Invasive Meningococcal X Disease during the COVID-19 Pandemic, Brazil.

Invasive meningococcal disease persists as a fulminant disorder worldwide. Although cases caused by Neisseria meningitidis serogroup X (MenX) occur infrequently, outbreaks have been reported in countries in Africa in recent decades. We report 2 cases of MenX invasive meningococcal disease in São Paulo, Brazil, in 2021 and 2022, during the COVID-19 pandemic.

Quality of dialysis water and dialysate in haemodialysis centres: Highlight for occurrence of non-fermenting gram-negative bacilli.

AIMS: To evaluate the physicochemical and microbiological quality of dialysis water and dialysate samples from haemodialysis centres. METHODS AND RESULTS: Samples were fortnightly collected from three haemodialysis centres in Bauru City, Brazil, between July 2017 and June 2018, at the stages of post-reverse osmosis, reuse and dialysate. Analyses included determination of conductivity, fluoride, nitrate and sulphate; test for total coliform bacteria; count of heterotrophic bacteria; count and identification of non-fermenting gram-negative bacilli (NFGNB); drug susceptibility test; biofilm formation capacity; and genetic similarity among some isolated NFGNB. Of the analysed samples, only 4/72 (5.6%) had conductivity values ≥10 mS/cm, 4/216 (1.9%) presented total coliforms and 1/216 (0.5%) had heterotrophic bacteria count >100 CFU/ml. NFGNB were isolated from 99/216 (45.8%) samples, and the major identified micro-organisms included Herbaspirillum aquaticum/huttiense, Brevundimonas aurantiaca, Cupriavidus metallidurans, Pseudomonas aeruginosa and Ralstonia insidiosa. Isolates of P. aeruginosa and Burkholderia cepacia complex were sensitive to most antimicrobials and, together with isolates of Ralstonia insidiosa and Ralstonia pickettii, showed strong biofilm formation capacity. Some isolates expressed the same electrophoretic profile on pulsed-field gel electrophoresis, indicating the persistence of bacterial clones in the systems over time. CONCLUSIONS: NFGNB were observed in several dialysis water and dialysate samples from all investigated centres, which may represent a risk to the health of patients. SIGNIFICANCE AND IMPACT OF THE STUDY: Regular inclusion of actions for NFGNB control and monitoring in haemodialysis fluids are suggested for greater safety of the dialytic process.

Emergence of MDR invasive Neisseria meningitidis in El Salvador, 2017-19.

BACKGROUND: Invasive meningococcal disease (IMD) is an acute, highly transmissible and potentially fatal disease caused by Neisseria meningitidis. Prompt antimicrobial therapy and prophylaxis are recommended, where penicillin or ciprofloxacin are the available choices. However, the emergence of resistant isolates of N. meningitidis poses a challenge for antimicrobial therapy. OBJECTIVES: To describe the clinical, epidemiological and biological characteristics of six penicillin- and ciprofloxacin-resistant, culture-confirmed IMD cases reported in El Salvador, Central America, between 2017 and 2019. METHODS: Following the detection of six patients presenting with IMD in El Salvador, clinical data were collected and epidemiological action plans conducted. Isolates were subjected to antimicrobial susceptibility testing by broth microdilution and WGS for genotyping and molecular characterization analysis, including phylogeny comparison with global sequences available from public databases. RESULTS: A total of six IMD cases caused by N. meningitidis serogroup Y, resistant to both penicillin (MIC >8.0 mg/L) and ciprofloxacin (MIC 0.125 mg/L), were detected from 2017 to 2019. Genomic analysis showed that penicillin resistance was mediated by the production of ß-lactamase ROB-1. Ciprofloxacin resistance was attributed to an amino acid substitution in DNA gyrase (T91I). All isolates were classified as ST3587, clonal complex 23, and were genetically highly similar, based on core-genome SNP analysis. CONCLUSIONS: To the best of our knowledge, we report the first cases of MDR N. meningitidis causing IMD in Latin America. Our findings highlight the emergence of this potential public health threat, with a profound impact on the efficacy of IMD treatment and prophylaxis protocols.

