Potentially Pathogenic Multidrug-Resistant Escherichia coli in Lamb Meat.

Extended-spectrum cephalosporin (ESC) resistance remains a threat since ESC are important antimicrobials used to treat infections in humans and animals. Escherichia coli is an important source of ESC-resistance genes, such as those encoding extended-spectrum ß-lactamases (ESBLs). E. coli is a common commensal of lambs. Reports that contaminated food can be a source of ESC-resistant bacteria in humans and that ESBL-producing E. coli are found in sheep in Brazil led us to survey their presence in retail lamb meat. Twenty-five samples intended for human consumption were screened for ESC-resistant E. coli, and the isolates were characterized. IncI1-blaCTX-M-8 and IncHI2-blaCTX-M-2 were the main plasmids responsible for ESC resistance. The plasmids harbored common ESBL genes in Enterobacteriaceae from food-producing animals in Brazil. IncI1-blaCTX-M-14 and IncF-blaCTX-M-55 plasmids, associated with human infections, were also detected. Few CTX-M-producing E. coli have been clustered by typing methods, and some may be genetically pathogenic. The findings indicate the presence of diverse strains of E. coli, harboring important ESBL genes, in lamb meat in Brazil. Surveillance of ESC-resistant bacteria could reduce the spread of antimicrobial resistance through the food chain.

Tuberculose pulmonar e extrapulmonar em pacientes com AIDS sob uso da Terapia Antirretroviral (TARV) de terceira linha / Pulmonary and extrapulmonary tuberculosis in AIDS patients using third-line antiretroviral therapy (ART)

Objetivo: Esse estudo consistiu em realizar levantamento retrospectivo da prevalência de tuberculose pulmonar e extrapulmonar em indivíduos com AIDS em uso de antirretrovirais da terceira linha. Métodos: Foram inclusos nesse estudo prontuários de trezentos pacientes acima de 18 anos de idade, compreendidos entre intervalos de diagnóstico do HIV. Resultados: Dezessete pacientes acima de cinco anos de diagnóstico, desenvolveram Tuberculose na forma pulmonar e extrapulmonar. No período de 5 a 15 anos 7% dos pacientes desenvolveram tuberculose pulmonar e um paciente neurotuberculose. Dos pacientes com tempo de diagnóstico superior a 15 anos, 7% apresentaram forma pulmonar, e dois casos de TB extrapulmonar (miliar e abdominal). As morbidades não infecciosas observadas foram Hiperlipidemia Mista 23,52%, Hipotireoidismo 11,76% e Psicose Orgânica 5,88%. Conclusão: Os resultados deste levantamento indicam redução dos casos de tuberculose em pacientes com AIDS neste município, fato que pode ser decorrente da adesão TARV e status imunológico.

Objective: This study consisted of a retrospective survey of the prevalence of pulmonary and extrapulmonary tuberculosis in individuals with AIDS using third-line antiretrovirals. Methods: We included in this study medical records of three handred patients over 18 years of age, comprised between intervals of HIV diagnosis. Results: Seventeen patients over five years of diagnosis developed pulmonary and extrapulmonary tuberculosis. Within 5 to 15 years 7% of the patients developed pulmonary tuberculosis and one patient neurotuberculosis. Of the patients with a diagnosis of more than 15 years, 7% had pulmonary form, and two cases of extrapulmonary TB (miliary and abdominal). The non-infectious morbidities observed were Mixed Hyperlipidemia 23.52%, Hypothyroidism 11.76% and Organic Psychosis 5.88%. Conclusion: The results of this survey indicate a reduction in tuberculosis cases in AIDS patients in this municipality, a fact that may be due to ART adherence and immunological status.

Dissemination of Multidrug-Resistant Commensal Escherichia coli in Feedlot Lambs in Southeastern Brazil.

Antimicrobial resistance (AR) is a public health issue since it limits the choices to treat infections by Escherichia coli in humans and animals. In Brazil, the ovine meat market has grown in recent years, but studies about AR in sheep are still scarce. Thus, this study aims to investigate the presence of AR in E. coli isolated from lambs during feedlot. To this end, feces from 112 lambs with 2 months of age, after weaning, were collected on the first day of the animals in the feedlot (day 0), and on the last day before slaughtering (day 42). Isolates were selected in MacConkey agar supplemented with 4 mg/L of ceftiofur and identified by biochemical methods. Isolates were submitted to an antimicrobial susceptibility test by disc-diffusion and PCR to investigate genes for phylogenetic group, virulence determinants and resistance to the several antimicrobial classes tested. The genetic localization of the bla genes detected was elucidated by S1-PFGE followed by Southern blot-hybridizations. The isolates were typed by XbaI-PFGE and MLST methods. Seventy-eight E. coli were isolated from 8/112 (7.1%) animals on day 0, and from 55/112 (49.1%) animals on day 42. Since only fimH was present in almost all E. coli (97.4%) as a virulence gene, and also 88.5% belonged to phylogroups B1 or A, we consider that isolates represent intestinal commensal bacteria. The dendrogram separated the 78 non-virulent isolates in seven clusters, two of which comprised 50 E. coli belonging to ST/CC 1727/446 or ST 3994 recovered on day 42 commonly harboring the genotype bla CMY -2-aac(3)-IIa -tetA-sul1-sul2-floR-cmlA. Special attention should be given to the presence of bla CTX-M-15, a worldwide gene spread, and bla CTX-M-14, a hitherto undetected gene in Enterobacteriaceae from food-producing animals in Brazil. Importantly, E. coli lineages and plasmids carrying bla genes detected here have already been reported as sources of infection in humans either from animals, food, or the environment, which raises public health concerns. Hence, two types of commensal E. coli carrying important AR genes clearly prevailed during feedlot, but lambs are also reservoirs of bacteria carrying important AR genes such as bla CTX-M-14 and bla CTX-M-15, mostly related to antimicrobial treatment failure.