Assuntos
Infecção Hospitalar/microbiologia , Enterococcus faecium/isolamento & purificação , Microbiologia Ambiental , Infecções por Bactérias Gram-Positivas/microbiologia , Hospitais , Enterococos Resistentes à Vancomicina/isolamento & purificação , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Análise por Conglomerados , Enterococcus faecium/efeitos dos fármacos , Genótipo , Humanos , Testes de Sensibilidade Microbiana , Tipagem Molecular , Reação em Cadeia da Polimerase , Fatores de Virulência/genéticaRESUMO
More than 1,500 perirectal swab cultures and 552 environmental and equipment cultures were collected during the study period. Enterococcus faecium was the most frequent species isolated, being responsible for 71% of the positive cultures. Fifty infections were documented, with bloodstream infections (18, 36%) being the most frequent, followed by urinary tract infection (15, 30%). An educational intervention was given to 136 healthcare workers (HCWs), and a questionnaire regarding vancomycin-resistant enterococcus (VRE) transmission was also performed pre- and post-intervention. Overall, 858 opportunities of patient care were evaluated. The compliance with contact precautions did not improve; however, in general, the proportion of correct answers regarding VRE increased significantly when comparing pre- and post-intervention periods (p < 0.05). On the other hand, the proportion of environmental and equipment contaminated by VRE decreased significantly from pre- (23.2%) to post-intervention (8.2%) (p < 0.001) and was associated with a significant decrease in VRE infection from 7.7 to 1.9 when comparing the pre- and post-intervention periods. The use of vancomycin (defined daily dose [DDD]) did not change significantly over the study period (p = 0.970), and the use of teicoplanin increased (p < 0.001). Seventy-six percent of E. faecium belong to type and subtype A by pulsed-field gel electrophoresis (PFGE). This predominant type was found in the environment and caused colonization and infection. In conclusion, the present study showed that reduction of the proportion of environmental and equipment contamination was associated with a decrease of colonization and infection due to VRE, and that the strategy to control VRE dissemination should be based on local problems.
Assuntos
Infecção Hospitalar/epidemiologia , Infecção Hospitalar/microbiologia , Enterococcus/efeitos dos fármacos , Contaminação de Equipamentos , Infecções por Bactérias Gram-Positivas/epidemiologia , Controle de Infecções/métodos , Resistência a Vancomicina , Adulto , Idoso , Bacteriemia/epidemiologia , Bacteriemia/microbiologia , Bacteriemia/prevenção & controle , Portador Sadio/epidemiologia , Portador Sadio/microbiologia , Portador Sadio/prevenção & controle , Análise por Conglomerados , Infecção Hospitalar/prevenção & controle , Educação Médica Continuada , Eletroforese em Gel de Campo Pulsado , Enterococcus/classificação , Enterococcus/genética , Enterococcus/isolamento & purificação , Microbiologia Ambiental , Feminino , Genótipo , Infecções por Bactérias Gram-Positivas/microbiologia , Infecções por Bactérias Gram-Positivas/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Tipagem Molecular , Competência Profissional/estatística & dados numéricos , Inquéritos e Questionários , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia , Infecções Urinárias/prevenção & controleRESUMO
In this study, we report the characterization of a strain of Enterococcus faecium vanA, which grows only in the presence of vancomycin (VDEfm-UEL). The bacterium was isolated from the feces of a female patient who had undergone surgical treatment of Reinke’s edema and was receiving intravenous vancomycin therapy for infection with methicillin/oxacillin-resistant Staphylococcus aureus, a postoperative complication. Antimicrobial dependence was further confirmed by the vancomycin E-test. VDEfm-UEL was also shown to be resistant to ampicillin, ciprofloxacin, chloramphenicol, erythromycin, levofloxacin, penicillin, rifampicin, and teicoplanin. The putative virulence genes efaA, gelE and esp were detected by PCR. The ddl gene from VDEfm-UEL was cloned and sequenced. Vancomycin dependence seems to be associated with the insertion of a nucleotide in that sequence, which results in a frame-shift mutation, introducing a premature stop codon. This is the first report of vancomycin-dependent E. faecium isolation in a university hospital in Brazil.
Assuntos
Idoso , Feminino , Humanos , Antibacterianos/farmacologia , Enterococcus faecium/efeitos dos fármacos , Resistência a Vancomicina/genética , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Enterococcus faecium/genética , Enterococcus faecium/isolamento & purificação , Fezes/microbiologia , Mutação da Fase de Leitura/genética , Hospitais Universitários , Testes de Sensibilidade Microbiana , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Reação em Cadeia da PolimeraseRESUMO
In this study, we report the characterization of a strain of Enterococcus faecium vanA, which grows only in the presence of vancomycin (VDEfm-UEL). The bacterium was isolated from the feces of a female patient who had undergone surgical treatment of Reinke's edema and was receiving intravenous vancomycin therapy for infection with methicillin/oxacillin-resistant Staphylococcus aureus, a postoperative complication. Antimicrobial dependence was further confirmed by the vancomycin E-test. VDEfm-UEL was also shown to be resistant to ampicillin, ciprofloxacin, chloramphenicol, erythromycin, levofloxacin, penicillin, rifampicin, and teicoplanin. The putative virulence genes efaA, gelE and esp were detected by PCR. The ddl gene from VDEfm-UEL was cloned and sequenced. Vancomycin dependence seems to be associated with the insertion of a nucleotide in that sequence, which results in a frame-shift mutation, introducing a premature stop codon. This is the first report of vancomycin-dependent E. faecium isolation in a university hospital in Brazil.
Assuntos
Antibacterianos/farmacologia , Enterococcus faecium/efeitos dos fármacos , Resistência a Vancomicina/genética , Idoso , Infecção Hospitalar/microbiologia , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Enterococcus faecium/genética , Enterococcus faecium/isolamento & purificação , Fezes/microbiologia , Feminino , Mutação da Fase de Leitura/genética , Hospitais Universitários , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Reação em Cadeia da PolimeraseRESUMO
Escherichia coli strains isolated from 100 urine samples taken from patients with urinary tract infections (UTI) and from 20 normal fecal (NF) samples were examined for serum resistance, mannose-resistant hemagglutination of human erythrocytes (MRHA) and for production of aerobactin, hemolysis and colicin. Among the UTI E. coli strains, 79% produced aerobactin, 69% showed serum resistance, 44% produced MRHA, 32% were beta-hemolytic and 22% were colicinogenic. A greater proportion of UTI E. coli strains produced aerobactin, colicin V, beta-hemolysis and MRHA when compared to NF strains. Production of MR hemagglutins was significant correlated with that of aerobactin and hemolysin. These results suggest that the presence of aerobactin may be a significant etiological factor in UTI, and that the production of MR adhesins and of hemolysin also might contribute to the virulence of these strains
