Caracterização dos mecanismos de resistência à vancomicina em isolados de Enterococcus faecium de um hospital terciário brasileiro
DOI:
https://doi.org/10.17058/reci.v14i2.18967Palavras-chave:
Enterococcus faecium, Vigilância Epidemiológica, Resistência a Medicamentos, Resistência à VancomicinaResumo
Justificativa e Objetivos: Enterococcus faecium resistente à vancomicina (VREf) é um patógeno oportunista responsável por infecções hospitalares, caracterizado por crescente prevalência e falta de estudos epidemiológicos abrangentes. O objetivo foi avaliar a ocorrência de VREf e dos elementos genéticos de resistência à vancomicina vanA e vanB em cepas isoladas de pacientes atendidos em um hospital terciário no Brasil. Métodos: Os isolados foram obtidos por amostragem de conveniência de acordo com as solicitações médicas de rotina durante nove meses. As cepas foram identificadas por testes bioquímicos, Sistema de Microbiologia Automatizada BD Phoenix®, e confirmadas por MALDI-TOF. O perfil de sensibilidade aos antimicrobianos foi determinado por difusão em disco e pelo BD Phoenix®. A resistência à vancomicina foi avaliada e confirmada pela técnica de microdiluição. A detecção molecular dos genes de resistência vanA e vanB foi investigada por reação em cadeia da polimerase (PCR) e sequenciamento de DNA. Resultados: Um total de 8.376 culturas foi realizado, sendo 19 (0.22%) identificadas como Enterococcus sp., e nove (47%), como Enterococcus faeciumresistente à vancomicina. A análise do teste de sensibilidade aos antimicrobianos do E. faecium mostrou alta resistência aos antimicrobianos. A análise para determinar o perfil genético dos isolados de E. faecium por PCR mostrou que todos eles carregavam o gene vanA associado à resistência à vancomicina. Conclusão: Durante o período de estudo, observou-se baixa ocorrência de espécies de Enterococcus. No entanto, todos os isolados de VREf apresentaram o gene vanAassociado à resistência à vancomicina e mostraram resistência aos antimicrobianos comumente utilizados, alertando sobre a eficácia dos tratamentos antimicrobianos disponíveis para infecções causadas por esses isolados.
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Van Tyne D, Gilmore MS. Friend Turned Foe: Evolution of Enterococcal Virulence and Antibiotic Resistance. Annu Rev Microbiol 2014; 68: 337–56. https://www.annualreviews.org/doi/10.1146/annurev-micro-091213-113003
Marin Garrido A. Antimicrobial Resistance in Enterococci. J Infect Dis Ther 2014; 02. http://esciencecentral.org/journals/antimicrobial-resistance-in-enterococci-2332-0877.1000150.php?aid=27622
Loureiro RJ, Roque F, Teixeira Rodrigues A, et al. O uso de antibióticos e as resistências bacterianas: breves notas sobre a sua evolução. Rev Port Saúde Pública 2016; 34: 77–84. https://linkinghub.elsevier.com/retrieve/pii/S087090251500067X
Gardete S, Tomasz A. Mechanisms of vancomycin resistance in Staphylococcus aureus. J Clin Invest 2014; 124: 2836–40. http://www.jci.org/articles/view/68834.
Stogios PJ, Savchenko A. Molecular mechanisms of vancomycin resistance. Protein Sci 2020; 29: 654–69. https://onlinelibrary.wiley.com/doi/10.1002/pro.3819
Lee T, Pang S, Daley DA, et al. The changing molecular epidemiology of Enterococcus faecium harbouring the van operon at a teaching hospital in Western Australia: A fifteen-year retrospective study. Int J Med Microbiol 2022; 312: 151546. https://linkinghub.elsevier.com/retrieve/pii/S1438422121000758
Stagliano DR, Susi A, Adams DJ, et al. Epidemiology and Outcomes of Vancomycin-Resistant Enterococcus Infections in the U.S. Military Health System. Mil Med 2021; 186: 100–7. http://www.ncbi.nlm.nih.gov/pubmed/33499465
Lastinger LMW, Abner S, Edwards JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: Summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol 2020; 41: 1-18. https://doi.org/10.1017%2Fice.2019.296
Sacramento AG, Zanella RC, Esposito F, et al. Changed epidemiology during intra and interhospital spread of high-risk clones of vanA-containing Enterococcus in Brazilian hospitals. Diagn Microbiol Infect Dis 2017; 88: 348–351. htps://doi.org/10.1016/j.diagmicrobio.2017.05.008
