Brazilian Journal of Infectious Diseases最新文献

{"title":"MOLECULAR CHARACTERIZATION OF CARBAPENEMASE CO-PRODUCTION IN KLEBSIELLA PNEUMONIAE","authors":"Patrícia Guedes Garcia ,&nbsp;Ana Clara de Lelis Araújo ,&nbsp;Alessandra Figueiredo de Castro Nassar ,&nbsp;Lívia Mara Silva ,&nbsp;Luciana Debortoli de Carvalho ,&nbsp;Márcio Roberto Silva ,&nbsp;Marcelo Silva Silvério ,&nbsp;Olavo dos Santos Pereira Júnior ,&nbsp;Romário Costa Fochat","doi":"10.1016/j.bjid.2026.104650","DOIUrl":"10.1016/j.bjid.2026.104650","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Carbapenem-resistant <em>Klebsiella pneumoniae</em> represents a serious public health threat due to its high prevalence and therapeutic difficulty. This resistance is often associated with the production of carbapenemases such as KPC, NDM, and OXA-48. The dissemination of these isolates in hospital environments requires continuous surveillance and strict infection control measures. In this context, this study aimed to investigate the prevalence and the genes encoding carbapenemases in carbapenem-resistant clinical isolates of <em>K. pneumoniae</em> from hospitalized patients, as well as to verify carbapenemase co-production in these isolates.</div></div><div><h3>Methods</h3><div>This is a cross-sectional study conducted between 2020 and 2023 at a public hospital located in the Zona da Mata region of Minas Gerais, Brazil. Carbapenem-resistant <em>K. pneumoniae</em> strains obtained from clinical samples were analyzed. Initial species identification was performed by phenotypic methods and subsequently confirmed by mass spectrometry. Screening for carbapenem resistance was conducted by phenotypic tests, and detection of the resistance genes <em>blaKPC</em>, <em>blaNDM</em>, <em>blaOXA-48</em>, <em>blaIMP</em>, and <em>blaVIM</em> was carried out by real-time polymerase chain reaction (qPCR). The study was approved by the Human Research Ethics Committee.</div></div><div><h3>Results</h3><div>A total of 67 carbapenem-resistant clinical isolates of <em>K. pneumoniae</em> were included, 30 from the years 2020 to 2022 and 37 from 2023. Molecular analysis revealed that 56.71% (n = 38) of isolates had only the <em>blaKPC</em> gene, while 10.44% (n = 7) expressed only the <em>blaNDM</em> gene. Co-production of <em>blaKPC</em> and <em>blaNDM</em> was identified in 31.35% (n = 21) of samples, and co-production of <em>blaKPC</em> and <em>blaOXA-48</em> was detected in 1.5% (n = 1). It was observed that all co-production cases occurred in 2023, totaling 22 of the 37 isolates from that period, corresponding to 59.45% of the strains analyzed that year.</div></div><div><h3>Conclusion</h3><div>The detection of <em>K. pneumoniae</em> with co-production of carbapenemase genes demonstrates the complexity of this species’ resistance profile and its clinical relevance in the dissemination of carbapenem resistance. These findings reinforce the need for more effective control strategies, the maintenance of microbiological surveillance programs, and the continuous development of studies to support targeted clinical interventions.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104650"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454320","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"PREVALENCE OF STAPHYLOCOCCUS AUREUS IN PUBLIC HOSPITALS IN MANAUS, AMAZONAS","authors":"Caroline Sousa Martins de Almeida ,&nbsp;Francielle Sousa Belém ,&nbsp;Lucas de Souza Andrade ,&nbsp;Cristiane Nazaré Fidelis Aparício ,&nbsp;Ana Carolina Moura Xavier ,&nbsp;Jackeline da Silva Luciano ,&nbsp;Paula Taquita Serra ,&nbsp;Ivanildes dos Santos Bastos ,&nbsp;Patrícia Puccinelli Orlandi","doi":"10.1016/j.bjid.2026.104707","DOIUrl":"10.1016/j.bjid.2026.104707","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Staphylococcus aureus</em> is an asymptomatic colonizer present in about 30% of the global population and is estimated to account for 17% of healthcare-associated infections (HAIs) worldwide. Due to its ability to form biofilms, this pathogen can survive for long periods on hospital surfaces, contributing to antimicrobial resistance. The objective of this study was to identify the prevalence of <em>S. aureus</em> in three public hospitals in Manaus, Amazonas.