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Objective: How did the antimicrobial resistance profile of critically ill patients evolve before, during, and after COVID-19 surge periods?, Methods: We retrospectively analysed all critically ill mechanically ventilated adult patients admitted to eight Brazilian hospitals from January 1st, 2018, to April 30th, 2023. We stratified the patients into three periods based on their admission date: pre-surge (Jan 01/2018-Mar 01/2020), surge (Mar 01/2020 - Oct 01/2021), and post-surge (after Oct 01/2021). We compared the proportion of positive cultures, prevalence of pathogens, and resistance rates across periods using the rate ratios (RR) and their 95% confidence intervals (95% CI)., Results: We analysed 9,780 ICU patients: 3,718 were in the pre-surge, 3,815 in the surge, and 2,247 in the post-surge period. Patients in the surge period were younger (median: 70 vs. 74 pre-surge vs. 75 post-surge) and presented a higher duration of invasive mechanical ventilation (median 7 vs. 5 days). The utilisation of blood and respiratory cultures increased throughout periods (56.9 pre-surge vs. 69.4 surge vs. 70.4 patients/1,000 patient days post-surge). The isolation of carbapenem-resistant gram-negative bacteria increased during the surge (RR [95% CI]: 1.8 [1.5-2.2], compared to pre-surge), decreased in post-surge (RR [95% CI]: 0.72 [0.6-0.9], and remained higher than pre-surge (RR [95% CI]: 1.3 [1.0-1.6]). Resistance rates for Pseudomonas aeruginosa reduced from 32% in pre- to 23% post-surge, whereas Klebsiella pneumoniae doubled during the surge, 26% to 52%, and remained higher than pre-surge., Conclusion: Carbapenem resistance increased during the surge period. Although it decreased post-surge, it remained higher than the rates observed before the pandemic., (Copyright © 2024. Published by Elsevier Inc.)

Non-diphtheria Corynebacterium species (NDC) belonging to the human skin and mucosa microbiota are frequently neglected as contaminants. However, reports of human infections by Corynebacterium spp. have increased considerably in recent years. In this study, a group of six NDC isolates of urine (n = 5) and sebaceous cyst (n = 1) from two South American countries were identified at genus level or misidentified based on API® Coryne and genetic/molecular analyses. The 16S rRNA (99.09-99.56%) and rpoB (96.18-97.14%) gene sequence similarities of the isolates were higher when compared with Corynebacterium aurimucosum DSM 44532  T . Multilocus sequence analysis (MLSA) indicated that these six NDC isolates compose a distinctive phylogenetic clade. Genome-based taxonomic analysis with the whole-genome sequences was able to separate these six isolates from other known Corynebacterium type strains. Average nucleotide identity (ANI), average amino acid identity (AAI), and digital DNA-DNA hybridization (dDDH) values between closely related type strains and the six isolates were considerably lower than the currently recommended threshold values for species circumscription. Phylogenetic and genomic taxonomy analyses indicated these microorganisms as a novel Corynebacterium species, for which we formally propose the name Corynebacterium guaraldiae sp. nov. with isolate 13 T (= CBAS 827 T  = CCBH 35012 T ) as type strain., (© 2023. The Author(s) under exclusive licence to Sociedade Brasileira de Microbiologia.)

The presence of Kerstersia gyiorum in lower leg wounds has been reported in case studies from several countries., Objective: This study evaluated the antimicrobial susceptibility profile of K gyiorum isolated from a chronic wound., Methods: An 85-year-old woman with chronic venous insufficiency presented to an intermediate care unit in Niteroi City, Rio de Janeiro, Brazil, with an instep chronic wound of 14 cm² with wound duration of 6 months. K gyiorum was identified by matrix-assisted laser desorption ionization-time of flight, confirmed by 16S rRNA partial sequence analysis, and classified as resistant for ciprofloxacin by reagent strips(minimum inhibitory concentration [MIC] = 32 µg/mL) and the broth macrodilution method (MIC = 8 µg/mL). Intermediate resistance for ciprofloxacin was verified by microscan (MIC = 2 µg/mL)., Conclusion: The authors identified the first, to their knowledge, lower leg wound with K gyiorum in Brazil and verified that it was ciprofloxacin resistant.

