Carbapenem-resistant IMP-1-producing Pseudocitrobacter vendiensis emerging in a hemodialysis unit.

Hemodialysis patients are at high risk for bloodstream infections associated with highest morbidity and mortality rates. Bacterial species not commonly related to such infections has been hardly identified by traditional methods. Pseudocitrobacter is a novel genus of the order Enterobacterales that is associated with carbapenemase genes and nosocomial infection. In this context, we have investigated nine cases of bloodstream infections by carbapenem-resistant Gram-negative bacilli in patients assisted at a hemodialysis unit in Brazil. The infections were caused by a metallo-ß-lactamase (IMP-1)-producing clone (> 90% XbaI-PFGE similarity) of Pseudocitrobacter vendiensis, displaying a multidrug-resistant profile to broad-spectrum cephalosporins, carbapenems, chloramphenicol, and trimethoprim-sulfamethoxazole. S1-PFGE and Southern blot hybridization revealed that blaIMP-1 was carried by a 200-kb IncC/ST3 plasmid. Patients were successfully treated with amikacin, and strict disinfection procedures and hand washing protocols were reinforced. We report the emergence of P. vendiensis, a recently described species of the genus, in bloodstream infections of patients undergoing hemodialysis. Considering the epidemic potential of carbapenemase-producing Enterobacterales in hospital settings, surveillance of this emerging pathogen is of utmost importance.

Genome and plasmid context of two rmtG-carrying Enterobacter hormaechei isolated from urinary tract infections in Brazil.

OBJECTIVES: Enterobacter hormaechei is an important causative agent of severe infections in critically ill patients. Aminoglycosides are among the main antibiotics for the treatment of E. hormaechei infections, however the development of antimicrobial resistance is an increasing problem. RmtG is a 16S rRNA methyltransferase, a class of enzymes conferring high-level resistance to clinically relevant aminoglycosides. The aim of this study was to characterise the full genetic context of plasmids harbouring the rmtG gene in two aminoglycoside-resistant E. hormaechei isolated in Brazil. METHODS: ThermtG-harbouring plasmids were transferred to an Escherichia coli J53 recipient strain and were fully sequenced using a MiSeq sequencing system. Complete genome assemblies were accomplished using a combination of Newbler v.3.0, SPAdes 3.10.0 and phrap/cross_match programs. Plasmid sequences were annotated using RAST server and were then manually curated using BLAST databases and ISfinder. Easyfig 2.0 was used to map and compare regions of interest containing rmtG in both plasmids. RESULTS: Both isolates carried thermtG gene on an IncA/C plasmid of ˜152kb and ˜235kb, respectively, associated with a Tn3 transposon. The plasmids contain a transfer region as well as genes involved in plasmid stability and resistance to ß-lactams, sulfonamides and quaternary ammonium compounds. One of the plasmids also carried the mrk operon encoding type 3 fimbriae. CONCLUSION: This first detection ofrmtG in E. hormaechei supports the ability for horizontal transfer. The location in complex genetic platforms carried by Tn3 transposons in IncA/C plasmids may facilitate dissemination to other Gram-negative pathogens, further limiting treatment options.

Draft genome sequence of an aminoglycoside-resistant RmtD2-producing Enterobacter cloacae subsp. cloacae ST395 in Brazil.

OBJECTIVES: Enterobacter cloacae has recently emerged as an important agent of nosocomial infections owing to the dissemination of extended-spectrum ß-lactamases and carbapenemases in this species. In this context, a rise in the therapeutic use of aminoglycosides was noticed, followed by the accelerated development of resistance mechanisms. In this study, we report the draft genome sequence of a multidrug-resistant E. cloacae subsp. cloacae strain (Ec2) isolated from an active surveillance culture of a patient with Chagas disease. METHODS: Whole-genome sequencing (WGS) was performed using a Nextera XT DNA library and NextSeq platform. RESULTS: WGS analysis revealed the presence of 5527 coding genes, 62 RNA-encoding genes and 275 pseudogenes. Strain Ec2 belongs to sequence type 395 (ST395) and carries 22 transferable antibiotic resistance genes, comprising eight antimicrobial classes, including the rmtD2 gene conferring high-level aminoglycoside resistance. CONCLUSIONS: This draft genome can be used in comparative genomic analyses with different E. cloacae strains. In addition, it could help at elucidating epidemiological aspects regarding the dissemination of clinically relevant resistance genes.