</div></div><div><h3>Methods</h3><div>Samples were collected from hospital surfaces using sterile swabs. They were inoculated in Brain Heart Infusion broth at 37°C for 24 hours, then isolated on selective Mannitol Salt Agar. Selected colonies underwent biochemical tests for species confirmation.</div></div><div><h3>Results</h3><div>A total of 997 samples from hospital surfaces were collected, of which 544 (54.56%) showed <em>S. aureus</em> growth. Hospital A (HA) had the highest prevalence, with 38.90% positive samples, followed by Hospital B (HB) with 33.39%, and Hospital C (HC) with 27.71%. Among hospital sectors, the wards and intensive care units (ICUs) showed the highest colonization rates. In HA, 46.23% of ward and 37.26% of ICU samples were positive. In HB, positivity was 44.75% in wards and 43.09% in ICUs. In HC, the ward showed the highest prevalence (65.56%) compared to other hospitals, while the ICU had 17.22%. The most frequently contaminated surfaces were patient beds (HA: 12.26%; HB: 18.23%; HC: 33.77%), floors (HA: 14.15%; HB: 13.81%; HC: 8.61%), and oxygen regulators (HA: 10.38%; HB: 19.89%; HC: 26.49%).</div></div><div><h3>Conclusion</h3><div>This study revealed a high prevalence of <em>S. aureus</em> on hospital surfaces, which is concerning as these surfaces can act as reservoirs, facilitating cross-transmission in the hospital environment. Epidemiological studies are essential to better understand the behavior of this bacterium and to develop new protocols and strategies to reduce its spread.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104707"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"COST REDUCTION AND RESOURCE OPTIMIZATION: ECONOMIC EVALUATION OF AN ANTIMICROBIAL PROGRAM IN AN INFECTIOUS DISEASES HOSPITAL","authors":"Lucas Mendes Feitosa Dias ,&nbsp;Karine Kimberlly Rocha da Fonseca ,&nbsp;Lílian Macambira Pinto ,&nbsp;Evelyne Santana Girão","doi":"10.1016/j.bjid.2026.104711","DOIUrl":"10.1016/j.bjid.2026.104711","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>The Antimicrobial Management Program (AMP) is an institutional strategy aimed at optimizing antimicrobial use in healthcare services, ensuring therapeutic efficacy, reducing adverse events associated with inappropriate use, preventing the selection of resistant microorganisms, and lowering unnecessary healthcare costs. In an infectious diseases hospital, patients often require intensive and prolonged antimicrobial use, making this setting particularly vulnerable to resistant bacteria and high expenditures on costly therapies. This study aimed to analyze the economic impact of the AMP on antimicrobial treatment costs in an infectious diseases hospital.</div></div><div><h3>Methods</h3><div>This is a descriptive and retrospective study based on AMP monitoring data collected in 2024 in a tertiary hospital specializing in infectious diseases. Information was obtained from program performance indicators, including planned versus actual antimicrobial expenditure and adherence to clinical stewardship interventions. The study was approved under protocol number 7.423.682 and CAAE 85396524.8.0000.5044.</div></div><div><h3>Results</h3><div>In 2024, projected antimicrobial expenditures were estimated at R$590,626.48. Through AMP intervention strategies, actual spending totaled R$298,503.35, resulting in direct savings of R$292,123.13 and an optimization rate of 50.54%. These results were achieved through interdisciplinary clinical audits, early treatment reassessments, and promotion of responsible use of broad-spectrum antimicrobials. The program also had a positive clinical impact, with infection cure rates of up to 27% in some months and hospital mortality rates below 26% among monitored patients.</div></div><div><h3>Conclusion</h3><div>The AMP proved effective in reducing antimicrobial expenditures in an infectious diseases hospital without compromising clinical outcomes. The savings of over R$290,000 in a single year demonstrate the strategy’s economic potential, particularly in high-complexity settings. Strengthening such initiatives is essential for the sustainability of healthcare systems and the fight against antimicrobial resistance.