A 6-month prospective surveillance was conducted in the Department of General Surgery of the Rio de Janeiro University Hospital. Postoperative infections were classified according to CDC criteria. This study reports a significant rate (16.9%) in surgical infections detected by surveillance in a series where 45% of surgical interventions were classified as clean. The majority (52.7%) was apparent only after patient discharge from the hospital. Bacterial cultures were obtained from 42 out of 55 infected wounds. Staphylococcus aureus was the most frequently found pathogen (33.9%), followed by Escherichia coli (20.3%). With the exception of S. aureus isolates, multiresistance was found in 66% of coagulase-negative staphylococci and 60% of gram-negative bacteria. This study showed that community surveillance associated with hospital surveillance is necessary in order to determine accurate rates of surgical site infections, and also showed that the emergence of multiresistant bacterial strains was common among isolates of surgical infections.
The present study was designed to characterize beta-lactamase genes and evaluate polymerase chain reaction (PCR) typing for multidrug-resistant Pseudomonas aeruginosa pulsed-field gel electrophoresis (PFGE) genotype A isolates from Rio de Janeiro, Brazil, collected between April 1999 and March 2000 and one additional isolate collected in June 2002. As reported previously, all of the genotype A isolates produced non-characterized metallo-beta-lactamase. These isolates (22) were screened for the bla(SPM) gene by PCR and dot-blotting. Isolates were typed by PCR fingerprinting with primers RAPD-1, 272, 208, 1290, ERIC-1 and ERIC-2. The bla(SPM) gene was detected in 18 (82%) of the 22 isolates. PCR fingerprinting gave results that correlated with PFGE, except with primer 1290. In Rio de Janeiro and other Brazilian states, nearly all SPM-producing P. aeruginosa isolates belong to a single PFGE type accounting for a large proportion of drug-resistant P. aeruginosa hospital infections. RAPD PCR fingerprinting may be a useful technique to screen for an epidemic multidrug-resistant strain in Brazil.
Previous analysis of Pseudomonas aeruginosa class-1 integrons from Rio de Janeiro, Brazil, revealed the bla GES gene in one isolate. We screened isolates of two widespread PFGE genotypes, A and B, at a public hospital in Rio, for the presence of bla GES . The gene was detected in all seven P. aeruginosa isolates belonging to genotype B. Three of the seven genotype-B isolates were resistant to amikacin, aztreonam, ceftazidime, cefepime, ciprofloxacin, gentamicin, imipenem, meropenem, piperacillintazobactam and ticarcillin-clavulanic acid. The other four isolates were resistant to all these agents, except gentamicin, imipenem, meropenem and piperacillin-tazobactam. A synergistic effect between ceftazidime and imipenem or clavulanic acid suggested the production of GES-type ESBL. Key Words: Pseudomonas aeruginosa, bla GES , antibiotics, public hospital, Rio de Janeiro, Brazil.Extended spectrum beta-lactamases (ESBLs) are enzymes with the ability to inactivate extended-spectrum cephalosporins and monobactams [1]. Various ESBL-types have been found in Pseudomonas aeruginosa, but new types are still emerging, including an extended spectrum betalactamase, GES [2]. Clinical laboratory detection of ESBL producing P. aeruginosa is important, because ESBL may confer resistance to ceftazidime (CAZ), an antimicrobial agent widely prescribed for P. aeruginosa infections [3].GES-1 beta-lactamase was first detected in a Klebsiella pneumoniae isolate obtained in France in 1998 [2] from a child transferred from Cayenne, French Guiana. The gene, bla GES-1 , conferred an extended-spectrum cephalosporin resistance profile, including clavulanic acid (CA), tazobactam and imipenem (IPM) [2]. The bla GES-1 gene was subsequently detected in P. aeruginosa from France, [4] and in K. pneumoniae from Portugal [5], isolated between 1999 and 2001. A GES-1 producing P. aeruginosa isolate was also detected in São Paulo, Brazil in the SENTRY surveillance program [6]. A new variant, GES-2, was described in P. aeruginosa from South Africa, isolated in 2000 [7], with the ability to confer intermediate resistance to IPM. Two other ESBLs, IBC-1 and IBC-2, were included in the group of GES-type beta-lactamases due similarity in the amino acid sequences. IBC-1 was described in an Enterobacter cloacae clinical isolate and IBC-2 in a P. aeruginosa clinical isolate, both obtained in Greece between 1998 and 2000 [8-10]. A doubledisk synergy test with CAZ and IPM was able to identify 16 of 19 CAZ-resistant, bla IBC-1 -carrying E. cloacae isolates [9]. The bla GES and bla IBC genes were found as gene cassettes integrated into class-1 integrons. Two other types of the GES enzyme were described (GES-3 and GES-4) in Klebsiella pneumoniae isolates from Japan [11,12], also encoded by gene cassettes inserted into class-1 integrons located in plasmids.Between 1999 and 2000, we detected two multidrug-resistant pulsed-field gel electrophoresis (PFGE) P. aeruginosa genotypes, named A and B, among 115 clinical isolates obtained at Hospital Universitário Clementino Fraga...
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