Clinical Epidemiology and multiresistant molecular characterization of aeruginosa Pseudomonas of hospitals of São Luís of the Maranhão, region east of the Brazilian Amazônia.
The dynamic of nosocomial infections due to Pseudomonas aeruginosa in restricted hospital units, and their spread to other sites and hospitals characterizing an outbreak is still a challenge for the control of this bacteria. In this work our objectives were: (1) to identify risk factors for multi resistant P. aeruginosa (MDRPA) acquisition; (2) to study the possibility of the persistent bacteria stay in chronically hospitalized patients; (3) to characterize genetically strains from hospital outbreaks due to P. aeruginosa. We studied P. aeruginosa isolates obtained from hospitalized patients in seven hospitals in São Luís, state of Maranhão, from June 2000 to June 2003. The achieved results showed that: (1) the previous use of metronidazol, clindamycin, mechanical ventilation, enteral feeding, length of stay higher than 10 days and clinical treatment were independent risks associated to MDRPA acquisition to hospitalized patients; (2) a long term inpatient presented repeated episodes of nosocomial infections caused by P. aeruginosa during his stay. The isolates obtained from these episodes represented relapses and reinfections; (3) we identified multirresistant clones circulating in different hospitals, coexisting in given moments in a unique hospital. One of these, considered to be the dominant clone, harbored a metallo-ß-lactase blaSPM gene. Some clones displayed sensibility profile changes during the studied period. We demonstrated that the metallo-ß-lactase blaSPM carrier clone, previously identified in other Brazilian regions, is also present in Maranhão. For the first time it is showed that the previous use of clindamycin and metronidazol represents a risk factor for MDRPA acquisition. In addition, were used for the first time in Brazil the pulsed-field electroforesis analysis to characterize recurrent P. aeruginosa infections. The COS (colistin-only-sensitive) resistance profile was identified circulating in the studied region hospitals.
Advisor:Ana Carolina Paulo Vicente; Verônica Viana Vieira
School:Faculdades Oswaldo Cruz
Source Type:Master's Thesis
Keywords:Pseudomonas aeruginosa Cross Infection Drug Resistance Microbial
Date of Publication:10/31/2006