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104711"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453771","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"INFECTIONS CAUSED BY NDM- AND NDM+KPC-PRODUCING ENTEROBACTERALES: EPIDEMIOLOGICAL PROFILE IN A UNIVERSITY HOSPITAL","authors":"Rafael Amoroso Santos,&nbsp;Nathália de Lima Martins Abichabki,&nbsp;Nayara Maria Garcia,&nbsp;Renata Helena Candido Pocente,&nbsp;Denissani Aparecida Ferrari dos Santos Lima,&nbsp;Amaury Quaggio Neto,&nbsp;Lécio Rodrigues Ferreira,&nbsp;Natali Canelli Valim,&nbsp;Leonardo Neves de Andrade,&nbsp;Valdes Roberto Bollela,&nbsp;Cinara Silva Feliciano","doi":"10.1016/j.bjid.2026.104685","DOIUrl":"10.1016/j.bjid.2026.104685","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>The production of New Delhi Metallo-β-lactamase (NDM) by Enterobacterales has a major impact on antimicrobial therapy, particularly in multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains, significantly limiting treatment options. Additionally, the co-production of NDM and <em>Klebsiella pneumoniae</em> carbapenemase (KPC) has emerged and may result in pandrug-resistant phenotypes. This study aimed to describe the local epidemiology of infections caused by NDM- and NDM+KPC-producing Enterobacterales, correlating clinical and microbiological data.</div></div><div><h3>Methods</h3><div>Bacterial isolates producing NDM or co-producing NDM and KPC were analyzed from various clinical specimens (urine, tracheal aspirate, blood, surgical wounds) collected from patients admitted to a university hospital between January and June 2025. Detection of NDM and KPC was performed using an immunochromatographic assay for carbapenemases, and bacterial identification was carried out by MALDI-TOF. Clinical data were obtained through chart review.</div></div><div><h3>Results</h3><div>During the study period, 36 NDM-producing isolates and 9 NDM+KPC co-producing isolates were identified, comprising <em>Klebsiella pneumoniae</em> (n = 27), <em>Klebsiella oxytoca</em> (n = 1), <em>Klebsiella variicola</em> (n = 2), <em>Enterobacter cloacae</em>(n = 12), <em>Escherichia coli</em> (n = 1), and <em>Kluyvera intermedia</em> (n = 2). The majority (n = 16, 35%) were isolated from urine samples, followed by tracheal aspirates (n = 9, 20%). A total of 33 patients were affected, with a median age of 63 years; 42% (n = 14) were hospitalized in clinical wards and 21% (n = 7) in intensive care units. Five patients (15.2%) were immunosuppressed, and the overall mortality rate was 42% (n = 14).</div></div><div><h3>Conclusion</h3><div>A significant circulation of NDM-producing Enterobacterales was observed, mainly <em>K. pneumoniae</em> and <em>E. cloacae</em>, predominantly from urinary and tracheal aspirate samples. The detection of isolates co-producing NDM and KPC highlights the potential for dissemination of even broader resistance phenotypes, directly impacting available therapeutic options. These findings underscore the importance of active microbiological surveillance, strict infection control measures, and rational antimicrobial use to prevent the spread of these clinically and epidemiologically relevant strains.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104685"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453964","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"CONSERVED STRUCTURAL INTERACTIONS SUGGEST POTENTIAL BINDING OF N-ACETYLCYSTEINE TO THE UREASE OF CLINICAL ACINETOBACTER ISOLATES","authors":"Ana Lídia Pires de Assis Pinto,&nbsp;João Pedro Vasques da Conceição,&nbsp;Fabio Faria da Mota","doi":"10.1016/j.bjid.2026.104686","DOIUrl":"10.1016/j.bjid.2026.104686","url":null,"abstract":"<div><h3>Introduction</h3><div>N-acetylcysteine (NAC), a mucolytic widely used in medical practice for the treatment of viral infections, has also shown antimicrobial properties through the inhibition of the bacterial urease of <em>Proteus mirabilis</em> [1]. Urease is a nickel-dependent enzyme that hydrolyzes urea into ammonia and carbon dioxide, promoting bacterial persistence through an increase in local pH. In <em>Acinetobacter</em> spp.<em>,</em> a genus frequently associated with multidrug-resistant infections, urease is a virulence factor critical for persistence in macrophages during lung infection [2].</div></div><div><h3>Objective</h3><div>This study evaluated the binding of NAC to the immature (apoenzyme) and mature (holoenzyme) forms of urease from clinical <em>Acinetobacter</em> isolates.