, 2009 a 2018 / Muertes y hospitalizaciones de víctimas de eventos toxicológicos no medicamentosos en Brasil, 2009 a 2018 / Deaths and hospitalizations of victims of non-drug toxicological events in Brazil, 2009 to 2018

Objetivo: determinar a taxa de internações por eventos agudos de intoxicação não medicamentosa (NMx) e analisar a mortalidade decorrente desses agravos no Brasil, de 2009 a 2018. Métodos: estudo de série temporal, no qual se analisaram registros de internações por "tratamento de intoxicação ou envenenamento por exposição a substâncias de uso não medicamentoso" no Sistema de Informações Hospitalares (SIH), por regressão de Prais-Winsten. Resultados: ocorreram 125.570 internações em virtude de intoxicação NMx. A taxa média de internações foi de 6,3/100 mil habitantes, sendo maior no sexo masculino (8,0/100 mil hab.) comparado ao feminino (4,6/100 mil hab.). A taxa de internações e a mortalidade geral de internações por intoxicação NMx diminuíram de 9,4 para 4,5/100 mil hab. e de 2,5 para 1,6/1 milhão de hab., respectivamente. Conclusões: houve redução da taxa de internações e da mortalidade por intoxicações NMx durante a década analisada.

Objetivo: determinar la tasa de hospitalizaciones por eventos agudos de intoxicación no medicamentosa (NMx) y analizar la mortalidad resultante en Brasil de 2009 a 2018. Métodos: estudio de serie temporal en el que se analizaron los registros de hospitalizaciones por "tratamiento de intoxicación o envenenamiento por exposición a sustancias de uso no farmacológico" del Sistema de Información Hospitalaria (SIH) por la regresión de Prais-Winsten. Resultados: hubo 125.570 hospitalizaciones por intoxicación NMx. La mortalidad promedio de hospitalizaciones fue de 6,3/100 mil hab., siendo más alta en el sexo masculino (8,0/100 mil hab.) en comparación con el femenino (4,6/100 mil hab.). La tasa de hospitalizaciones y la mortalidad global de las hospitalizaciones por NMx disminuyeron de 9,4 a 4,5 por 100 mil hab. y de 2,5 a 1,6 por 1 millón de hab., respectivamente. Conclusiones: hubo reducción en la tasa de hospitalizaciones y en la mortalidad por intoxicaciones NMx durante la década analizada.

Objective: to determine the rate of hospitalizations due to acute non-drug poisoning (NDP) events and to analyze mortality arising from these health conditions in Brazil from 2009 to 2018. Methods: this was a time-series study using Prais-Winsten regression to analyze records of hospitalizations for "treatment of intoxication or poisoning due to exposure to non-drug substances" held on the Hospital Information System. Results: there were 125,570 hospitalizations due to NDP. The average hospitalization rate was 6.3/100,000 inhabitants, although it was higher in males (8.0/100,000 inhab.) compared to females (4.6/100,000 inhab.). The hospitalization rate and the overall mortality rate due NDP to fell from 9.4 to 4.5/100,000 inhab. and from 2.5 to 1.6/1 million inhab., respectively. Conclusions: there was a reduction in the NDP hospitalization rate and in mortality due to NDP during the decade analyzed.

Evaluation of blood stream infections by Candida in three tertiary hospitals in Salvador, Brazil: a case-control study.