Upward Gaze Palsy: a Valuable Sign to Distinguish Spinocerebellar Ataxias.

Spinocerebellar ataxias (SCAs) represent a large group of heredodegenerative diseases, with great phenotypic and genotypic heterogeneity. However, in the clinical neurological practice, some symptoms and signs might help differentiate the SCAs. This study's aims were to evaluate the frequency of upward gaze palsy (UGP) and investigate its role in assisting in the clinical differentiation of SCAs. We included 419 patients with SCAs (248 with SCA3, 95 with SCA10, 38 with SCA2, 22 with SCA1, 12 with SCA7, and 4 with SCA6). This study compared UGP with other known markers of disease severity-age of onset, disease duration, SARA score, and size of CAG expansion, and also other semiologic features, as bulging eyes. This sign was significantly more prevalent in SCA3 (64.11%), compared with SCA10 (3.16%; p < 0.001) and other SCAs (SCA1, SCA2, SCA7-11.84%; p < 0.001). UGP showed very high sensibility ins SCA3 (92.9), although lacking of specificity (64.1%). The odds ratio (OR) of UGP were also very high, 23.52 (95% CI 12.38-44.69), and was significantly correlated with larger CAG expansions, age, and disease duration in SCA3 patients, but not with age of onset or severity of the ataxic syndrome. This study showed that UGP is highly suggestive of SCA3 and has high sensitivity for the differential diagnosis among SCAs, and it could be of great value for bedside semiologic tool.

Sleep disorders in spinocerebellar ataxia type 10.

As sleep disturbances have been reported in spinocerebellar ataxias (SCAs), including types SCA1, SCA2, SCA3, SCA6 and SCA13, identification and management of these disturbances can help minimise their impact on SCA patients' overall body functions and quality of life. To our knowledge, there are no studies that investigate sleep disturbances in SCA10. Therefore, the aim of this study was to assess sleep disturbances in patients with SCA10. Twenty-three SCA10 patients and 23 healthy controls were recruited. Patients were evaluated in terms of their demographic and clinical data, including disease severity (Scale for the Assessment and Rating of Ataxia, SARA) and excessive daytime sleepiness (Epworth Sleepiness Scale, ESS), and underwent polysomnography. SCA10 patients had longer rapid eye movement (REM) sleep (p = .04) and more REM arousals than controls (p< .0001). There was a correlation of REM sleep onset with the age of onset of symptoms (r = .459), and with disease duration (r = -.4305). There also was correlation between the respiratory disturbance index (RDI) and SARA (r = -.4013), and a strong indirect correlation between arousal index and age at onset of symptoms (r = -.5756). In conclusion, SCA10 patients had sleep abnormalities that included more REM arousals and higher RDI than controls. Our SCA10 patients had sleep disorders related to shorter disease duration and lower severity of ataxia, in a pattern similar to that of other neurodegenerative diseases.

A prospective study of treatment of carbapenem-resistant Enterobacteriaceae infections and risk factors associated with outcome.

BACKGROUND: To describe the clinical and microbiological data of carbapenem-resistant Enterobacteriaceae (CRE) infections, the treatment used, hospital- and infection-related mortality, and risk factors for death. METHODS: A prospective cohort conducted from March 2011 to December 2012. Clinical, demographic, and microbiological data such as in vitro sensitivity, clonality, carbapenemase gene mortality related to infection, and overall mortality were evaluated. Data were analyzed using Epi Info version 7.0 (CDC, Atlanta, GA, USA) and SPSS (Chicago, IL, USA). RESULTS: One hundred and twenty-seven patients were evaluated. Pneumonia, 52 (42 %), and urinary tract infections (UTI), 51 (40.2 %), were the most frequent sites of infection. The isolates were polyclonal; the Bla KPC gene was found in 75.6 % of isolates, and 27 % of isolates were resistant to colistin. Mortality related to infection was 34.6 %, and was higher among patients with pneumonia (61.4 %). Combination therapy was used in 98 (77.2 %), and monotherapy in 22.8 %; 96.5 % of them were UTI patients. Shock, age, and dialysis were independent risk factors for death. There was no difference in infection-related death comparing colistin-susceptible and colistin-resistant infections (p = 0.46); neither in survival rate comparing the use of combination therapy with two drugs or more than two drugs (p = 0.32). CONCLUSIONS: CRE infection mortality was higher among patients with pneumonia. Infections caused by colistin-resistant isolates did not increase mortality. The use of more than two drugs on combination therapy did not show a protective effect on outcome. The isolates were polyclonal, and the bla KPC gene was the only carbapenemase found. Shock, dialysis, and age over 60 years were independent risk factors for death.

