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Background and Objectives: Methicillin-resistant Staphylococcus aureus (MRSA) is one of the most frequent causes of healthcare-associated and community-acquired infections and with its advancement, vancomycin became the main therapeutic option. However, its indiscriminate 2 use favored the emergence of MRSA with reduced susceptibility to vancomycin, commonly associated with vancomycin treatment failure, persistent bacteremia, prolonged hospitalization and adverse clinical outcome. This study evaluated the occurrence of MRSA with reduced vancomycin susceptibility and determined some molecular characteristics in comparison with vancomycin-susceptible MRSA (VS-MRSA). Methods: Determination of antimicrobial susceptibility profile, the minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) for vancomycin, vancomycin-tolerance, SCCmec and agr typing were performed in a total of 177 MRSA. Thereafter, they were screened for hVISA by BHIA-3V and BHIA-6V and confirmed with population analysis profile - area under the curve method (PAPAUC). Results: VT-MRSA and hVISA phenotypes were found in 13.6% and 5.1% of clinical isolates of MRSA, respectively, and the presence of hVISA was statistically significant among VT-MRSA isolates (p

Objective: To conduct a reflection about the pathogenicity, antimicrobial resistance, and clinical implications of the infections caused by Staphylococcus aureus . Method: Reflexive analysis, supported by theoretical references about the pathogenicity, antimicrobial resistance, and clinical implications of the staphylococcal infections. Results: The pathogenesis of S. aureus infections is complex and depends on the host characteristics, expression of virulence factors and ability to develop resistance to antimicrobials. Methicillin-resistant S. aureus (MRSA) is related to an advancement of healthcare- and community-acquired infections, being vancomycin the primary therapeutic option. Infections caused by S. aureus with reduced vancomycin susceptibility (hVISA/VISA) have been associated with treatment failures and increased mortality. Conclusion: With the evolution of S. aureus to MRSA, hVISA and VISA, the treatment of staphylococcal infections has become a major challenge for the medical clinic, and an adequate and early antibiotic therapy is essential for decreasing morbidity and mortality rates related to this microorganism.

Methicillin-resistant Staphylococcus aureus (MRSA) is anopportunistic pathogen that affectspublic health representing the most common infections related to health care and community. MRSA infections are classified as health care-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) defined by the bacteria genetic profile. This study conducts a molecular characterization of eighty-one MRSA isolates from a hospital in Porto Alegre, RS, Brazil, in a period from January to June of 2012. A multiplex PCR was performed to determine the SCCmec types. From the 81 isolates, 24 (30%) were type I, 10 (12%) type II, 21 (26%) type III, 4 (5%) type IVa, 12 (15%) isolates were type IVc, 1 isolate was type I and IVc (1%) and 1 was type III and IVc (1%) simultaneously, while non-typable isolates corresponded to 8 isolates (10%). However most of the isolates were carrying SCCmec types related to HA-MRSA, the results reveal a change in the epidemiology, considering the decrease of the incidence of SCCmec type III and the increase of isolates being typed as SCCmec I.

A fidelidade dos genomas é defendida por mecanismos conhecidos como sistemas de repetições palindrômicas curtas agrupadas e regularmente interespaçadas (CRISPRs). Três tipos de sistemas CRISPR II (CRISPR1-cas, CRISPR2 e CRISPR3-cas) têm sido identificados em cepas de enterococos isolados de amostras clínicas e ambientais. O objetivo deste estudo foi observar a distribuição dos CRISPR1-cas, CRISPR2 e CRISPR3-cas em cepas não-clínicas de Enterococcus faecalis e Enterococcus faecium isoladas de amostras alimentícias e fecais, incluindo animais marinhos selvagens. A presenca dos CRISPRs foi determinada por PCR em 120 cepas de enterococos, sendo 67 E. faecalis e 53 E. faecium. É o primeiro relato da presença do sistema CRISPRs nas estirpes E. faecalis e E. faecium isoladas de amostras fecais de animais marinhos selvagens. Os resultados mostraram que em cepas não-clínicas, os CRISPRs foram mais frequentemente detectados em E. faecalis do que em E. faecium. E as frequências de CRISPR1-cas e CRISPR2 foram maiores (60%) em cepas de E. faecalis isoladas de fezes de animais, quando comparadas à amostras de alimentos. Ambas as cepas apresentaram baixas freqüências de CRISPR3-cas (8,95% e 1,88%). Em conclusão, as diferenças nos habitats das espécies de enterococos podem estar relacionadas com os resultados observados na distribuição dos sistemas CRISPRs. The fidelity of the genomes is defended by mechanism known as Clustered Regularly Interspaced Short Palindromic Repeats (CRISPR) systems. Three Type II CRISPR systems (CRISPR1-cas, CRISPR2 and CRISPR3-cas) have been identified in enterococci isolates from clinical and environmental samples. The aim of this study was to observe the distribution of CRISPR1-cas, CRISPR2 and CRISPR3-cas in non-clinical strains of Enterococcus faecalis and Enterococcus faecium isolates from food and fecal samples, including wild marine animals. The presence of CRISPRs was evaluated by PCR in 120 enterococci strains, 67 E. faecalis and 53 E. faecium. It is the first report of the presence of the CRISPRs system in E. faecalis and E. faecium strains isolated from wild marine animal fecal samples. The results showed that in non-clinical strains, the CRISPRs were more frequently detected in E. faecalis than in E. faecium. And the frequencies of CRISPR1-cas and CRISPR2 were higher (60%) in E. faecalis strains isolated from animal feces, compared to food samples. Both strains showed low frequencies of CRISPR3-cas (8.95% and 1.88%). In conclusion, the differences in the habitats of enterococcal species may be related with the results observe in distribution of CRISPRs systems.

