OBJECTIVE:Enterobacteriaceae bacteria harboring Klebsiella pneumoniae carbapenemase are a serious worldwide threat. The molecular identification of these pathogens is not routine in Brazilian hospitals, and a rapid phenotypic screening test is desirable. This study aims to evaluate the modified Hodge test as a phenotypic screening test for Klebsiella pneumoniae carbapenemase.METHOD:From April 2009 to July 2011, all Enterobacteriaceae bacteria that were not susceptible to ertapenem according to Vitek2 analysis were analyzed with the modified Hodge test. All positive isolates and a random subset of negative isolates were also assayed for the presence of blaKPC. Isolates that were positive in modified Hodge tests were sub-classified as true-positives (E. coli touched the ertapenem disk) or inconclusive (distortion of the inhibition zone of E. coli, but growth did not reach the ertapenem disk). Negative results were defined as samples with no distortion of the inhibition zone around the ertapenem disk.RESULTS:Among the 1521 isolates of Enterobacteriaceae bacteria that were not susceptible to ertapenem, 30% were positive for blaKPC, and 35% were positive according to the modified Hodge test (81% specificity). Under the proposed sub-classification, true positives showed a 98% agreement with the blaKPC results. The negative predictive value of the modified Hodge test for detection was 100%. KPC producers showed high antimicrobial resistance rates, but 90% and 77% of these isolates were susceptible to aminoglycoside and tigecycline, respectively.CONCLUSION:Standardizing the modified Hodge test interpretation may improve the specificity of KPC detection. In this study, negative test results ruled out 100% of the isolates harboring Klebsiella pneumoniae carbapenemase-2. The test may therefore be regarded as a good epidemiological tool.

Resistance of microbes to commonly used antibiotics became a major concern at the end of the last century. Because Streptococcus pneumoniae is the most common pathogen in respiratory infections, we conducted microbiological assessment of drug susceptibility patterns among strains collected from two different population groups: 1) adult and pediatric patients (375 isolates) with different infections, and 2) healthy children in day care centers (< 5 years old; 350 isolates). High level resistance to penicillin was not identified in either group. Intermediate resistance levels were similar in both groups (adults: 9.9%; children: 9.2%). The Central West region of Brazil tended to have lower susceptibility of S.pneumoniae from infected adults and children to penicillin (81% vs. 93% in the South and 90% in the Southeast), tetracycline (64% vs. 80% and 76%), and trimethoprim/sulfamethoxazole (14% vs. 34%). Susceptibility was similar among strains from nasal cultures of healthy children tested in each of 4 regions of Brazil. All isolates were susceptible to cefaclor, cefotaxime and amoxacillin/clavulanate. This study, in two distinct populations, allowed characterization of local microbiological resistance patterns. This data is expected to be of use in guiding empiric therapy in the different regions of Brazil.

Polymyxins are one of most important antibiotics available for multidrug-resistant Gram-negative infections. Diverse chromosomal resistance mechanisms have been described, but the polymyxin resistance phenotype is not yet completely understood. The objective of this study was to characterize colistin resistant mcr-1-producing strains isolated from human infections over one year in a hospital setting (Hospital das Clínicas, São Paulo, Brazil). We isolated 490 colistin-resistant Gram-negative rods, of which eight were mcr-1.1-positive Escherichia coli, the only species with this result, indicating a low incidence of the mcr-1 production mechanism among colistin-resistant isolates. All mcr-1.1 positive isolates showed similarly low MICs for colistin and were susceptible to most antibiotics tested. The isolates showed diversity of MLST classification. The eight mcr-1.1-positive E. coli genomes were sequenced. In seven of eight isolates the mcr-1.1 gene is located in a contig that is presumed to be a part of an IncX4 plasmid; in one isolate, it is located in a contig that is presumed to be part of an IncHI2A plasmid. Three different genomic contexts for mcr-1.1 were observed, including a genomic cassette mcr-1.1-pap2 disrupting a DUF2806 domain-containing gene in six isolates. In addition, an IS1-family transposase was found inserted next to the mcr-1.1 cassette in one isolate. An mcr-1.1-pap2 genomic cassette not disrupting any gene was identified in another isolate. Our results suggest that plasmid dissemination of hospital-resident strains took place during the study period and highlight the need for continued genomic surveillance.

e4214th International Congress on Infectious Diseases (ICID) Abstracts strains. Results of antimicrobial synergy testing indicate that although certain combinations may act synergistically, it was still strain dependent. These preliminary findings require further confirmation with testing of a larger number of isolates.