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      Antimicrobial susceptibility among Enterococcus isolates from the city of Porto Alegre, RS, Brazil Translated title: Sensibilidade aos antimicrobianos entre amostras de Enterococcus isolados na cidade de Porto Alegre, RS, Brasil

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          Abstract

          Resistance to several classes of antimicrobial agents is a remarkable characteristic of enterococcal strains increasingly reported worldwide. Information about strains isolated in the southern region of Brazil is still limited. In this study, a total of 455 consecutive enterococcal isolates recovered from patients living in Porto Alegre, Brazil, were identified at species level and evaluated for their antimicrobial susceptibilities by agar diffusion testing. The most frequent species was E. faecalis (92.8%), followed by E. faecium (2.9%), E. gallinarum (1.5%), E. avium (1.1%), E. hirae (0.7%), E. casseliflavus (0.4%), E. durans (0.4%), and E. raffinosus (0.2%). According to the results of disk tests 62.0% of the strains were resistant to tetracycline, 42.6% to erythromycin, 24.8% to chloramphenicol, 22.6% to ciprofloxacin, 22.0% to norfloxacin, 3.5% to ampicillin, 3.5% to nitrofurantoin. High level resistance to aminoglycosides was found in 37.8% of the isolates, with 23.5% being resistant to gentamicin, 14.3% to streptomycin, and 2.8% to both gentamicin and streptomycin. No vancomycin resistant or b-lactamase producing isolates were found. The results indicate that a significant percentage of isolates are resistant to different antimicrobials, pointing out the need for control strategies to avoid dissemination of resistant isolates and for continuous surveillance for the detection of emerging resistance traits.

          Translated abstract

          A resistência a várias classes de agentes antimicrobianos é uma característica marcante dos enterococos observada em diferentes regiões geográficas. Informações sobre amostras isoladas na região sul do Brasil ainda são limitadas. No presente estudo, 455 enterococos isolados consecutivamente de pacientes moradores na cidade de Porto Alegre, Brasil, foram identificados ao nível de espécie e testados em relação a sua sensibilidade aos antimicrobianos através de testes de difusão em agar. As espécies mais freqüentes foram E. faecalis (92,8%), seguidas por E. faecium (2,9%), E. gallinarum (1,5%), E. avium (1,1%), E. hirae (0,7%), E. casseliflavus (0,4%), E. durans (0,4%) e E. raffinosus (0,2%). Os testes de sensibilidade revelaram que 62,0% das amostras foram resistentes à tetraciclina, 42,6% à eritromicina, 24,8% ao cloranfenicol, 22,6% à ciprofloxacina, 22,0% à norfloxacina, 3,5% à ampicilina e 3,5% á nitrofurantoína. Resistência a níveis elevados de aminoglicosídeos foi encontrada em 37,8% das amostras, com 23,5% sendo resistente à gentamicina, 14,3% à estreptomicina e 2,8% a ambos gentamicina e estreptomicina. Nenhuma amostra com resistência adquirida à vancomicina ou produtora de b-lactamase foi encontrada. Os resultados indicam um significante percentual de amostras resistentes a diferentes antimicrobianos, apontando a necessidade de estratégias de controle para evitar a disseminação de cepas resistentes e de vigilância contínua para a detecção de características emergentes de resistência.

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          Plasmid-mediated resistance to vancomycin and teicoplanin in Enterococcus faecium.

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            The life and times of the Enterococcus.

            B E Murray (1990)
            Enterococci are important human pathogens that are increasingly resistant to antimicrobial agents. These organisms were previously considered part of the genus Streptococcus but have recently been reclassified into their own genus, called Enterococcus. To date, 12 species pathogenic for humans have been described, including the most common human isolates, Enterococcus faecalis and E. faecium. Enterococci cause between 5 and 15% of cases of endocarditis, which is best treated by the combination of a cell wall-active agent (such as penicillin or vancomycin, neither of which alone is usually bactericidal) and an aminoglycoside to which the organism is not highly resistant; this characteristically results in a synergistic bactericidal effect. High-level resistance (MIC, greater than or equal to 2,000 micrograms/ml) to the aminoglycoside eliminates the expected bactericidal effect, and such resistance has now been described for all aminoglycosides. Enterococci can also cause urinary tract infections; intraabdominal, pelvic, and wound infections; superinfections (particularly in patients receiving expanded-spectrum cephalosporins); and bacteremias (often together with other organisms). They are now the third most common organism seen in nosocomial infections. For most of these infections, single-drug therapy, most often with penicillin, ampicillin, or vancomycin, is adequate. Enterococci have a large number of both inherent and acquired resistance traits, including resistance to cephalosporins, clindamycin, tetracycline, and penicillinase-resistant penicillins such as oxacillin, among others. The most recent resistance traits reported are penicillinase resistance (apparently acquired from staphylococci) and vancomycin resistance, both of which can be transferred to other enterococci. It appears likely that we will soon be faced with increasing numbers of enterococci for which there is no adequate therapy.
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              Multiple-drug resistant enterococci: the nature of the problem and an agenda for the future.

              Enterococci, leading causes of nosocomial bacteremia, surgical wound infection, and urinary tract infection, are becoming resistant to many and sometimes all standard therapies. New rapid surveillance methods are highlighting the importance of examining enterococcal isolates at the species level. Most enterococcal infections are caused by Enterococcus faecalis, which are more likely to express traits related to overt virulence but--for the moment--also more likely to retain sensitivity to at least one effective antibiotic. The remaining infections are mostly caused by E. faecium, a species virtually devoid of known overt pathogenic traits but more likely to be resistant to even antibiotics of last resort. Effective control of multiple-drug resistant enterococci will require 1) better understanding of the interaction between enterococci, the hospital environment, and humans, 2) prudent antibiotic use, 3) better contact isolation in hospitals and other patient care environments, and 4) improved surveillance. Equally important is renewed vigor in the search for additional drugs, accompanied by the evolution of new therapeutic paradigms less vulnerable to the cycle of drug introduction and drug resistance.
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                Author and article information

                Journal
                bjm
                Brazilian Journal of Microbiology
                Braz. J. Microbiol.
                Sociedade Brasileira de Microbiologia (São Paulo, SP, Brazil )
                1517-8382
                1678-4405
                September 2004
                : 35
                : 3
                : 199-204
                Affiliations
                [01] orgnameFundação Faculdade Federal de Ciências Médicas de Porto Alegre orgdiv1Departamento de Microbiologia e Parasitologia
                [02] orgnameFundação de Amparo a Pesquisa do Estado do Rio Grande do Sul
                [03] orgnameUniversidade Federal do Rio de Janeiro orgdiv1Instituto de Microbiologia
                Article
                S1517-83822004000200005 S1517-8382(04)03500305
                10.1590/S1517-83822004000200005
                83020622-75c8-481e-83a5-f0f90cc91b15

                This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

                History
                : 14 January 2004
                : 18 August 2004
                : 22 April 2004
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 35, Pages: 6
                Product

                SciELO Brazil

                Categories
                Medical Microbiology

                enterococcal,antimicrobial susceptibility,resistance,Enterococcus,teste de sensibilidade,resistência

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