</div></div><div><h3>Methods</h3><div>The structures were modeled using AlphaFold3 (apo) and AlphaFill (holo), the latter including Ni²⁺ cofactors in the active site. NAC was submitted to molecular docking with AutoDock Vina (v1.2.7) in both forms. The interactions were analyzed in PoseView, and the conservation of residues was verified by multiple alignment of 233 sequences of clinical isolates using MAFFT (v7.505).</div></div><div><h3>Results</h3><div>Docking simulations suggested similar binding affinities for the apoenzyme and holoenzyme, –4.7 kcal/mol and –4.4 kcal/mol, respectively. NAC interacted with an overlapping set of residues in both forms, including His133, His135, His218, His245, His271, and Ala362, mainly through hydrogen bonds and salt bridges. In the apoenzyme, a salt bridge was observed with Lys216, while in the holoenzyme, NAC formed a specific hydrogen bond with Asp359 and coordinated both Ni²⁺ ions — an interaction absent in the apo form. These subtle differences reflect the structural changes associated with enzymatic maturation, but overall, the binding mode was highly conserved. The multiple alignment of 233 <em>Acinetobacter</em> spp. urease sequences from clinical isolates confirmed that all interacting residues are highly conserved, reinforcing their functional importance.</div></div><div><h3>Conclusion</h3><div>The ability of NAC to bind to structurally essential residues of the active site of urease from clinical <em>Acinetobacter</em> spp. suggests the potential repositioning of this drug for the attenuation of virulence in clinical infections by multidrug-resistant <em>Acinetobacter baumannii</em>.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104686"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453965","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IMPACT OF THE COVID-19 PANDEMIC ON ANTIMICROBIAL CONSUMPTION IN BRAZIL: A RETROSPECTIVE STUDY FROM 2014 TO 2021","authors":"Matheus Negri Boschieiro ,&nbsp;Nathalia Sansone ,&nbsp;Laura Ribeiro Matos ,&nbsp;Lucas Silva Mello ,&nbsp;Luiz Felipe Azevedo Marques ,&nbsp;Fernando Augusto Lima Marson","doi":"10.1016/j.bjid.2026.104674","DOIUrl":"10.1016/j.bjid.2026.104674","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>During the COVID-19 pandemic, an increase in hospital use of these medications was observed, raising concerns regarding their impact on antimicrobial resistance. The objective of this study was to evaluate antimicrobial consumption in Brazil during the COVID-19 pandemic period.</div></div><div><h3>Methods</h3><div>Retrospective study. Data on antimicrobial consumption were obtained from the National Controlled Products Management System. Consumption was calculated in annual Defined Daily Doses per 1,000,000 inhabitant-days (DDD/1,000,000 inhabitant-days), using the formula: (total weight dispensed in the year, in g × 1,000,000) ÷ (DDD of the substance, in g × Brazilian population of the year × 365). Multiple linear regression was performed to assess the association between consumption and the pandemic, including an interaction term between the month of dispensing and the pandemic period (2014–2019 considered pre-pandemic and 2020 onward as post-pandemic). Results were expressed as estimates with 95% confidence intervals and a significance level of α &lt; 0.05.</div></div><div><h3>Results</h3><div>The following antimicrobials were included: amoxicillin, amoxicillin-clavulanic acid, azithromycin, ceftriaxone, chloramphenicol, ciprofloxacin, clarithromycin, clindamycin, doxycycline, erythromycin, levofloxacin, sulfamethoxazole-trimethoprim, tetracycline, and vancomycin. The highest DDD value was observed for azithromycin in 2017 (2,305.13 per 1,000,000 inhabitant-days), followed by amoxicillin-clavulanic acid in 2019 (1,090.22) and amoxicillin in 2017 (1,079.20). In 2020, ceftriaxone (+175.1%), meropenem (+55.2%), and clindamycin (+23.6%) showed increased consumption compared with 2019, whereas erythromycin (−91.3%), clarithromycin (−73.5%), and amoxicillin (−59.9%) exhibited the greatest decreases. In 2021, ceftriaxone (+212.4%) consumption further increased, while erythromycin (−86.9%), clarithromycin (−73.0%), and amoxicillin (−61.0%) maintained a declining trend. In multiple linear regression, the model was statistically significant (p &lt; 0.05) for amoxicillin, azithromycin, chloramphenicol, ciprofloxacin, clarithromycin, doxycycline, erythromycin, tetracycline, vancomycin, and meropenem. However, there was no statistically significant interaction between consumption and the pandemic period in any model.