Invasive infections caused by Candida spp. are an important problem in immunocompromised patients. There is scarce data on the epidemiology of blood stream candidiasis in Salvador, Brazil. This study evaluates the risk factors associated with candidemia, among patients admitted to three tertiary, private hospitals, in Salvador, Brazil. We conducted a case-control, retrospective study to compare patients with diagnosis of candidemia in three different tertiary hospitals in Salvador, Brazil. Patients were matched for nosocomial, acquired infections, according to the causal agent: cases were defined by positive blood cultures for Candida species. Controls were those patients who had a diagnosis of systemic bacterial infection, with a positive blood culture to any bacteria, within the same time period (+/- 30 days) of case identification. The groups were compared for the main known risk factors for candidemia and for mortality rates. A hundred thirty-eight patients were identified. Among the 69 cases, only 14 were diagnosed as infected by Candida albicans. Candida species were defined in only eight cultures: C. tropicalis (4 cases), C. glabrata, C. parapsilosis, C. guillermondi, C. formata (1 case each). The main risk factors, identified in a univariate analysis, were: presence of a central venous catheter (CVC), use of parenteral nutrition support (PNS), previous exposure to antibiotics, and chronic renal failure (CRF). No association was detected with surgical procedures, diabetes mellitus, neutropenia or malignancies. Patients were more likely to die during the hospitalization period, but the rates of death caused by the infections were similar for cases and controls. The length of hospitalization was similar for both groups, as well as the time for a positive blood culture. Blood stream infection by Candida spp. is associated with CVC, PNS, previous use of antibiotics, and CRF. The higher mortality rate for cases probably better reflects the severity of the underlying diseases, than as a direct consequence of Candidemia.

Avaliação da colonização por bactérias multirresistentes em pacientes admitidos via central de regulação do estado em um hospital filantrópico em Salvador, Bahia / Evaluation of colonization by multiresistant bacteria in patients admitted via central regulation of the state in a philanthropic hospital in Salvador, Bahia / Evaluación de la colonización por bacterias multirresistentes en pacientes admitidos vía central de regulación del estado en un hospital filantrópico en Salvador, Bahia

Justificativa e Objetivos: Infecções Relacionadas à Assistência à Saúde (IRAS) são consideradas um problema de saúde pública cujo controle pode minimizar a morbimortalidade dos pacientes. A instituição precoce de isolamento de contato para pacientes possivelmente colonizados por microrganismos multirresistentes (MR), pode reduzir sua disseminação os casos de IRAS e custos hospitalares. O objetivo deste estudo foi avaliar a frequência e impacto de culturas de vigilância positivas com microrganismos multirresistentes (MR) após um surto de Enterococcus spp. resistentes à vancomicina (VRE). Métodos: Foram implementadas rotinas de coleta de culturas de vigilância a partir de abril de 2014 para pacientes procedentes de outras unidades de saúde via Central de Regulação do Estado e Município em um hospital filantrópico em Salvador­BA. Resultados: Foram avaliados 663 pacientes no período de dezembro de 2014 a dezembro de 2015, sendo que 42 destes apresentaram cultura de vigilância positiva para microrganismos gram positivos e negativos MR. Após a implementação da rotina de realização de culturas de vigilância, não foram mais detectados surtos na nossa unidade. Conclusão: A rotina de culturas de vigilância pode funcionar como um importante instrumento na prevenção da disseminação de MR.(AU)

Background and Objectives: Health Care Related Infections (IRAS) are considered a public health problem whose control can minimize patients' morbidity and mortality. The early institution of contact isolation for patients possibly colonized by multiresistant (MR) microorganisms can reduce their spread in cases of IRAS and hospital costs. This study aimed to evaluate the frequency and impact of positive surveillance cultures with multiresistant (MR) microorganisms following an outbreak of vancomycin resistant Enterococcus spp. (VRE). Methods: Surveillance cultures collection routines were implemented since April / 14 for patients referred from other health to a philanthropic hospital in Salvador ­ Bahia via state and municipal referral center. Results: A total of 663 patients were evaluated in the period from December / 14 to December / 15, and 42 of them had a positive surveillance culture for gram positive and negative MR microorganisms. After the routine implementation of surveillance cultures, no outbreaks were detected in our unit. Conclusion: Despite the high cost, the study showed that routine surveillance cultures are an important tool in preventing MR dissemination.(AU)