Cytotoxicity and genotoxicity of natural resin-based experimental endodontic sealers.

OBJECTIVES: The development of endodontic sealers based on natural resins seems to be promising, given their improved biological properties. This study evaluated the cytotoxic and genotoxic effects of two experimental root canal sealers, based on extracts from Copaifera multijuga and Ricinus communis (castor oil polymer), comparing them to synthetic resin-based sealers: a single methacrylate-based, a multi-methacrylate-based, and an epoxy resin-based sealers. MATERIALS AND METHODS: Sealers were prepared, set, and exposed to cell culture medium for 24 h at 37 °C with CO2. V79 cells were exposed to serial dilutions of the extracts of each sealer for 24 h. Cell viability was measured by the MTT assay and genotoxicity was assessed by the formation of micronuclei. RESULTS: The single methacrylate-based sealer had the most cytotoxic effects, with significant reduction in cell viability in all dilutions of the extract. The castor oil polymer-based sealer was, on the other hand, the most biocompatible sealer, with no cytotoxic effects at any concentration. All tested sealers were not genotoxic, excepting the single methacrylate-based sealer. CONCLUSIONS: The tested natural resin-based sealers presented low cytotoxic and no genotoxic effects on cell cultures. CLINICAL RELEVANCE: These results may suggest a good alternative to develop new endodontic sealers, in order to achieve better biological response and healing, when compared to commercially available sealers.

Effectiveness and biological compatibility of different generations of dentin adhesives.

OBJECTIVES: Besides possessing good mechanical properties, dental materials should present a good biological behavior and should not injure the involved tissues. Bond strength and biocompatibility are both highly significant properties of dentin adhesives. For that matter, these properties of four generations of adhesive systems (Multi-Purpose/Single Bond/SE Plus/Easy Bond) were evaluated. MATERIALS AND METHODS: Eighty bovine teeth had their dentin exposed (500- and 200-µm thickness). Adhesive was applied on the dentin layer of each specimen. Following that, the microshearing test was performed for all samples. A dentin barrier test was used for the cytotoxicity evaluation. Cell cultures (SV3NeoB) were collected from testing materials by means of 200- or 500-µm-thick dentin slices and placed in a cell culture perfusion chamber. Cell viability was measured 24 h post-exposition by means of a photometrical test (MTT test). RESULTS: The best bonding performance was shown by the single-step adhesive Easy Bond (21 MPa, 200 µm; 27 MPa, 500 µm) followed by Single Bond (15.6 MPa, 200 µm; 23.4 MPa, 500 µm), SE Plus (18.2 MPa, 200 µm; 20 MPa, 500 µm), and Multi-Purpose (15.2 MPa, 200 µm; 17.9 MPa, 500 µm). Regarding the cytotoxicity, Multi-Purpose slightly reduced the cell viability to 92% (200 µm)/93% (500 µm). Single Bond was reasonably cytotoxic, reducing cell viability to 71% (200 µm)/64% (500 µm). The self-etching adhesive Scotchbond SE decreased cell viability to 85% (200 µm)/71% (500 µm). Conversely, Easy Bond did not reduce cell viability in this test, regardless of the dentin thickness. CONCLUSIONS: Results showed that the one-step system had the best bond strength performance and was the least toxic to pulp cells. In multiple-step systems, a correct bonding technique must be done, and a pulp capping strategy is necessary for achieving good performance in both properties. CLINICAL RELEVANCE: The study showed a promising system (one-step self-etching), referring to it as a good alternative for specific cases, mainly due to its technical simplicity and good biological responses.

