Staphylococcus aureus is one of the principal human pathogens that colonize healthy individuals in the community in general, and it is responsible for severe infections in hospitalized patients. Due to an increase in the prevalence of strains of methicillin-resistant S. aureus (MRSA), combating these microorganisms has become increasingly difficult. A descriptive study was carried out on 231 patients in intensive care at the Oswaldo Cruz University Hospital (HUOC) in Recife, Brazil between January and April 2003 to determine the prevalence of S. aureus and MRSA and to evaluate risk factors for colonization by these bacteria when introduced into Intensive Care Units (ICUs). Body secretions were collected from the nostrils, axillary and perineal regions, and from broken skin lesions, of all patients during the first 48 hours following admission to the ICU. Samples were inoculated into blood agar and mannitol-salt-agar culture medium and identified by Gram staining, and by coagulase, DNAse and agglutination (Slidex Staph Test®) tests. Growth in Mueller-Hinton agar with 4% sodium chloride and 6mg/L oxacillin was used to identify MRSA. In addition, the latex agglutination test was performed to identify penicillin-binding protein, PBP 2A. The prevalence of S. aureus and MRSA was 87/231 (37.7%) and 30/231 (12.98%), respectively. There was no association between any risk factor studied (age, sex, origin of the patient -whether hospital or community, previous hospitalization, use of current or previous antibiotic therapy, corticotherapy and/or immunotherapy, reason for hospitalization and place of hospitalization) and the presence of S. aureus. However, a significant association was established between previous hospitalization and the presence of MRSA (RR:1.85; CI:1.00-3.41; p=0.041). The nostrils were the principal site of colonization by both S. aureus (80.4%) and MRSA (26.4%), followed by the perineal area, with rates of 27.6% and 12.6%, respectively. If only the nostrils had been investigated, the study would have failed to diagnose 17 patients (19.5%) as carriers of the pathogen into the ICU, thus contributing towards cross-dissemination.

O Staphylococcus aureus é um dos principais patógenos que coloniza indivíduos saudáveis na comunidade e responde por infecções em pacientes hospitalizados. Um estudo transversal foi realizado para determinar a prevalência de S. aureus meticilina-resistente e sensível entre 231 pacientes, internados entre janeiro e abril de 2003, nas unidades de terapia intensiva (UTIs) do Hospital Universitário Oswaldo Cruz, assim como os possíveis fatores associados à colonização. Foram coletadas secreções de narinas, axilas, região perineal e dermatoses com soluções de continuidade, de todos os pacientes, nas primeiras 48 horas de internamento nas UTIs. O material foi semeado em meios de cultura adequados. A prevalência de S. aureus igualou-se a 37,7% (87/231), sendo 13% (30/231) meticilina-resistente e 24,8% (57/231) meticilina-sensível. Idade, sexo, uso de antibioticoterapia, corticoterapia, motivo e local do internamento não se associaram à presença do S. aureus ou do meticilina-resistente. Houve associação significante entre procedência hospitalar e colonização por S. aureus, independente da cepa, e entre internamento anterior e presença do S. aureus meticilina-resistente. As narinas foram o sítio de colonização mais significante, por S. aureus meticilina-resistente (47/57=82,4%) e sensível (23/30=76,7%). Foi alta a prevalência do S. aureus (meticilina resistente ou sensível), assim como do meticilina-resistente entre os pacientes das UTIs deste hospital. Estudos futuros poderão comprovar se os resultados aqui descritos e medidas de rastreamento para S. aureus poderiam ser adotadas, de forma prospectiva, para se avaliar o risco, assim como a magnitude do efeito, no controle de infecções hospitalares provocadas por estes patógenos.

Two new examples of OXA-72-producing Acinetobacter baumannii isolate resistant to a broad spectrum of antimicrobials, but not polymyxin B, have been identified in Recife, Brazil. Molecular typing indicated a close genetic link with the OXA-72-producing A. baumannii previously isolated in São Paulo, suggesting the possibility of clonal dissemination within the country.

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cThis work reports the identification of the first case of a K⌹C-2-producing Pseudomonas putida isolate (PP36) in Brazil. The PP36 isolate was resistant to all the antimicrobials tested except polymyxin B. In addition to the discovered bla KPC-2 gene, genetic analysis showed the presence of a class 1 integron containing the dhfrXVb gene and the new allele arr-6, which codes for resistance to rifampin. These elements were found in an IncFI 65-kb plasmid. Since the first detection of a Klebsiella pneumoniae isolate harboring the bla KPC gene in a large plasmid in 1996 in North Carolina (15) and until 2005, the geographic distribution of these K. pneumoniae carbapenemase (KPC) enzymes in Enterobacteriaceae, mainly K. pneumoniae, was limited to the eastern part of the United States (6). Nowadays, the worldwide spread of KPC-producing, Gram-negative pathogens represents a potential clinical threat with devastating effects on patient outcomes (13).Although KPCs are mostly identified in K. pneumoniae, they have recently been observed among other Gram-negative pathogens, such as Pseudomonas spp. in America (11,14) and Acinetobacter baumannii in Puerto Rico (12). KPC-2-producing K. pneumoniae and Escherichia coli clinical isolates were also identified in Brazil (8,9). Besides these, to date, only one report describes the isolation of Pseudomonas putida producing KPC-2 in Texas (2). Those few reports show the spreading of the KPC-2 enzyme among potential pathogenic bacteria, an observation which might be of great concern for infection control programs. In the present study, we report the identification of the first case of a KPC-2-producing P. putida isolate in Brazil and highlight the importance of this finding in terms of hospital infection control.An 8-year-old boy was admitted to the Oncology Pediatric Center at the University Hospital Oswaldo Cruz, Recife, Brazil, in July 2008 to initiate a new cycle of chemotherapy for Burkitt's lymphoma. Ten days following admission, he presented fever and diarrhea and was sent to the Pediatric Intensive Care Unit and given a further 10 days of empirical intravenous antibiotic therapy with meropenem (1 g every 8 h) and vancomycin (500 mg every 6 h). The patient evolved with febrile neutropenia and gastrointestinal bleeding. Due to fungal sepsis by Candida spp., he received voriconazole (7 mg/kg of body weight every 12 h) for 21 days. Transcatheter bloodstream cultures showed the presence of a carbapenem-resistant P. putida isolate (herein named PP36). Since the patient has no history of traveling abroad, we assumed that this infection was acquired at the hospital. The bacterial identification was performed by a mini-Api ID32 GN card (bioMeriéux, Marcy l'Etoile, France). Meropenem therapy (1 g every 8 h) was restarted, and the catheter was removed. After the removal, the patient evolved to negative bloodstream cultures until the 67th day of internment when he was discharged.Broth microdilution assays (Table 1) showed that the PP36 isolate was resistant to all antimicrobials tested a...

The present work reports the detection of the first case of nosocomial Klebsiella oxytoca producing class A carbapenemase KPC-2 in Brazil. The isolate KPN106 carried a 65-kb IncW-type plasmid that harbors the bla KPC gene and Tn4401b. Moreover, we detected the presence of a class 1 integron containing a new allele, arr-8, followed by a 5=-truncated dhfrIIIc gene. In view of the recent results, we emphasize the high variability of the bacterial and genetic hosts of this resistance determinant.

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