</div></div><div><h3>Conclusion</h3><div>An increase in the consumption of certain antimicrobials was observed during the post-pandemic period. However, the findings do not indicate a statistically significant association between the COVID-19 pandemic and national antimicrobial consumption.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104674"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ACTIVITY OF NEW ANTIMICROBIALS AGAINST MULTIDRUG-RESISTANT CLINICAL ISOLATES OF KLEBSIELLA PNEUMONIAE AND ACINETOBACTER BAUMANNII","authors":"Eduardo Alexandrino Medeiros,&nbsp;Karen de Castro Bauab,&nbsp;Felipe Alberto Lei,&nbsp;Caio de Castro Novais,&nbsp;Samily Aquino de Sá Oliveira,&nbsp;Josiane Trevisol Leal,&nbsp;Diego Cassola Pronunciato,&nbsp;Diogo Boldin Ferreira","doi":"10.1016/j.bjid.2026.104638","DOIUrl":"10.1016/j.bjid.2026.104638","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>Given the scarcity, or even absence, of effective therapies for the treatment of infections caused by multidrug-resistant (MDR) <em>K. pneumoniae</em> and/or <em>A. baumannii</em> in Brazil, combinations of β-lactams with next-generation β-lactamase inhibitors and tetracycline derivatives have emerged as promising antimicrobials.</div></div><div><h3>Objective</h3><div>To evaluate the <em>in vitro</em> activity of new antimicrobials against MDR isolates obtained from patients hospitalized in ICUs of six hospitals in the metropolitan region of São Paulo.</div></div><div><h3>Methods</h3><div>A total of 121 isolates of <em>K. pneumoniae</em> and 27 of <em>A. baumannii</em>, prospectively collected from patients hospitalized in six ICUs of the metropolitan region of São Paulo between 08/01/2023 and 10/31/2024, resistant to carbapenems, were analyzed. MICs for polymyxin B/E (POL), omadacycline (OMC), and eravacycline (ERV) were determined by broth microdilution (Sensititre, Thermo Fisher). For <em>K. pneumoniae</em>, 118 isolates without evidence of metallo-β-lactamase production were additionally tested for ceftazidime-avibactam (CZA), imipenem-relebactam (IMR), and meropenem-vaborbactam (MEV). Resistance genes of 55 <em>K. pneumoniae</em> and 21 <em>A. baumannii</em> were correlated with phenotypes.</div></div><div><h3>Results</h3><div>The susceptibility rates of <em>K. pneumoniae</em> to CZA, IMR, and MEV were 87.29%, 74.58%, and 82.20%, respectively. Among the 59 isolates resistant to amikacin (AMI) and POL, these rates were 96.91%, 75.86%, and 82.76%. Applying FDA breakpoints, 6 isolates (4.96%) were resistant to OMC (MIC &gt; 8 mg/L) and 12 (9.92%) were intermediate (8 mg/L). Even among AMI/POL-resistant isolates, OMC susceptibility was 91.53%. For ERV, the MIC₉₀ was 1 mg/L in the overall group and 2 mg/L among resistant isolates. Of the 55 genomes analyzed, 92.73% carried blaKPC-2, 3.64% blaNDM-1, and 1.82% both. Two isolates with blaNDM-1 showed favorable MICs for ERV (0.5 mg/L) and OMC (≤ 4 mg/L). In <em>A. baumannii</em>, MIC₅₀/MIC₉₀ values were 2/8 mg/L for OMC and 0.5/2 mg/L for ERV. Among the 10 isolates resistant to POL, OMC showed an increased MIC₉₀ to 8 mg/L, but ERV maintained a profile similar to the overall group.</div></div><div><h3>Conclusion</h3><div><em>K. pneumoniae</em> strains showed excellent activity to CZA, IMR, and MEV. MDR <em>K. pneumoniae</em> and <em>A. baumannii</em> strains were also susceptible to OMC and ERV, including subgroups resistant to POL, reinforcing the potential of these drugs as therapeutic options in highly resistant settings such as Brazilian ICUs.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104638"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454125","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"IN VITRO ACTIVITY OF AZTREONAM-AVIBACTAM AGAINST CLINICAL ISOLATES OF ENTEROBACTERALES COLLECTED IN BRAZIL FOR THE ATLAS SURVEILLANCE PROGRAM, 2018–2023","authors":"Lorena Cristina Correa Fehlberg,&nbsp;Camilla Natal De Gaspari,&nbsp;Daniela V Pachito","doi":"10.1016/j.bjid.2026.104639","DOIUrl":"10.1016/j.bjid.2026.104639","url":null,"abstract":"<div><h3>Introduction</h3><div>Aztreonam-avibactam (ATM-AVI) was developed for the treatment of infections caused by Enterobacterales, particularly carbapenem-resistant isolates that produce metallo-β-lactamases (MBLs). Aztreonam is stable to hydrolysis by MBLs, while avibactam inhibits class A and C β-lactamases, which may also be co-produced with MBLs that inactivate aztreonam. In this study, the <em>in vitro</em> activity of ATM-AVI was evaluated against clinical isolates of Enterobacterales, both MBL producers and non-producers, collected as part of the global ATLAS surveillance program.