Successful Non-Surgical Root Canal Treatment on Auto-Transplanted Maxillary Premolar with Apical Periodontitis.

Auto-transplantation is a procedure that replaces traumatized or congenitally missing teeth. While most auto-transplanted teeth are successfully integrated into recipient sites, the donor tooth may develop apical periodontitis, causing early failure. In the present case report, the periodontic resident performed the procedure on a 15-year-old male by selecting donor teeth #4 and #13 and transplanting them at recipient sites #29 and #20, respectively. After 6 weeks, the patient was referred to the endodontic resident for evaluation of tooth #20 due to symptom development. While one auto-transplanted tooth (donor tooth #4, recipient site #29) was successfully integrated, the other (donor tooth #13, recipient site #20) was unsuccessful: the patient was diagnosed with pulp necrosis and a chronic apical abscess. Because of the patient's age, collaboration among periodontic, endodontic, and orthodontic residents/specialists informed the clinical decision to pursue non-surgical root canal treatment (NSRCT) rather than extraction. The canal was cleaned and shaped to a size #80 using copious irrigation of 2.5% sodium hypochlorite (NaOCl), followed by 17% ethylenediaminetetraacetic acid (EDTA) via the EndoVac Negative Pressure Irrigation system. The tooth was dried with paper points, and then calcium hydroxide was mixed with 2.5% NaOCl and placed with an amalgam carrier 2 mm from the radiographic apex. The tooth was next temporized with Teflon tape and Fuji TRIAGE. Four weeks later, after confirming the patient was asymptomatic and tooth mobility had decreased, the canal was obturated using EndoSequence Bioceramic Root Repair Material Fast Set Putty in 2 mm incremental layers to achieve a three-dimensional fill and create an apical plug to prevent gutta-percha extrusion, then backfilled in incremental layers of gutta-percha to the cementoenamel junction (CEJ). At the 8-month follow-up, the patient was asymptomatic, and the periodontal ligament (PDL) had no signs of periapical pathology. When teeth undergoing auto-transplantation procedures develop apical periodontitis, NSRCT can be implemented.

Molecular characterization of persistent subclinical mastitis-causing Staphylococcus aureus from dairy farms.

The study aimed to evaluate the genetic diversity of Staphylococcus aureus causing subclinical mastitis (SM) isolated from dairy cows and to assess the effect of the infection status (transient vs. persistent) on the milk and component yield. A total of six dairy farms in São Paulo state were used for the selection of cows with SM caused by S. aureus. S. aureus strains (n = 56) obtained from three biweekly aseptic mammary quarter milk samplings (n = 1140 from 95 cows) were subjected to MALDI-TOF MS analysis for species confirmation and further PFGE analysis. Intramammary infections (IMI) caused by S. aureus were categorized as transient (T: when only one out of 3 milk samplings had positive isolation of any pulsotype) or persistent (P: when two (P2) or three (P3) milk samplings had positive isolation of identical pulsotype over the consecutive episodes of SM. The SmaI macrorestriction fragment profiles of 56 S. aureus isolates showed a dominant S. aureus clonal pattern (PFGE type A; n = 50; 89.3%) within and among the herds. The SM-causing S. aureus represented a reduction of quarter milk yield of 26.2% in transient and 54.8% in persistent cases as well as a reduction of total solid yield of 38.1% and 49.4%, respectively, when compared with the healthy control quarters. Overall, the greater chance of S. aureus to be persistent is when a dominant clonal pattern is present in the herd which consequently may be associated with the cause of accentuated milk loss.

Oxacillin resistance and antimicrobial susceptibility profile of Staphylococcus saprophyticus and other staphylococci isolated from patients with urinary tract infection.

