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A fter the first description of NDM-1 carbapenemase in a Providencia rettgeri isolate in Brazil in February 2013 (1), the public hospital where this isolate was recovered began an active surveillance in search of asymptomatic carriers and in the hospital environment. Furthermore, a retrospective study of carbapenem-resistant isolates stored at that hospital since 2012 was performed. Six NDM-1-producing Enterobacter hormaechei subsp. oharae isolates, identified by the Vitek2 system and hsp60 genotyping, were recovered and characterized by phenotypic assays and molecular techniques, such as PCR and DNA sequencing (2, 3). One isolate (CCBH10892) was recovered from a rectal swab of a patient at the intensive care unit (ICU) in September 2012 (a time period prior to the isolation of NDM-positive P. rettgeri). The others were isolated from March to May 2013 from rectal swabs of patients (n ϭ 4) and a sink (n ϭ 1) located in the same ICU.Pulsed-field gel electrophoresis (PFGE) of XbaI-digested DNA (4) showed that all isolates belonged to the same clone; the isolates were considered to be multidrug resistant, as they were susceptible only to amikacin (MIC range of 8 to 16 mg/liter) and polymyxin B (MIC Յ 1 mg/liter) by the Etest method (Fig. 1). Besides bla NDM-1 , all these isolates carried bla CTX-M-15 , qnrB4, and aac(6)-Ib genes, detected by PCR and sequencing. Plasmid analysis by restriction digests with S1 nuclease and Southern blotting (5) showed that the bla NDM-1 and qnrB4 genes were located on the same plasmids, ranging in size from 420 to 490 kb (Fig. 1).To obtain a comprehensive in-depth view of the genetic structure surrounding the bla NDM-1 , bla CTX-M-15 , and qnrB4 genes, the genomic sequence of the CCBH10892 isolate was determined on an Illumina MiSeq system. A total of 1,149,470 reads (5,373,710 bp) were assembled with Geneious assembler (Biomatters) to generate 56 contigs. We found bla NDM-1 in a 94,795-bp contig flanked by a truncated ISAba125 sequence at the right boundary and by a bleomycin resistance gene (ble MBL ) at the left (GenBank accession number KF727591). This region shared 99% identity with the NDM region present in a plasmid carried by a Klebsiella pneumoniae isolate from Taiwan (6). In this contig, some conjugation and plasmid transfer genes and a replication protein gene belonging to the IncF group were also observed. However, this replicon could not be detected by the PCR-based replicon typing (PBRT) scheme (7).The qnrB4 gene was found in a 16,569-bp contig in which ISCR1 and genes encoding permeases (sapA, sapB, and sapC) and phage shock proteins (pspA, pspB, pspC, and pspD) and AmpC bla DHA-1 (GenBank accession number KF646592) were also observed. This same region has been reported in different plasmids of other bacterial species (8).bla was integrated into the chromosome associated with an upstream ISEcp1 element in a 277,989-bp contig (part of it is in the sequence available at GenBank accession number KF727590). This transposition unit was inserted into the flhC gene, which enc...

Greater public health attention should be given to prevent salmonellosis in the community and in hospital settings to reduce the rates of Typhimurium strains with multidrug resistance.

Leptospirosis is an endemic zoonotic disease in Brazil and is widespread throughout rural populations in the state of Rio Grande do Sul. This study aimed to identify presumptive infecting Leptospira serogroups in human and animal cases and describe their occurrences within the ecoregions of the state by animal species. Data for human and animal leptospirosis cases were gathered from the government’s passive surveillance systems and presumptive infecting serogroups were identified based on a two-fold titer difference in serogroups in the microscopic agglutination test (MAT) panel. A total of 22 different serogroups were reported across both human and animal cases. Serogroup Icterohaemorrhagiae was the most common among humans, while serogroup Sejroe predominated among animal cases, particularly bovines. Each ecoregion had a large distribution of cases, with 51% of the human cases in the Parana–Paraiba ecoregion, and 81% of the animal cases in the Savannah ecoregion. Identifying and mapping the serogroups circulating using the One Health approach is the first step for further understanding the distribution of the disease in the state. This study has the potential to aid in guiding public health and agricultural practices, furthering the need for a human vaccine in high-risk populations to complement control and prevention efforts.

BackgroundBetween November 2013 and June 2014, 56 cases of bacteremia (15 deaths) associated with the use of Total Parenteral Nutrition (TPN) and/or calcium gluconate (CG) were reported in four Brazilian states.MethodsWe analyzed 73 bacterial isolates from four states: 45 from blood, 25 from TPN and three from CG, originally identified as Acinetobacter baumannii, Rhizobium radiobacter, Pantoea sp. or Enterobacteriaceae using molecular methods.ResultsThe first two bacterial species were confirmed while the third group of species could not be identified using standard identification protocols. These isolates were subsequently identified by Multi-Locus Sequence Analysis as Phytobacter diazotrophicus, a species related to strains from similar outbreaks in the United States in the 1970’s. Within each species, TPN and blood isolates proved to be clonal, whereas the R. radiobacter isolates retrieved from CG were found to be unrelated.ConclusionThis is the first report of a three-species outbreak caused by TPN contaminated with A. baumannii, R. radiobacter and P. diazotrophicus. The concomitant presence of clonal A. baumannii and P. diazotrophicus isolates in several TPN and blood samples, as well as the case of one patient, where all three different species were isolated simultaneously, suggest that the outbreak may be ascribed to a discrete contamination of TPN. In addition, this study highlights the clinical relevance of P. diazotrophicus, which has been involved in outbreaks in the past, but was often misidentified as P. agglomerans.Electronic supplementary materialThe online version of this article (10.1186/s12879-018-3287-2) contains supplementary material, which is available to authorized users.