BACKGROUND One of the most stigmatizing physical sequelaeof leprosy in cured patients is the development of chronic lower extremity ulcers. The bacterial diversity present in ulcers is considered one of the factors that can delay the healing process, as well as serve as a focus for severe secondary infections. OBJECTIVE To identify the microbiota and antimicrobial resistance profile of bacteria isolated from skin ulcers in patients cured of leprosy. METHODS After obtaining informed consent, material was collected from ulcers of 16 patients treated at the Outpatient Public Health Dermatology Clinic of Rio Grande do Sul and Hospital Colônia Itapuã. Sampleswere collected during dressing, and the material sent to the Microbiology Laboratory of the Federal University of Health Sciences of Porto Alegre for microbiological culture. Methicillin-resistant Staphylococcus aureus (MRSA) was characterized by two molecular methods, including detection of the mecA gene by PCR and SCCmecgene typing. RESULTS Cultures revealed microorganisms in all ulcers: Gram-negative bacilli in 80%, Gram-positive cocci in 63%, and mixed microflora in 36%. Staphylococcus aureus and Pseudomonas aeruginosa were the most prevalent bacteria. Assessment of the antimicrobial resistance profile was notable for the presence of MRSA. Molecular analysis of this isolate revealed presence of the mecA gene contained in a type IV staphylococcal cassette chromosome mec (SCCmec). CONCLUSIONS In patients with leprosy, laboratory culture of skin ulcers is essential for correct antibiotic selection and to control emerging pathogens, such as MRSA carrying SCCmec type IV.

INTRODUCTION: Methicillin-resistant Staphylococcus aureus (MRSA) is an important pathogen commonly associated with nosocomial infections. However, it has also been associated with community-acquired skin and soft tissue infections (CA-MRSA). There are few data on the identification and prevalence of CA-MRSA infections in Brazil. METHODS: This is a cross-sectional study of 104 patients with community-acquired skin infections attending two health care centers in Porto Alegre, southern Brazil. MRSA isolates were characterized by molecular methods, including detection of the mecA gene by PCR, gene SCCmec typing, Panton-Valentine leukocidin (PVL) detection, pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). RESULTS: From the 104 samples, 58 Staphylococcus aureus isolates were obtained, of which five (8.6%) had a CA-MRSA-resistant profile. All five isolates had the mecA gene and amplified to SCCmec type IV. Analysis of chromosomal DNA by PFGE revealed the presence of two clusters related to international clones (OSPC and USA 300), with a Dice similarity coefficient >80%. The study was complemented by MLST, which detected three different strains: ST30, ST8, and ST45, the latter not presenting any relation with the clones compared in PFGE. CONCLUSIONS: The presence of CA-MRSA reveals an important change in the epidemiology of this pathogen and adds new elements to the knowledge of the molecular biology of infections by MRSA with SCCmec type IV in southern Brazil.