BACKGROUND: Staphylococcus saprophyticus is the second most frequent community-acquired causative agent of urinary tract infection (UTI). The objective of this study was to evaluate the susceptibility profile and resistance detection in Staphylococcus species. isolated from patients with UTI. MATERIALS AND METHODS: The isolates were investigated using the disk diffusion method, Vitek I system, E-test®, and detection of the mecA gene. RESULTS: Most isolates (76.2%) were resistant to oxacillin by the disk diffusion method, followed by those resistant to penicillin (72.2%). The oxacillin disk diffusion method, E-test, and Vitek I method showed higher sensitivity (94.4%) and lower specificity (28.9, 26.5, and 24.0%, respectively) than the cefoxitin disk diffusion test (sensitivity: 83.5%, specificity: 85.5%) for the detection of oxacillin resistance. CONCLUSIONS: The large number of oxacillin-resistant isolates indicates that the breakpoint value recommended by the Clinical and Laboratory Standards Institute may overestimate oxacillin resistance in S. saprophyticus. Thus, changes in these guidelines are necessary for the correct detection of this resistance.

Microhardness and sealing ability of materials used for root canal perforations.

Root perforations may lead to a loss of integrity in the root and periodontium, violations of the biologic periodontal distance, and injuries to periodontal tissue. This study sought to analyze the effect of root canal biomechanical preparation on the microhardness and the marginal sealing ability of different materials used to treat root perforations. Standard root perforations were performed in 96 bovine incisors. The teeth were divided into four groups (n = 24), based on the material used to treat those teeth: Mineral trioxide aggregate (MTA) (Group 1), MTA protected with cyanoacrylate (Group 2), MTA protected with glass ionomer (GI) cement (Group 3), and castor oil bean (COB) cement (Group 4). After root perforations were closed, the root canals were prepared biomechanically and teeth were sectioned longitudinally. Microleakage and microhardness of sealed perforations were assessed; microleakage data were submitted to analysis of variance (ANOVA) testing, while microhardness data were submitted to Dunnet and Tukey tests (p < 0.05). Group 4 reported the lowest amount of microleakage (0.65 mm), followed by Group 3 (1.02 mm), Group 1 (1.14 mm), and Group 2 (1.30 mm); however, no difference was detected among the groups. Groups 1-3 demonstrated significantly higher microhardness values compared to COB. It was concluded that the chemical and mechanical agents used during root canal preparation did not affect the sealing procedures. Administering surface protection to MTA did not improve microhardness or sealing.

A Brazilian Inter-Hospital Candidemia Outbreak Caused by Fluconazole-Resistant Candida parapsilosis in the COVID-19 Era.

Horizontal transmission of fluconazole-resistant Candida parapsilosis (FRCP) through healthcare workers' hands has contributed to the occurrence of candidemia outbreaks worldwide. Since the first COVID-19 case in Brazil was detected in early 2020, hospitals have reinforced hand hygiene and disinfection practices to minimize SARS-CoV-2 contamination. However, a Brazilian cardiology center, which shares ICU patients with a cancer center under a FRCP outbreak since 2019, reported an increased FRCP candidemia incidence in May 2020. Therefore, the purpose of this study was to investigate an inter-hospital candidemia outbreak caused by FRCP isolates during the first year of the COVID-19 pandemic in Brazil. C. parapsilosis bloodstream isolates obtained from the cancer (n = 35) and cardiology (n = 30) centers in 2020 were submitted to microsatellite genotyping and fluconazole susceptibility testing. The ERG11 gene of all isolates from the cardiology center was sequenced and compared to the corresponding sequences of the FRCP genotype responsible for the cancer center outbreak in 2019. Unprecedentedly, most of the FRCP isolates from the cardiology center presented the same genetic profile and Erg11-Y132F mutation detected in the strain that has been causing the persistent outbreak in the cancer center, highlighting the uninterrupted horizontal transmission of clonal isolates in our hospitals during the COVID-19 pandemic.

Characterization of Uropathogenic Escherichia coli Reveals Hybrid Isolates of Uropathogenic and Diarrheagenic (UPEC/DEC) E. coli.