Transfer of KPC-2 carbapenemase from Klebsiella pneumoniae to Enterobacter cloacae in a patient receiving meropenem therapy.

The horizontal transfer of a plasmid bearing the blaKPC-2 gene from K. pneumoniae to E. cloacae infecting the respiratory tract of a patient during meropenem therapy was elucidated. This finding is particularly worrisome, since these drugs are of last resort for multidrug-resistant Gram-negative pathogens.

Trichocomaceae: biodiversity of Aspergillus spp and Penicillium spp residing in libraries.

INTRODUCTION: Atmospheric air is the most common vehicle for the dispersion of fungi. Fungi belonging to the genera Aspergillus and Penicillium are cosmopolitan and are classified in the family Trichocomaceae. Species of the genera are commonly found in soil, decaying organic materials, animal feed, stored grains, and other materials. This study aimed to determine the taxonomic diversity of airborne fungi of the genera Aspergillus and Penicillium residing in the dust of library environments to contribute to current knowledge of these characteristic genera. METHODOLOGY: Three libraries in the city of Cuiaba, State of Mato Grosso, Brazil, were selected as the study areas. A total of 168 samples were collected at randomized sites within each library in areas containing journals, archives, in study rooms, and in collection storage areas in two different periods, the dry season (n = 42)  and the rainy season (n = 42). Samples were collected by exposing Petri dishes containing Sabouraud agar with chloramphenicol to the environmental air. Additional samples were collected with sterile swabs which were rubbed over the surface of randomly chosen books on the shelves; the swabs were subsequently incubated in the laboratory. RESULTS AND CONCLUSION: The genus Aspergillus was highlighted as one of the principal airborne fungi present in indoor environments. Aspergillus spp was identified in 1,277 (89.6%) samples and Penicillium spp in 148 (10.4%). The dry period exhibited a greater number of isolates of the two taxons.

Epidemiological and clinical characteristics of nosocomial candidiasis in university hospitals in Cuiabá--Mato Grosso, Brazil.

BACKGROUND: Fungal infections are emerging as an important cause of human disease, especially among hospitalized patients with serious underlying disease and several risk factors. AIMS: To evaluate epidemiological and clinical characteristics of patients with nosocomial candidiasis in university hospitals in Cuiabá - MT, Brazil. METHODS: A descriptive study of 91 patients admitted to university hospitals in Cuiabá - MT, with clinical and laboratory diagnosis of nosocomial candidiasis, over a 20-month period. RESULTS: A rate for nosocomial infections by Candida spp. of 5 per 1000 admissions, proportional mortality of 14.4% and lethality of 53.8% were determined. The patient age ranged from 29 days to 82 years-old, among which, 74.7% were adults and 25.3% children. The intensive care units contributed with the highest number of cases of infection by Candida spp. (69.2%). The most important underlying disease was gastrointestinal tract disease (11%). Prematurity and low birth weight were the most important risk factors among newborns. The use of antibiotics, invasive procedures, H(2) blockers, multiple blood transfusions and stay length of ≥21 days were the most frequent risk factors among adults. Candida albicans was the most common species in all cases. CONCLUSIONS: In this study, C. albicans was the most frequently detected species in candidiasis and risk factors increased the susceptibility of hospitalized patients to acquiring a nosocomial infection by Candida spp.

Species of Candida isolated from anatomically distinct sites in military personnel in Cuiabá, Mato Grosso, Brazil.

