Unusual association of NDM-1 with KPC-2 and armA among Brazilian Enterobacteriaceae isolates.

We report the microbiological characterization of four New Delhi metallo-ß-lactamase-1 (blaNDM-1)-producing Enterobacteriaceae isolated in Rio de Janeiro, Brazil. blaNDM-1 was located on a conjugative plasmid and was associated with Klebsiella pneumoniae carbapenemase-2 (blaKPC-2) or aminoglycoside-resistance methylase (armA), a 16S rRNA methylase not previously reported in Brazil, in two distinct strains of Enterobacter cloacae. Our results suggested that the introduction of blaNDM-1 in Brazil has been accompanied by rapid spread, since our isolates showed no genetic relationship.

Microbiological studies of abscesses complicating Bothrops snakebite in humans: a prospective study.

Forty patients with abscesses at the site of Bothrops bite were evaluated. Ten brought the snake responsible for the bite, Bothrops jararaca in all cases. On admission a sample was collected from each case for aerobic and anaerobic culture, and no abscesses drained spontaneously. None of the patients had received antibacterial therapy at this time. The bacteria most frequently isolated were Morganella morganii (23 patients), Providencia rettgeri (7) Enterobacter sp. (4), Escherichia coli (3), group D streptococcus (11) and Bacteroides sp. (6). All enterobacteria tested were sensitive to chloramphenicol, aminoglycosides and cefotaxime. Group D streptococci were sensitive to chloramphenicol, ampicillin and penicillin G, whereas anaerobic bacteria were sensitive to chloramphenicol and tetracycline. These results suggest that in cases of abscess formation secondary to Bothrops bite, chloramphenicol alone is a good choice, being both safe and cheap.

[Bacterial flora of the oral cavity, fangs and venom of Bothrops jararaca: possible source of infection at the site of bite]. / Flora bacteriana da cavidade oral, presas e veneno de Bothrops jararaca: possível fonte de infecção no local da picada.

Culture of fang, fang sheath and venom of fifteen healthy freshly captured Bothrops jararaca were analyzed. The bacteria most frequently encountered were group D streptococci (12 snakes), Enterobacter sp. (6), Providencia rettgeri (6), Providencia sp. (4), Escherichia coli (4), Morganella morganii (3) and Clostridium sp. (5). The bacteria observed are similar to those found in the abscesses from Bothrops bitten patients. Since these snake mouth bacteria may be inoculated during the snake bite, bacterial multiplication and infection may occur under favorable conditions.

Evaluation of antimicrobial schemes in episodes of fever and granulocytopenia in children with cancer

The efficacy of two antibiotic regimens used as initial empiric therapy was evaluated in 299 episodes of fever and granulocytopenia in children with cancer. Of these, 148 were treated with the combination cefoxitin-amikacin-carbenicillin and the remaining 151 with ceftriaxone-amikacin. All of the patients were evaluated at the beginning and 72 hours after starting treatment with laboratory tests and based on their clinical condition. Each was classified according to the type of infection. A few modifications were made to the initial treatment plan and in accordance with the clinical condition of each patient. Over 52% of the episodes were due to fever of unknown origin and 47.2% due to infections, of which 33.8% proved to be positive blood cultures mainly for Staphylococcus aureus and Pseudomonas aeruginosa. The modifications made to the basic treatment regimens were the addition of amphotericin B, clindamycin or vancomycin. An 89.2% therapeutic index percentage was obtained, independent from the use of either antibiotic scheme. The total therapeutic index for the study was 83.6%