(1) Background: Pathogenic Escherichia coli are divided into two groups: diarrheagenic (DEC) and extraintestinal pathogenic (ExPEC) E. coli. ExPEC causing urinary tract infections (UTIs) are termed uropathogenic E. coli (UPEC) and are the most common cause of UTIs worldwide. (2) Methods: Here, we characterized 112 UPEC in terms of phylogroup, serotype, the presence of virulence factor-encoding genes, and antimicrobial resistance. (3) Results: The majority of the isolates were assigned into the phylogroup B2 (41.07%), and the serogroups O6 (12.5%) and O25 (8.9%) were the most frequent. Five hybrid UPEC (4.5%), with markers from two DEC pathotypes, i.e., atypical enteropathogenic (aEPEC) and enteroaggregative (EAEC) E. coli, were identified, and designated UPEC/aEPEC (one isolate) and UPEC/EAEC (four isolates), respectively. Three UPEC/EAEC harbored genes from the pap operon, and the UPEC/aEPEC carried ibeA. The highest resistance rates were observed for ampicillin (46.4%) and trimethoprim/sulfamethoxazole (34.8%), while 99.1% of the isolates were susceptible to nitrofurantoin and/or fosfomycin. Moreover, 9.8% of the isolates were identified as Extended Spectrum ß-Lactamase producers, including one hybrid UPEC/EAEC. (4) Conclusion: Our data reinforce that hybrid UPEC/DEC are circulating in the city of Botucatu, Brazil, as uropathogens. However, how and whether these combinations of genes influence their pathogenicity is a question that remains to be elucidated.

Genetic and Antimicrobial Resistance Profiles of Mammary Pathogenic E. coli (MPEC) Isolates from Bovine Clinical Mastitis.

Mammary pathogenic E. coli (MPEC) is one of the main pathogens of environmental origin responsible for causing clinical mastitis worldwide. Even though E. coli are strongly associated with transient or persistent mastitis and the economic impacts of this disease, the virulence factors involved in the pathogenesis of MPEC remain unknown. Our aim was to characterize 110 MPEC isolates obtained from the milk of cows with clinical mastitis, regarding the virulence factor-encoding genes present, adherence patterns on HeLa cells, and antimicrobial resistance profile. The MPEC isolates were classified mainly in phylogroups A (50.9%) and B1 (38.2%). None of the isolates harbored genes used for diarrheagenic E. coli classification, but 26 (23.6%) and 4 (3.6%) isolates produced the aggregative or diffuse adherence pattern, respectively. Among the 22 genes investigated, encoding virulence factors associated with extraintestinal pathogenic E. coli pathogenesis, fimH (93.6%) was the most frequent, followed by traT (77.3%) and ompT (68.2%). Pulsed-field gel electrophoresis analysis revealed six pulse-types with isolates obtained over time, thus indicating persistent intramammary infections. The genes encoding beta-lactamases detected were as follows: blaTEM (35/31.8%); blaCTX-M-2/blaCTX-M-8 (2/1.8%); blaCTX-M-15 and blaCMY-2 (1/0.9%); five isolates were classified as extended spectrum beta-lactamase (ESBL) producers. As far as we know, papA, shf, ireA, sat and blaCTX-M-8 were detected for the first time in MPEC. In summary, the genetic profile of the MPEC studied was highly heterogeneous, making it impossible to establish a common genetic profile useful for molecular MPEC classification. Moreover, the detection of ESBL-producing isolates is a serious public health concern.

Patients with Cervical Dystonia Demonstrated Decreased Cognitive Abilities and Visual Planning Compared to Controls.

BACKGROUND: Cervical dystonia (CD) involves clinical and motor manifestations, and visual and cognitive dysfunctions may also be frequent. OBJECTIVE: To evaluate functional vision, visual attention, and cognitive aspects in patients with CD compared with a control group. METHODS: Fifty patients with CD were assessed using the Useful Field of View Test (UFOV), the Mini Mental State Examination (MMSE), and the Trail Making Tests (TMT-A and TMT-B), and compared with an identical number of health controls matched by sex, age, and educational level. RESULTS: No differences were seen between the groups in terms of MMSE score (P = 0.481), but the CD patient group had poorer scores for the TMA-A (P = 0.004) and TMT-B (P = 0.004). For the UFOV subtests, a decrease was found for visual processing speed (P < 0.001), divided attention (P < 0.001), and selective attention (P = 0.001), as well as higher frequency in the categories with higher risk index in the UFOV test (P < 0.001). CONCLUSION: Patients with CD may exhibit decreased functional vision and visual attention, as well as higher risk in performing complex activities.

