Banca de DEFESA: EMÍLIA SOUSA DE OLIVEIRA

Uma banca de DEFESA de MESTRADO foi cadastrada pelo programa.
DISCENTE : EMÍLIA SOUSA DE OLIVEIRA
DATA : 22/02/2019
HORA: 14:00
LOCAL: Sala Jucá (Bloco anexo I do CB)
TÍTULO:

EMERGENCY OF vancomycin-resistant Enterococcus sp. IN NATAL-RN

PALAVRAS-CHAVES:

Vancomycin-resistant Enterococcus, clonal spread, colonization, PFGE, MLST

PÁGINAS: 97
GRANDE ÁREA: Ciências Biológicas
ÁREA: Microbiologia
SUBÁREA: Biologia e Fisiologia dos Microorganismos
ESPECIALIDADE: Bacterologia
RESUMO:

Vancomycin-resistant enterococci (VRE) clonal spread and outbreaks cause major
problems in health institutions around the world. In Brazil, several available studies
describe VRE outbreaks or clonal dissemination scenarios mostly involving
Enterococcus faecalis and Enterococcus faecium. We aimed to characterize, at
molecular level, the VRE recovered from patient colonization and infection in
different hospitals of Natal. Sixty-two VRE isolates were collected from 51 patients
of 7 hospitals, for two years (2015-2016). Identification at the species level by
specific primers sodA and ddl was performed by Polymerase Chain Reation (PCR).
Susceptibility to antibiotics were assessed by disk-difusion, MIC test strip
(vancomycin) and agar dilution (teicoplanin) (EUCAST, 2018; CLSI, 2018). Search
of vancomycin resistance (vanA/vanB) and putative virulence (cylA/asa1/gelE/esp)
genes was performed by PCR. Clonal relationship was evaluated by Pulse-filed Gel
Electrophoresis (PFGE), and representative strains from main PFGE types also by
Multilocus Sequence Typing (MLST). Sixty-one isolates were identified as
Enterococcus faecalis and only one as Enterococcus faecium. Resistance to
vancomycin, teicoplanin ciprofloxacin, tetracycline and erythromycin were observed
in all isolates, and 98,4% were to teicoplanin by Minimum Inhibitory Concentration
(MIC) (MIC = 4 to 64mg/L). Vancomycin and teicoplanin MICs were 16 até ≥ 256
µg/ml e 4 até 64µg/L, respectively. In addition, 88,7% (n=55/62) and 40,3%
(n=25/62) were also resistant to gentamicin or streptomycin, respectively. None was
resistant to linezolid or chloramphenicol. Just the E. faecium was ampicillin resistant. 

Operon vanA was observed in all isolates. Occurrence of virulence factors included
gelE (98,4%; n=60/61), asa1 (100%; n=61/61), cylA (16,4%; n=10/61) and esp
(9,8%; n=6/61). Two PFGE types were identified; type A (50,8%; n=31/61) and type
B (49,18%; n=30/60). The MLSTs of the representative isolates were typed as ST525
and ST6. Both clones were co-circulating during the period of the study. This study
highlights a high rate of patient colonization with vancomycin-resistant E. faecalis
with vanA and a silent spread of two clones previously associated with human
infections in Brazil (ST525) or worldwide (ST6). Although their transmission routes
of this ERV in Natal remain to clarify, the inter-hospital spread during a long period
of time highlight the need of better hygiene measures and antimicrobial stewardship
to contain a potential multi-hospital epidemic scenario associated with infection.

MEMBROS DA BANCA:
Presidente - 1452833 - MARIA CELESTE NUNES DE MELO
Interna - 2121234 - VANIA SOUSA ANDRADE
Externa à Instituição - GILMARA CELLI MAIA DE ALMEIDA - UERN