Influenza viruses cause seasonal epidemics with patients displaying respiratory infection leading to high morbidity and mortality in some cases. However, even during periods of epidemic prevalence, clinical diagnoses are problematic. Clinical laboratory tests became more important, especially after the H1N1 pandemics in 2009. To date, several tests are available from classic to molecular approaches, although some of them may present limitations for a promptly diagnostic response, including time consuming, average sensitivity or sensibility. From April 2009 to the present, the influenza A(H1N1)pdm09 virus has been evolving continuously, acquiring new amino acid changes that may alter its antigenic characteristics, virulence, and its antiviral drug susceptibility. This review provides an overview of various techniques, including those recommend by Centers for Disease Control and Prevention, for specific diagnosis of influenza infection. DOI: http://dx.doi.org/10.17525/vrrjournal.v20i2.252

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) is an opportunistic pathogen that affects public health representing the most common infections related to health care and community. MRSA infections are classified as health care-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) defined by the bacteria genetic profile. Objective: This study conducts a molecular characterization of MRSA isolates from a hospital in Porto Alegre, RS, Brazil, in order to determine the profile of SCCmec types. Methods: Eighty-one MRSA isolates from a hospital in Porto Alegre, RS, Brazil, collected from January to June of 2012 were included in the study. A multiplex PCR was performed to determine the SCCmec types. Results: From the 81 isolates, 24 (30%) were type I, 10 (12%) type II, 21 (26%) type III, 4 (5%) type IVa, 12 (15%) isolates were type IVc, 1 isolate was type I and IVc (1%) and 1 was type III and IVc (1%) simultaneously, while non-typable isolates corresponded to 8 isolates (10%). Conclusion: However most of the isolates were carrying SCCmec types related to HA-MRSA; the results reveal a change in the epidemiology, considering the decrease of the incidence of SCCmec type III and the increase of isolates being typed as SCCmec I. Methicillin-resistant Staphylococcus aureus (MRSA) is anopportunistic pathogen that affectspublic health representing the most common infections related to health care and community. MRSA infections are classified as health care-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) defined by the bacteria genetic profile. This study conducts a molecular characterization of eighty-one MRSA isolates from a hospital in Porto Alegre, RS, Brazil, in a period from January to June of 2012. A multiplex PCR was performed to determine the SCCmec types. From the 81 isolates, 24 (30%) were type I, 10 (12%) type II, 21 (26%) type III, 4 (5%) type IVa, 12 (15%) isolates were type IVc, 1 isolate was type I and IVc (1%) and 1 was type III and IVc (1%) simultaneously, while non-typable isolates corresponded to 8 isolates (10%). However most of the isolates were carrying SCCmec types related to HA-MRSA, the results reveal a change in the epidemiology, considering the decrease of the incidence of SCCmec type III and the increase of isolates being typed as SCCmec I.

Staphylococcus aureus is responsible for a broad variety of infectious diseases. The main concern is about methicillin-resistant isolates (MRSA), which are usually limited to hospitals. In recent years, community associated or acquired MRSA infections (CA-MRSA) have been frequently reported and emerged in the world. Some phenotypic and genotypic characteristics are distinct between hospital and community infection. Currently, there is reduced sensibility profile to different antimicrobials, reason why it is necessary to issue an alert to healthcare professionals, dermatologists in particular, about the importance of knowing the differences between the infections, preventing wrong and unsuccessful empirical therapy.

Staphylococcus aureus resistente à meticilina foi inicialmente descrito como um típico microrganismo adquirido em infecções nosocomiais. No entanto, nos últimos anos Staphylococcus aureus resistente à meticilina adquirido na comunidade é causa de infecções de pele e tecidos moles, mas infecções graves como pneumonia e sepse podem ocorrer. Este relato descreve um caso de sepse em criança, complicado com pneumonia secundária a lesão em partes moles por Staphylococcus aureus resistente à meticilina adquirido na comunidade no Sul do Brasil. O paciente foi atendido em Unidade de Emergência com história de ferimento provocado por trauma em membro inferior que evoluiu para celulite, pneumonia e sepse. Methicillin-resistant Staphylococcus aureus was initially described as a typical microorganism acquired in nosocomial infections. However, over recent years, community-acquired methicillin-resistant Staphylococcus aureus has been a cause of skin and soft-tissue infections. Serious infections such as pneumonia and sepsis can also occur. This report describes a case of sepsis in a child that was complicated by pneumonia secondary to soft tissue lesions that were due to community-acquired methicillin-resistant Staphylococcus aureus in southern Brazil. The patient was attended at the Emergency Unit with a history of injury caused by lower-limb trauma that evolved to cellulitis, pneumonia and sepsis.