Objective To analyze the profile of patients with microorganisms resistant to carbapenems, and the prevalence of the enzyme Klebsiella pneumoniae carbapenemase in interobacteriaceae.Methods Retrospective descriptive study. From the isolation in bacteriological tests ordered by clinicians, we described the clinical and epidemiological characteristics of patients with enterobacteria resistants to carbapenems at a university hospital, between March and October 2013.Results We included 47 isolated patients in this study, all exhibiting resistance to carbapenems, including 9 patients who were confirmed as infected/colonized with K. pneumoniae carbapenemase. Isolation in tracheal aspirates (12; 25.5%) predominated. The resistance to ertapenem, meropenem, and imipenem was 91.5%, 83.0% and 80.0%, respectively. Aminoglycosides was the class of antimicrobials that showed the highest sensitivity, 91.5% being sensitive to amikacin and 57.4% to gentamicin.Conclusion The K. pneumoniae carbapenemase was an important agent in graun isotaling in hospital intection. The limited therapeutic options emphasize the need for rapid laboratory detection, as well as the implementation of measures to prevent and control the spread of these pathogens.

The emergence of Extended-Spectrum Beta-Lactamase (ESBL)-producing microorganisms in Brazilian hospitals is a challenge that concerns scientists, clinicians and healthcare institutions due to the serious risk they pose to confined patients. The goal of this study was the detection of ESBL production by clinical strains of Escherichia coli and Klebsiella sp. isolated from pus, urine and blood of patients at Hospital Universitário Santa Maria, Rio Grande Sul, RS, Brazil and the genotyping of the isolates based on bla SHV genes. The ESBL study was carried out using the Combined Disc Method, while Polymerase Chain Reaction (PCR) was used to study the bla SHV genes. Of the 90 tested isolates, 55 (61.1%) were identified as ESBL-producing by the combined disk method. The bla SHV genes were found in 67.8% of these microorganisms. K. pneumoniae predominated in the samples, presenting the highest frequency of positive results from the combined disk and PCR.

This paper reports a case of peritonitis by Nocardia asteroides during continuous ambulatory peritoneal dialysis in a man who had systemic lupus erythematous and chronic renal failure. Diagnosis was established by microscopic examination (Gram and Kinyoun) and culture of centrifuged dialysis fluid and the patient was treated with Trimethoprin-Sulfamethoxazole by intraperitoneal route.

This paper reports a case of a single subcutaneous nodule caused by Pseudallescheria boydii in a renal transplant recipient, possibly of nontraumatic origin. The patient was treated surgically and with itraconazole.

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This paper reports a case of cutaneous infection of nontraumatic origin caused by Nocardia asteroides in a hospitalized patient with chronic obstructive pulmonary disease. Diagnosis was established by direct and histological examination, cultures from exudate and biopsy specimen. We discuss the classification of clinical forms of Nocardia infections affecting the skin.

CONTEXT: Staphylococcal scalded skin syndrome is an exfoliative skin disease. Reports of this syndrome in newborns caused by methicillin-resistant Staphylococcus aureus are rare but, when present, rapid diagnosis and treatment is required in order to decrease morbidity and mortality. CASE REPORT: A premature newly born girl weighing 1,520 g, born with a gestational age of 29 weeks and 4 days, developed staphylococcal scalded skin syndrome on the fifth day of life. Cultures on blood samples collected on the first and fourth days were negative, but Pseudomonas aeruginosa and Enterococcus sp. (vancomycin-sensitive) developed in blood cultures performed on the day of death (seventh day), and Pseudomonas aeruginosa and Serratia marcescens were identified in cultures on nasopharyngeal, buttock and abdominal secretions. In addition to these two Gram-negative bacilli, methicillin-resistant Staphylococcus aureus was isolated in a culture on the umbilical stump (seventh day). The diagnosis of staphylococcal scalded skin syndrome was based on clinical criteria. RESUMO CONTEXTO:A síndrome da pele escaldada estafilocócica é uma doença esfoliativa de pele. São raros os relatos desta síndrome causada por Staphylococcus aureus resistente à meticilina em neonatos, mas, quando presentes, exigem diagnóstico e tratamento rápidos para diminuir a morbidade e mortalidade. RELATO DE CASO: Uma menina recém-nascida prematura, pesando 1.520 g ao nascimento, com idade gestacional de 29 semanas e 4 dias, desenvolveu síndrome da pele escaldada estafilocócica no quinto dia de vida. As culturas de sangue coletadas no primeiro e quarto dias foram negativas, mas houve desenvolvimento de Pseudomonas aeruginosa e Enterococcus sp. (vancomicina sensível) na hemocultura realizada no dia do óbito (sétimo dia) e Pseudomonas aeruginosa e Serratia marcescens foram identificadas nas culturas de secreção da nasofaringe, nádega e da secreção abdominal. Na cultura do coto umbilical (sétimo dia), além desses dois bacilos Gram-negativos, foi isolado o Staphylococcus aureus resistente à meticilina. O diagnóstico da síndrome da pele escaldada estafilocócica foi baseado em critério clínico.

RESUMO:Foram estudadas 73 cepas de Staphylococcus aureus que apresentaram resistência à oxacilina e/ou cefoxitina na metodologia convencional e automação, isoladas no Hospital Universitário de Santa Maria no ano de 2008. O perfil de sensibilidade frente aos antimicrobianos foi avaliado através da difusão do disco e automação. Para o antimicrobiano vancomicina, foi realizada também a metodologia de microdiluição em caldo. Os isolados clínicos apresentaram resistência superior a 75% aos agentes βlactâmicos, macrolídeos, aminoglicosídeos, lincosamidas e quinolonas e sensibilidade de 73,97% ao sulfametoxazoltrimetoprima. Houve 100% de sensibilidade à linezolida, daptomicina e vancomicina. Na detecção dos MRSA, o disco de oxacilina detectou um número maior de cepas resistentes comparado ao de cefoxitina. A automação teve desempenho equivalente ao disco de oxacilina. A associação de duas metodologias, automação e disco de oxacilina, pode constituir uma boa alternativa a ser adotada na rotina laboratorial.Descritores: Staphylococcus aureus; Oxacilina; Cefoxitina. ABSTRACT:We studied 73 strains of Staphylococcus aureus that presented resistance to oxacillin and cefoxitin in the conventional methodology and automation, isolated at the University Hospital of Santa Maria in 2008. The sensitivity profile to antimicrobials was valued by disc diffusion (DD) and automation (Au). For the antibiotic vancomycin, the methodology of microdilution in broth was also done. The clinical isolates presented resistance superior to more than 75% βlactam agents, macrolides, aminoglycosides, lincosamides and quinolones and sensibility of 73.97% to trimethoprimsulfamethoxazole. There was 100% of sensibility to linezolid, daptomycin, and vancomycin. In the detection of MRSA, the oxacillin disc detected a greater number of resistant strains compared to cefoxitin. The automation had performance equivalent to the oxacillin disc. The combination of both methodologies, automation and oxacillin disc, can be a good alternative to be adopted in routine laboratory.Descriptors: Staphylococcus aureus; Oxacillin; Cefoxitin.