Environmental Clonal Spread of Azole-Resistant Candida parapsilosis with Erg11-Y132F Mutation Causing a Large Candidemia Outbreak in a Brazilian Cancer Referral Center.

Clonal outbreaks due to azole-resistant Candida parapsilosis (ARCP) isolates have been reported in numerous studies, but the environmental niche of such isolates has yet to be defined. Herein, we aimed to identify the environmental niche of ARCP isolates causing unremitting clonal outbreaks in an adult ICU from a Brazilian cancer referral center. C. parapsilosis sensu stricto isolates recovered from blood cultures, pericatheter skins, healthcare workers (HCW), and nosocomial surfaces were genotyped by multilocus microsatellite typing (MLMT). Antifungal susceptibility testing was performed by the EUCAST (European Committee for Antimicrobial Susceptibility Testing) broth microdilution reference method and ERG11 was sequenced to determine the azole resistance mechanism. Approximately 68% of isolates were fluconazole-resistant (76/112), including pericatheter skins (3/3, 100%), blood cultures (63/70, 90%), nosocomial surfaces (6/11, 54.5%), and HCW's hands (4/28, 14.2%). MLMT revealed five clusters: the major cluster contained 88.2% of ARCP isolates (67/76) collected from blood (57/70), bed (2/2), pericatheter skin (2/3), from carts (3/7), and HCW's hands (3/27). ARCP isolates were associated with a higher 30 day crude mortality rate (63.8%) than non-ARCP ones (20%, p = 0.008), and resisted two environmental decontamination attempts using quaternary ammonium. This study for the first time identified ARCP isolates harboring the Erg11-Y132F mutation from nosocomial surfaces and HCW's hands, which were genetically identical to ARCP blood isolates. Therefore, it is likely that persisting clonal outbreak due to ARCP isolates was fueled by environmental sources. The resistance of Y132F ARCP isolates to disinfectants, and their potential association with a high mortality rate, warrant vigilant source control using effective environmental decontamination.

Environmental persistence and virulence of Salmonella spp. Isolated from a poultry slaughterhouse.

Salmonella spp. is responsible for severe foodborne disease, and is one of the main agents involved in foodborne outbreaks worldwide. Contamination occurs mainly as a result of poultry and egg consumption since they can carry some serotypes pathogenic to humans. The aim of the study was to evaluate the persistence and pathogenic potential of Salmonella spp. (n = 40) isolated from poultry slaughterhouse mats, using adhesion and invasion assays, antimicrobial susceptibility by disc diffusion, and biofilm production as phenotypic tests and genotypic analyses. Polystyrene mats presented 3.2 times greater chance of isolating Salmonella than canvas mats. Besides, we observed resistance to tetracycline (17.5%), ampicillin (10%), cefotaxime (7.5%), trimethoprim-sulfamethoxazole (5%), and chloramphenicol (2.5%). All strains possessed the invA, sipB, sipD, ssaR, sifA, sitC, iroN, tolC, flgK, fljB, and flgL genes. The genes sopB and sipA were both present in 92.5% of the isolates, while sopD and spvB were observed in 90% and 32.5% of strains, respectively. All strains adhered to and invaded HeLa cells. Regarding biofilm production, 31 (77.5%) strains were able to produce biofilm on polystyrene microplates. Using PFGE, we detected the persistence of clones in the environment for up to 18 fromthe 20 weeks. The ability of these strains to produce a biofilm and thus persist in the environment and disperse through contact surfaces in the processing plant favors the contamination of food, aggravated by the pathogenic potential of these isolates demonstrated by their adhesion capacity, invasion and resistance to various antibiotic agents.