BACKGROUNDS: Some fungi are natural inhabitants of the human body but may result in disease when conditions are conducive to their development. Yeast infections are common and often occur in the skin and mucous membranes; however emerging species have changed this epidemiological profile. The ability to colonize different anatomical sites has been associated with the pathogenicity of Candida when environmental conditions are particularly favorable. In the case of hot, humid climates, the attrition suffered by the skin and weakened immune defenses may result in yeasts becoming pathogenic rather than commensal organisms. OBJECTIVE: The objective of this study was to diagnose yeast infections in military personnel and to evaluate the frequency of these infections in the individuals evaluated. METHODS: The clinical material analyzed was seeded in duplicate in Sabouraud dextrose agar (Difco™) and Mycosel medium (Difco™). The etiological agents were identified by observing the germ tubes, microculture and physiological characteristics, assimilation of carbon sources (auxanogram) and fermentation of carbon sources (zymogram). RESULTS: Of a total of 197 patients evaluated, 91 (46.2%) had episodes of candidiasis. The genitocrural region was the most commonly affected area (47.7%) followed by the interdigital regions (between the toes or fingers) (27.8%). Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata and emergent species such as Candida krusei and Candida guilliermondii were found. CONCLUSIONS: In the work environment, having to use shoes and uniforms for extended periods of time, in addition to stress and perspiration, were considered predisposing factors for the development of fungal infections.

Leveduras do gênero Candida isoladas de sítios anatomicamente distintos de profissionais militares em Cuiabá (MT), Brasil / Species of Candida isolated from anatomically distinct sites in military personnel in Cuiabá, Mato Grosso, Brazil

FUNDAMENTOS: Alguns fungos são habitantes do organismo humano e podem vir a causar alguma doença, quando há condições propícias para seu desenvolvimento. Infecções por leveduras são comuns e frequentes em pele e mucosas; contudo, espécies emergentes têm alterado o perfil epidemiológico. A habilidade de colonizar diversos sítios anatômicos tem sido associada à patogenicidade do gênero Candida, quando as condições ambientais são particularmente favoráveis. No caso de climas quentes e úmidos, os atritos sofridos pela pele ou as defesas imunitárias debilitadas podem fazer com que as leveduras deixem de ser comensais para se tornarem organismos patógenos. OBJETIVO: Diagnosticar candidíases em profissionais militares e avaliar a frequência dessas infecções nesses indivíduos. MÉTODOS: Os materiais clínicos analisados foram semeados em duplicata nos meios Sabouraud Dextrose-ágar (Difco) e Mycosel (Difco). Identificaram-se os agentes etiológicos por meio da observação de tubo germinativo, microcultivo e caracteres fisiológicos, assimilação de fontes de carbono (auxanograma) e fermentação de fontes de carbono (zimograma). RESULTADOS: De um total de 197 pacientes estudados, 91 (46,2 por cento) apresentaram quadros clínicos de candidíases. A região genitocrural foi considerada a mais acometida (47,7 por cento), seguida pelas regiões interdactilares (mãos e pés, 27,8 por cento). C. albicans, C. parapsilosis, C. tropicalis, C. glabrata e espécies emergentes, como C. krusei e C. guilliermondii, foram identificadas. CONCLUSÃO: No ambiente de trabalho, o uso de calçados e de uniformes por longos períodos de tempo, associado ao estresse e à sudorese, foi considerado fator predisponente para o desenvolvimento das infecções fúngicas.

BACKGROUNDS: Some fungi are natural inhabitants of the human body but may result in disease when conditions are conducive to their development. Yeast infections are common and often occur in the skin and mucous membranes; however emerging species have changed this epidemiological profile. The ability to colonize different anatomical sites has been associated with the pathogenicity of Candida when environmental conditions are particularly favorable. In the case of hot, humid climates, the attrition suffered by the skin and weakened immune defenses may result in yeasts becoming pathogenic rather than commensal organisms. OBJECTIVE: The objective of this study was to diagnose yeast infections in military personnel and to evaluate the frequency of these infections in the individuals evaluated. METHODS: The clinical material analyzed was seeded in duplicate in Sabouraud dextrose agar (Difco™) and Mycosel medium (Difco™). The etiological agents were identified by observing the germ tubes, microculture and physiological characteristics, assimilation of carbon sources (auxanogram) and fermentation of carbon sources (zymogram). RESULTS: Of a total of 197 patients evaluated, 91 (46.2 percent) had episodes of candidiasis. The genitocrural region was the most commonly affected area (47.7 percent) followed by the interdigital regions (between the toes or fingers) (27.8 percent). Candida albicans, Candida parapsilosis, Candida tropicalis, Candida glabrata and emergent species such as Candida krusei and Candida guilliermondii were found. CONCLUSIONS: In the work environment, having to use shoes and uniforms for extended periods of time, in addition to stress and perspiration, were considered predisposing factors for the development of fungal infections.