Cattoir V, Leclerq R. Twenty-five years of shared life with vancomycin-resistant enterococci: is it time to divorce? J Antimicrob Chemother 2013; 68: 731-42. https://doi.org/10.1093/jac/dks469
European Centre for Disease Prevention and Control, World Health Organization, Antimicrobial resistance surveillance in Europe 2023 – 2021 data, Publications Office of the European Union, 2023, https://data.europa.eu/doi/10.2900/63495
Orsi GB, Giuliano S, Franchi C, et al. Changed epidemiology of ICU acquired bloodstream infections over 12 years in an Italian teaching hospital. Minerva Anestesiol 2015; 81: 980–8. https://pubmed.ncbi.nlm.nih.gov/25411769
García-Solache M, Rice LB. The Enterococcus: a Model of Adaptability to Its Environment. Clin Microbiol Rev 2019; 32. https://journals.asm.org/doi/10.1128/CMR.00058-18
Resende M, Caierão J, Prates JG, et al. Emergence of vanA vancomycin-resistant Enterococcus faecium in a hospital in Porto Alegre, South Brazil. J Infect Dev Ctries 2014; 8: 160–7. https://jidc.org/index.php/journal/article/view/24518625
Arredondo-Alonso S, Top J, Corander J, et al. Mode and dynamics of vanA-type vancomycin resistance dissemination in Dutch hospitals. Genome Med 2021; 13: 1–18. https://genomemedicine.biomedcentral.com/articles/10.1186/s13073-020-00825-3
Djorić D, Little JL, Kristich CJ. Multiple Low-Reactivity Class B Penicillin-Binding Proteins Are Required for Cephalosporin Resistance in Enterococci. Antimicrob Agents Chemother 2020; 64. https://journals.asm.org/doi/10.1128/AAC.02273-19
Sacramento AG, Zanella RC, Esposito F, et al. Changed epidemiology during intra and interhospital spread of high-risk clones of vanA-containing Enterococcus in Brazilian hospitals. Diagn Microbiol Infect Dis 2017; 88: 348–51. http://www.ncbi.nlm.nih.gov/pubmed/28622949
Zhu W, Clark NC, McDougal, et al Vancomycin-Resistant Staphylococcus aureus Isolates Associated with Inc18-Like vanA Plasmids in Michigan. Antimicrob Agents Chemother 2008; 52. https://doi.org/10.1128/aac.00908-07
Bender JK, Cattoir V, Hegstad K, et al. Update on prevalence and mechanisms of resistance to linezolid, tigecycline and daptomycin in enterococci in Europe: Towards a common nomenclature. Drug Resist Updat 2018; 40: 25–39. https://linkinghub.elsevier.com/retrieve/pii/S1368764618300487
Mendes RE, Jones RN, Deshpande LM, et al. Daptomycin Activity Tested Against Linezolid-Nonsusceptible Gram-Positive Clinical Isolates. Microb drug resist 2009; 15: 245–9. https://doi.org/10.1089/mdr.2009.0045
Giraldo MR, Vargas-Neto LP, Ricaurte SA, et al. Bacteriemia por Enterococcus faecium resistente a daptomicina - reporte de caso en hospital de Bogotá, Colombia. Actualiz Sid Infect 2023; 30: 28-32. https://doi.org/10.52226/revista.v30i110.119
Cantón R, Garbajosa PR. Infections caused by multi-resistant Gram-positive bacteria (Staphylococcus aureus and Enterococcus spp.). Enferm Infec Microb Clin 2013; 31: 543-51. https://doi.org/10.1016/j.eimc.2013.08.001
Daulay FC, Sudiro S, Amirah A. Management Analysis of Infection Prevention: Nurses’ Compliance in Implementing Hand Hygiene in the Inventories of Rantauprapat Hospital. J Sci Res Med Biol Sci 2021; 2: 42–9. https://bcsdjournals.com/index.php/jsrmbs/article/view/218
Rocha IV, Xavier DE, Almeida KRH de, et al. Multidrug-resistant Acinetobacter baumannii clones persist on hospital inanimate surfaces. Brazilian J Infect Dis 2018; 22: 438–41. https://linkinghub.elsevier.com/retrieve/pii/S1413867018303222
Hemapanpairoa J, Changpradub D, Thunyaharn S, et al. Does Vancomycin Resistance Increase Mortality? Clinical Outcomes and Predictive Factors for Mortality in Patients with Enterococcus faecium Infections. Antibiotics 2021; 10: 105. https://www.mdpi.com/2079-6382/10/2/105
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Copyright (c) 2024 Igor Vasconcelos Rocha, Carlos Alberto das Neves de Andrade , Antônio Marcos Saraiva , Erika Danielle Gameiro da Fonsêca , Danilo Elias Xavier , Danielle Patrícia Cerqueira Macêdo
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