Justificación y objetivos: Infecciones Relacionadas a la Asistencia sanitaria (IRAS) se consideran un problema de salud pública cuyo control puede minimizar la morbimortalidad de los pacientes. La institución precoz de aislamiento de contacto para pacientes posiblemente colonizados por microrganismos multirresistentes (MR), puede reducir su diseminación de los casos de IRAS y costos hospitalarios. El objetivo del estudio fue evaluar la frecuencia e impacto de cultivos de vigilancia positivos con microrganismos multirresistentes (MR) después de un brote de Enterococcus spp. resistentes a la vancomicina (VRE). Métodos: Se implementaron rutinas de recolección de cultivos de vigilancia a partir de abril / 14 para pacientes procedentes de otras unidades de salud vía Central de Regulación del Estado y Municipio en un hospital filantrópico en Salvador - BA. Resultados: Se evaluaron 663 pacientes en el período de diciembre / 14 a diciembre / 15, siendo que 42 de ellos presentaron un cultivo de vigilancia positiva para microrganismos gram positivos y negativos MR. Después de la implementación de la rutina de realización de cultivos de vigilancia, ya no se detectaron brotes en nuestra unidad. Conclusión: La rutina de cultivos de vigilancia puede ser un importante instrumento en la prevención de la diseminación de MR.(AU)

Colistin induced neurotoxity: a case report and review of literature / Neurotoxicidade induzida pela colistina: relato de caso e revisão de literatura

OBJECTIVE: To describe a case of neurotoxity associated to Colistin. CASE DESCRIPTION: A 29-year-old black male under treatment for urinary tract infection with identification of Klebsiella pneumoniae in urine culture resistant to all carbapenem antibiotics, presented visual turbidity, paresthesia on the face and upper left limb, slowed and discordant speech in the fourth day of Colistin use. Symptoms improved after reduction of the dose of colistin with adjustment for renal function, with complete reversion after discontinuation of the drug. CONCLUSIONS: Colistin-mediated neurotoxicity must be suspected in patients with altered mental status of unknown etiology and therapy promptly interrupted.

OBJETIVO: Descrever um caso de neurotoxidade associada à Colistina. DESCRIÇÃO DO CASO (desnecessário repetição): Um homem negro de 29 anos sob tratamento para infecção do trato urinário com identificação de Klebsiella pneumoniae (escrever corretamente) em cultura de urina resistente a carbapenêmicos, apresentou turvação visual, parestesia em face e membro superior esquerdo, discurso lento e discordante na quarto dia de uso da Colistina. Os sintomas melhoraram após a redução da dose de colistina com ajuste para a função renal, com reversão completa após a descontinuação do fármaco. CONCLUSÕES: A neurotoxicidade mediada por colistina deve ser suspeitada em pacientes com estado mental alterado de etiologia desconhecida e a terapia prontamente interrompida.

Methicillin-resistant and methicillin-susceptible community-acquired Staphylococcus aureus infection among children.

Methicillin-resistant Staphylococcus aureus has emerged as a pathogen associated with community-acquired infections worldwide. We report the spectrum of community-acquired S. aureus infections and compare the patients infected with methicillin-susceptible or methicillin-resistant strains among patients aged <20 years. Overall, 90 cases of community-acquired S. aureus were detected in an 11-year period. Clinical and microbiological data were registered. Fifty-nine (66%) patients were male and the median age was two years. The majority (87%) of the patients were hospitalized and chronic underlying illnesses were detected in 27 (30%) cases. Overall, 34 (37.8%) patients had skin/soft tissue infections and 56 (62.2%) patients had deep-seated infection. Four (5.1%) patients were transferred to the intensive care unit and two (2.6%) died. Complications were detected in 17 (18.9%) cases, such as pleural effusion (41.2%), osteomyelitis (23.5%), and sepsis (17.6%). Six (6.7%) methicillin-resistant strains were detected. Patients infected with methicillin-susceptible or methicillin-resistant strains had similar baseline characteristics and treatment outcomes. Approximately 93% of the cases received systemic antibiotics, out of which 59 (65.5%) used oxacillin or cefalotin. Both methicillin-susceptible and methicillin-resistant S. aureus strains resulted in morbidity and death among children in this setting where methicillin-resistant strains are infrequent.

