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Introduction Febrile neutropenia is one of the most serious treatment-related complications in cancer patients. Susceptible to rapidly progressing infections, which result in prolonged hospitalization and use of broad-spectrum antibiotics, neutropenic patients are subject to colonization by multiresistant agents, which enhances the risk of infections. Methods In this study we included samples collected with nasal, oropharyngeal and anal swabs from hospitalized children with febrile neutropenia following chemotherapy, between March 2014 and 2015, aiming to elucidate colonization by S. aureus and Enterococcus spp., as well as their resistance profile. Results S. aureus was found in 22% of the patients and 14% of the events. Methicillin-resistant S. aureus colonized 13.6% of patients. Including anal swabs in the screening increased the identification of colonized patients by 20%. Enterococcus spp. was found in 27% of patients and 17% of episodes. Enterococcal isolates resistant to vancomycin, accounting for 25% of the total, were not isolated in anal swabs at any time, with the oropharyngeal site being much more important. The rate of infection by Enterococcus spp. was 4.5% of all patients and 16% among the colonized patients. Conclusion Especially in this population, colonization studies including more sites can yield a higher chance of positive results. Establishing the colonization profile in febrile neutropenic children following chemotherapy may help to institute an empirical antibiotic treatment aimed at antibiotic adequacy and lower induction of resistance, thereby decreasing the risk of an unfavorable clinical outcome.

Hospital-acquired infections account for high mortality rates and hospital costs. We analyzed pediatric data from a tertiary teaching hospital and found that most of the cases occurred in the intensive care unit and had significant association with invasive devices. Bloodstream infections were the main site of infection, and Gram-negative bacteria were the predominant etiology.

From July 2009 to July 2015, Staphylococcus aureus isolated from pediatric sterile sites were selected. Polymerase chain reaction was used to detect mecA and lukS-PV/lukF-PV genes. The rate of methicillin-resistant Staphylococcus aureus was 37.7%. Ten isolates had the lukS-PV/lukF-PV genes, 2 of which were methicillin-resistant Staphylococcus aureus. Skin and soft tissues infections were significantly associated with lukS-PV/lukF-PV positive isolates, P = 0.008.

To the Editor: Infections caused by carbapenem-resistant Enterobacteriaceae have been associated with higher death rates than infections caused by carbapenem-susceptible strains, and resistant infections are mostly treated with polymyxins (1). Several outbreaks caused by carbapenem- and polymyxin-resistant Klebsiella pneumoniae (CPRKp) have been reported, mainly from Europe, and represent an emerging threat.

BACKGROUND: After the dissemination of penicillin and oxacillin resistance in Staphylococcus aureus, vancomycin-intermediate and vancomycin resistant isolates have been reported. Even between isolates with minimum inhibitory concentrations (MICs) within the susceptible range, some authors have demonstrated that higher MICs correlate with higher lethality. METHODS: To test this hypothesis in our setting, we compared vancomycin MICs evaluated by two methods and clinical outcomes in hospitalized patients with S. aureus bacteremia. RESULTS: We compared lethality in patients infected with isolates that had MICs under or over 2 mg/L. Among patients infected with isolates that had microdilution MICs

To the editor, We read with interest the paper authored by Preoţescu LL and Streinu-Cercel O,1 and would like to input more data into their brief review on the subject of Staphylococcus aureus colonization in children. We have previously performed and published2 a colonization study, from March to November 2009, in 197 children in Sao Paulo, Brazil. Samples were obtained using swabs from both the anterior nares and the oropharynx of each individual. The overall prevalence of S. aureus was 65% and prevalence of methicillin-resistant isolates was 5.9%. In 51 patients (25.9%), S. aureus was detected in both sites. Oropharyngeal colonization without nasal colonization occurred in 42 cases (21.3%), whereas nasal colonization without colonization of the oropharynx was the case for 35 children (17.8%). Of the eleven MRSA isolates, six (3.2%) were found only in the oropharynx and three (1.6%) only in nares. Our results have shown, in addition to a high prevalence of colonization, the importance of investigating other sites in addition to the anterior nares.

We evaluated the performance of several methods for the detection of methicillin resistance in Staphylococcus aureus using 101 clinical S. aureus isolates from pediatric patients in a tertiary hospital in Brazil; 50 isolates were mecA-positive and 51 were mecA-negative. The Etest and oxacillin agar screening plates were 100% sensitive and specific for mecA presence. Oxacillin and cefoxitin disks gave sensitivities of 96 and 92%, respectively, and 98% specificity. Alterations of CLSI cefoxitin breakpoints increased sensitivity to 98%, without decreasing specificity. Our results highlight the importance of a continuing evaluation of the recommended microbiological methods by different laboratories and in different settings. If necessary, laboratories should use a second test before reporting a strain as susceptible, especially when testing strains isolated from invasive or serious infections. With the new (2007) CLSI breakpoints, the cefoxitin-disk test appears to be a good option for the detection of methicillin resistance in S. aureus. Dept Pediat, Div Pediat Infect Dis, Sao Paulo, Brazil Santa Casa Univ Hosp, Dept Pathol, Microbiol Lab, Sao Paulo, Brazil FMUSP, Hosp Clin, LIM 03, Sao Paulo, Brazil Web of Science

Goud et al 1 , in their very interesting article regarding the prevalence of Staphylococcus aureus in their community, state that “the anterior nares are the most common site for colonization”. Recent data suggest that the oropharynx could be more frequently colonized by S. aureus than the anterior nares 2-4 . Furthermore, even in some populations where nasal colonization is more common than oropharyngeal colonization, the use of a throat swab would increase significantly the rate of detection of the carriers 5 . In addition, another matter of discussion would be the chosen screening method for vancomycin resistance. The authors used disk-diffusion, which is not considered accurate and reliable enough for the detection of decreased susceptibility of S. aureus to this antimicrobial agent. It is of paramount importance to remember that, according to the current guidelines issued by the Clinical and Laboratory Standards Institute (CLSI, formerly NCCLS), minimum inhibitory concentration (MIC) tests should be performed to determine the susceptibility of all isolates of staphylococci to vancomycin. The disk test, although detecting accurately S. aureus containing vanA (vancomycin resistant isolates), does not differentiate vancomycin-susceptible from vancomycin-intermediate isolates 6 .