Background: Methicillin-resistant staphylococci can colonize and cause diseases in companion animals. Unfortunately, few molecular studies have been carried out in Brazil and other countries with the aim of characterizing these isolates. Consequently, little is known about the potential role of companion animals in transmitting these resistant bacteria to humans. In this work we searched for mecA gene among Staphylococcus isolates obtained from nasal microbiota of 130 healthy dogs and cats attended in a veterinary clinic located in the west region of Rio de Janeiro. The isolates recovered were identified to the species level and characterized using molecular tools., Results: A community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) isolate related to USA1100 (Southwest Pacific clone) and susceptible to all non-β-lactams was detected in a cat (1.7%, 1/60). Another coagulase-positive isolate harboring mecA was recovered from a dog (1.4%, 1/70) and identified as Staphylococcus pseudintermedius (MRSP) related to the European clone (ST71). The two isolates of Staphylococcus conhii subsp. urealyticus (1.4%, 1/70 dogs and 1.7%, 1/60 cats), similarly to the MRSP isolate, also presented high-level multiresistance. The majority of the methicillin-resistant coagulase-negative staphylococci recovered were Staphylococcus saprophyticus (5.7%, 4/70 dogs and 6.7%, 4/60 cats) and all clustered into the same PFGE type., Conclusions: This work demonstrates that mecA-harboring Staphylococcus isolates are common members of the nasal microbiota of the healthy companion animals studied (9.2%, 12/130 animals), including some high-level multiresistant isolates of S. pseudintermedius and S. conhii subsp. urealyticus. The detection, for the first time in South America, of USA1100-related CA-MRSA and of ST71 MRSP (European clone), colonizing companion animals, is of concern. Both S. pseudintermedius and S. aureus are important agents of infections for animals. The USA1100 CA-MRSA is a causative of severe and disseminated diseases in healthy children and adults. Additionally, MRSP is a nosocomial pathogen in veterinarian settings. It had already been demonstrated that the virulent ST71 MRSP is geographically spread over Europe and USA, with potential for zoonotic infections.

This article reports the spread of bla(KPC-2) in the Sao Paulo and Rio de Janeiro states, facilitated by globally spread K. pneumoniae clonal complex 258 (CC258) clones (ST258, ST11, and ST437) and a diversity of plasmids (IncFII, IncN, and IncL/M, two untypeable plasmids carrying Tn4401a or Tn4401b) successfully disseminated among species of the Enterobacteriaceae (Enterobacter cloacae, Serratia marcescens, and Citrobacter freundii). It also constitutes the first description of sequence type 258 (ST258) in Brazil, which was associated with a nosocomial hospital outbreak in Ribeirao Preto city.

Community-acquired infections by methicillin-resistant Staphylococcus aureus (CA-MRSA) in the absence of classic risk factors for MRSA diseases have been reported in different continents. In the article presented here, using molecular typing methods as pulsed-field gel electrophoresis, staphylococcal cassette chromosome mec typing, and multilocus sequence typing, we characterized CA-MRSA isolates from Rio Janeiro and Porto Alegre. The results indicated the presence of international CA-MRSA clones in these 2 Brazilian cities. In addition, Panton-Valentine leukocidin and a number of staphylococcal enterotoxin encoding genes were accessed in these MRSA isolates by polymerase chain reaction detection.

A vancomycin-resistant Enterococcus (VRE) was isolated from a blood culture of a patient in a Brazilian hospital who had a treatment history of a bone marrow transplant in the USA. The organism was identified as Enterococcus faecium, which exhibited an MIC (minimum inhibitory concentration) >or= 256 microg/mL for vancomycin. This was confirmed by E-test and the vanA gene was detected by PCR. Overlapping PCR revealed a left IR deletion and an additional 1.5 kb fragment between vanSH genes. DdeI digestion of vanRSHAX genes showed the determinant to be a T type variant, and the element was cloned and sequenced. These results revealed an IS1251 downstream of nucleotide 5820 of the VanA element. Insertions like this have not been reported previously in Brazil, but have been detected in the USA. The genotype and association with a patient previously treated in the USA suggest that this VRE was introduced from abroad, probably through inter-hospital strain spread.