Dissemination of NDM-producing bacteria in Southern Brazil.

BACKGROUND: The dissemination of NDM-1 carbapenemases (New Delhi Metallo-ß-lactamase) is a global public health problem, mainly in developing countries. The aim of this study was to characterize the spread of NDM-producing bacteria in the Southern Brazilian states analyzing epidemiological, molecular, and antimicrobial susceptibility aspects. METHODS: A total of 10,684 carbapenem-resistant isolates of Enterobacterales, Pseudomonas spp. and Acinetobacter spp. obtained from several hospitals in eight cities in Southern Brazil were screened, and 486 NDM-producing bacteria were selected. RESULTS: The incidence varied from 0.5 to 77 cases/100.000 habitants. ST11, ST15, ST340 and ST674 were the most common in K. pneumoniae. A total of 5 plasmids were identified in one K. pneumoniae strain: Col440I, Col440II, IncFIA(HI1), IncFIB(K), IncFIB(pQil)/ IncFII(K), and IncR. CONCLUSIONS: The number of patients with NDM-producing bacteria has increased in Southern Brazil, whose gene is present in different plasmids, explaining the expansion of this enzyme.

The Experience of Implementing a National Antimicrobial Resistance Surveillance System in Brazil.

Antimicrobial resistance (AMR) is a major public health threat of global proportions, which has the potential to lead to approximately ten million deaths per year by 2050. Pressured by this wicked problem, in 2014, the World Health Organization launched a call for member states to share AMR data through the implementation of the Global Antimicrobial Resistance Surveillance System (GLASS), to appropriately scale and monitor the general situation world-widely. In 2017, Brazil joined GLASS and, in 2018, started its own national antimicrobial surveillance program (BR-GLASS) to understand the impact of resistance in the country. We compiled data obtained from the complete routine of three hospitals' microbiology labs during the year of 2018. This pilot data sums up to 200,874 antimicrobial susceptibility test results from 11,347 isolates. It represents 119 different microorganisms recovered from 44 distinct types of clinical samples. Specimens came from patients originating from 301 Brazilian cities, with 4,950 of these isolates from presumed Healthcare-Associated Infections (HAIs) and the other 6,397 community-acquired cases. The female population offered 58% of the collected samples, while the other 42% were of male origin. The urinary tract was the most common topography (6,372/11,347 isolates), followed by blood samples (2,072/11,347). Gram-negative predominated the bacterial isolates: Escherichia coli was the most prevalent in general, representing 4,030 isolates (89.0% of these from the urinary tract). Coagulase-negative Staphylococci were the most prevalent bacteria in blood samples. Besides these two species, the ESKAPE group have consolidated their prevalence. Regarding drug susceptibility results, 141,648 (70.5%) were susceptible, 9,950 (4.9%) intermediate, and 49,276 (24.5%) resistant. Acinetobacter baumannii was the most worrisome microorganism, with 65.3% of the overall antimicrobial susceptibility tests showing resistance, followed by ESBL-producing Klebsiella pneumoniae, with a global resistance rate of 59%. Although this is a pilot project (still limited to one state), this database shows the importance of a nation-wide surveillance program,[153mm][-12mm] Q14 especially considering it already had patients coming from 301 distinct counties and 18 different states. The BR-GLASS Program is an ongoing project that intends to encompass at least 95 hospitals distributed in all five geographical regions in Brazil within the next 5 years.

Sistema Gerenciador de Ambiente Laboratorial: relato de experiência de uma ferramenta transformadora para a gestão laboratorial e vigilância em saúde / Laboratory Environment Management System: account of an experience with a transformational tool for laboratory management and health surveillance

Objetivo: apresentar o relato da experiência de implantação do sistema Gerenciador de Ambiente Laboratorial (GAL) como ferramenta de monitoramento e controle de exames laboratoriais, essencial à gestão e ao acompanhamento dos programas de saúde pública brasileira. Métodos: o GAL foi proposto como ferramenta de monitoramento e controle de exames laboratoriais, essencial à gestão e ao acompanhamento dos programas de saúde pública brasileira. O relato foi elaborado a partir de pesquisa documental. Resultados: o GAL tem favorecido a comunicação da informação, fornecendo subsídios para a melhoria na divulgação dos resultados dos ensaios e exames diagnósticos e planos estratégicos na área de saúde. Conclusão: após a implantação do GAL, houve uma melhora substancial na forma de gestão da informação adotada pelos laboratórios de saúde pública.

Objective: to present a report on the experience of implanting the Laboratory Environment Management (GAL) system as a tool for monitoring and controlling laboratory tests. Methods: GAL has been proposed as a tool for monitoring and controlling laboratory tests, vital to the management and monitoring of public health programs in Brazil. The report was compiled from documentary research. Results: GAL has favoured the communication of information, providing input for improving the dissemination of assay and diagnostic test results as well as strategic plans for health. Conclusion: following GAL’s implantation, there has been a substantial improvement in information management by public health laboratories.