No abstract

Background Aquatic matrices impacted by sewage may shelter carbapenem-resistant (CR) Gram-negative bacilli (GNB) harboring resistance genes of public health concern. In this study, sewage treatment plants (STPs) servicing well-defined catchment areas were surveyed for the presence of CR-GNB bearing carbapenemase genes (blaKPC or blaNDM). Results A total of 325 CR-GNB were recovered from raw (RS) and treated (TS) sewage samples as well as from water body spots upstream (UW) and downstream (DW) from STPs. Klebsiella-Enterobacter (KE) group amounted to 116 isolates (35.7%). CR-KE isolates were recovered from TS, DW (35.7%) and RS samples (44.2%) (p = 0.001); but not from UW samples. KE isolates represented 65.8% of all blaKPC or blaNDM positive strains. The frequency of blaKPC-or-NDM strains was positively associated with the occurrence of district hospitals located near STPs, as well as with the number of hospitalizations and of sewer connections serviced by the STPs. blaKPC-or-NDM strains were recovered from ST samples in 7 out of 14 STPs, including four tertiary-level STPs; and from 6 out of 13 DW spots whose RS samples also had blaKPC-or-NDM strains. Conclusions Clinically relevant GNB bearing blaKPC-or-NDM resist sewage treatments and spread into environmental aquatic matrices mainly from STPs impacted by hospital activities.

Objectives To (i) describe the nationwide antimicrobial susceptibility of Neisseria gonorrhoeae (NG) isolates cultured across Brazil in 2018–20 and compare it with NG antimicrobial resistance data from 2015–16, and (ii) present epidemiological data of the corresponding gonorrhoea patients in 2018–20. Methods Twelve representative sentinel sites cultured NG isolates from men with urethral discharge. Susceptibility to eight antimicrobials was examined using agar dilution method, according to WHO standards. The consenting participants were invited to provide epidemiological data. Results In total, 633 NG isolates (one isolate per participant) were analysed, and 449 (70.9%) questionnaires were answered. Heterosexual (68.2%) and homosexual (23.1%) sexual orientations were common, and most prevalent types of unprotected sexual intercourse were vaginal insertive (69.9%), oral giving (56.6%) and anal insertive (47.4%). The levels of in vitro NG resistance to ciprofloxacin, tetracycline, benzylpenicillin, azithromycin, cefixime, gentamicin, spectinomycin and ceftriaxone were 67.3%, 40.0%, 25.7%, 10.6%, 0.3%, 0%, 0% and 0%, respectively. Compliance with the recommended first-line ceftriaxone 500 mg plus azithromycin 1 g therapy was high (90.9%). Conclusions Compared with 2015–16, ciprofloxacin resistance has remained high and azithromycin and cefixime resistance rates have increased in Brazil. Resistance remained lacking to ceftriaxone, gentamicin and spectinomycin, which all are gonorrhoea treatment options. The increasing azithromycin resistance in Brazil and internationally may threaten the future use of azithromycin in dual regimens for treatment of gonorrhoea. Consequently, continued and enhanced quality-assured surveillance of gonococcal AMR, and ideally also treatment failures and including WGS, is imperative in Brazil and worldwide.

Introdução: O diagnóstico rápido e preciso da tuberculose (TB) e o início precoce do tratamento são fatores de grande importância para reduzir e minimizar o risco de contágio pelo Mycobacterium tuberculosis. Nesse contexto, as principais metodologias empregadas no Brasil para o diagnóstico da TB são os testes de baciloscopia e de cultura. Objetivo: O presente estudo tem como objetivo descrever os resultados de três técnicas laboratoriais para o diagnóstico da TB pulmonar. Métodos: Foram analisados dados de baciloscopias e culturas de 10.418 prontuários de pacientes de ambos os sexos, diferentes idades e locais de residência, no período de janeiro de 2011 a junho de 2014. Resultados: Foram analisados os prontuários de 284 pacientes com resultado positivo para o Complexo Mycobacterium Tuberculosis (CMTB). Dos 284 pacientes positivos para o CMTB, 210 apresentaram BAAR positivos (73,9%) e 74 negativos (26,1%). Nos cultivos em meio LJ, 255 amostras foram positivas (89,7%) e 29 negativas (10,3%), enquanto no meio de cultivo líquido Bactec MGIT® a positividade foi de 276 (97,1%) e 8 negativas (2,9 %). Conclusões: Observou-se que a identificação de BAAR em exame direto continua a ser de suma importância no diagnóstico precoce da TB. Os métodos de cultura, principalmente o sistema Bactec-MGIT®, mostraram neste estudo um incremento de 23,2% no diagnóstico da TB pulmonar.

Dedico este trabalho aos meus filhos Maria Eduarda e Vítor e ao meu afilhado Matheus, para que desde pequenos valorizem a importância dos estudos; ao meu marido Eduardo, pelo apoio incondicional; aos meus pais, que me permitiram chegar até aqui; à minha irmã Janay,pelo incentivo e por me substituir nas minhas ausências maternas e familiares; e à minha grande amiga Pérola -quem encontrou um amigo encontrou, no meu caso, uma Pérola. AGRADECIMENTOSA Deus, pelas tantas oportunidades que me proporcionou e por ter mе dado saúde е força para superar as dificuldades.Aos meus filhos, por entenderem todas as minhas ausências, eu peço perdão.Ao meu marido, por todas as noites não dormidas e por todas as infinitas formatações e correções gramaticais, a minha eterna gratidão.Aos meus pais, pelo amor, incentivo е apoio incondicionais.À minha orientadora, Professora Dra. Janeth de Oliveira Silva Naves, pela orientação, ensinamentos e confiança depositada durante todo este projeto.À Professora e amiga Dra.