Isolation of blaNDM-producing Enterobacteriaceae in a public hospital in Salvador, Bahia, Brazil

ABSTRACT Carbapenemases have great importance in the global epidemiological scenario since infections with carbapenemase-producing bacteria are associated with high mortality, especially in hospitalized patients in intensive care units. This study describes two microorganisms producers of the New Delhi Metallo-b-lactamase, Klebsiella pneumoniae and Citrobacter freundii, from two patients admitted to a public hospital in Salvador, Bahia. These are the first clinical cases of New Delhi Metallo-b-lactamase described in microorganisms in the north and northeast Brazil. The isolates were characterized by antimicrobial susceptibility test, with resistance to all β-lactams including carbapenems, negative Modified Hodge Test and the synergy test with Ethylenediaminetetraacetic acid, Phenylboronic Acid and Cloxacillin was positive only with Ethylenediaminetetraacetic acid (difference of >5 mm in the inhibition zone between the disk without and with the inhibitor). Analysis by multiplex PCR for blaIMP, blaVIM, blaNDM, blaKPC and blaOXA-48 enzymes confirmed the presence of blaNDM gene. This report of two different New Delhi Metallo-b-lactamase-producing microorganisms in a different region of Brazil confirms the risk of spreading resistance genes between different species and emphasizes the need for prevention and control of infections caused by these pathogens, which have limited treatment options and have been linked to high mortality rates.

Direct identification from positive blood broth culture by matrix-assisted laser desorption-ionization time-of-flight mass spectrometry (MALDI-TOF MS)

ABSTRACT Bloodstream infections (BSIs) are among the most concerning bacterial infections. They are one of the leading causes of morbidity and mortality, and occur in 30-70% of critical care patients. The prompt identification of the causative microorganism can help choosing the appropriate antimicrobial therapy that will lead to better clinical outcomes. Blood culture is one of the most relevant tests for microbiological diagnosis of bacterial infections. The introduction of the MALDI-TOF microbiological diagnosis significantly decreased the time of identifying microorganisms. However, it depends on the growth on solid culture medium. In this study, 538 bottles of positive blood cultures were evaluated to test the accuracy of an in house modified protocol. The study sample consisted of 198 Gram-negative and 350 Gram-positive bacteria. In all, 460 (83.94%) species were identified based on the direct plate findings. The protocol allowed the identification of 185/198 (93.43%) of the Gram-negative bacteria, including aerobes, anaerobes, and non-fermenters, and 275/350 (78.85%) of the Gram-positive bacteria. The proposed method has the potential to provide accurate results in comparison to the traditional method with the potential to reduce the turnaround time for the results and optimize antimicrobial therapy in BSI.

Emergence of Trichosporon mycotoxinivorans (Apiotrichum mycotoxinivorans) invasive infections in Latin America

We report the first two cases of Trichosporon mycotoxinivorans infections in Latin America. We also conducted a literature review and a microbiological investigation, including that of clinical and environmental isolates. A 30-year-old man with chronic renal failure had disseminated infection after dialysis and a 15-year-old boy with cystic fibrosis (CF) had pulmonary exacerbations with positive respiratory samples. A review of the relevant literature revealed that deep-seated infections were related to immunosuppression or invasive devices, while most of the CF patients showed a decline in lung function after positive cultures. Phylogenetic analyses revealed three distinct circulating genotypes. MALDI-TOF mass spectrometry analysis showed similar spectral profiles and correctly identified all strains/isolates. Biofilm production was documented in a bloodstream isolate and biofilm-producing cells showed high minimum inhibitory concentrations against antifungals.