</div></div><div><h3>Methods</h3><div>A total of 3151 non-duplicate Enterobacterales isolates collected from different infection sites in Brazilian hospitals between 2018 and 2023 were evaluated. Susceptibility testing was performed using broth microdilution. Antimicrobial susceptibility profiles were interpreted according to BrCAST (2025) breakpoints, including the established breakpoint for ATM-AVI of &gt; 4 mg/L. Carbapenemase-encoding genes were investigated by PCR followed by sequencing.</div></div><div><h3>Results</h3><div>The majority of Enterobacterales species evaluated were <em>Klebsiella pneumoniae</em> (36.0%; n = 1137), followed by <em>Escherichia coli</em> (31.6%; n = 998) and <em>Enterobacter</em> sp. (12.6%; n = 399). Overall, ATM-AVI inhibited 100% of isolates (MIC50/90, 0.06/0.25 mg/L), including those producing carbapenemases (588/960 isolates tested [61.2%]). Overall susceptibility to colistin (MIC50/90, 0.25/&gt;8 mg/L), meropenem (MIC50/90, ≤ 0.06/&gt; 16 mg/L), cefepime (MIC50/90, ≤ 0.125/&gt; 32 mg/L), and aztreonam (MIC50/90, 0.25/&gt; 64 mg/L) was 85.7%, 80.6%, 58.4%, and 56.9%, respectively. Among the 960 isolates tested for carbapenemases, 119 (12.4%) were positive for NDM-1 and 492 (51.2%) for KPC. Twenty-five isolates showed coproduction of two carbapenemases, 24 with KPC-2+NDM-1 and one with KPC-2+IMP-1. All 492 KPC-positive isolates were 100% and 94.72% susceptible to ATM-AVI and ceftazidime-avibactam, respectively.</div></div><div><h3>Conclusion</h3><div>ATM-AVI demonstrated excellent <em>in vitro</em> activity, inhibiting 100% of Enterobacterales isolates, both carbapenemase producers and non-producers, including MBLs. Antibiotics that retain activity against MBL-producing bacteria represent an urgent medical need, especially given the rising prevalence of severe infections caused by these difficult-to-treat microorganisms.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104639"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454126","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANALYSIS OF IN VITRO ACTIVITY OF CEFTAZIDIME-AVIBACTAM AGAINST CLINICAL ISOLATES OF PSEUDOMONAS AERUGINOSA COLLECTED FROM BRAZILIAN CENTERS FOR THE ATLAS SURVEILLANCE PROGRAM, 2018-2023","authors":"Lorena Cristina Correa Fehlberg,&nbsp;Camilla Natal De Gaspari,&nbsp;Daniela V Pachito","doi":"10.1016/j.bjid.2026.104629","DOIUrl":"10.1016/j.bjid.2026.104629","url":null,"abstract":"<div><h3>Introduction</h3><div><em>Pseudomonas aeruginosa</em> is a pathogen that causes severe infections that are difficult to treat, as this bacterium can express multiple resistance mechanisms, in addition to its intrinsically limited susceptibility to many antibiotics. In this study, the <em>in vitro</em> activity of ceftazidime-avibactam was evaluated against clinical isolates of <em>P. aeruginosa</em>, both carbapenemase-producing and non-producing, collected as part of the global ATLAS surveillance program.</div></div><div><h3>Methods</h3><div>A total of 1239 non-duplicate <em>P. aeruginosa</em> isolates were evaluated, collected from different infection sites in hospitals across Brazil between 2018 and 2023. Susceptibility testing was performed using broth microdilution. The antimicrobial susceptibility profile was analyzed according to the breakpoints established by BrCAST (2025). The search for carbapenemase-encoding genes was performed by PCR followed by sequencing. Results Ceftazidime-avibactam (90.0% susceptible; MIC50/90, 2.0/8.0 mg/L) and colistin (99.8% susceptible; MIC50/90, 1.0/1.0 mg/L) were the antibiotics with the best <em>in vitro</em> activity. Approximately 70% of isolates tested for imipenem, cefepime, ceftazidime, and piperacillin-tazobactam were classified as susceptible with increased exposure, according to BrCAST criteria (range 68.7% to 74.5%). Susceptibility to ceftolozane-tazobactam was 84.3% (MIC50/90, 1.0/32.0 mg/L), but this antibiotic was evaluated in only 949/1239 isolates. Resistance gene screening was performed on 153 isolates, of which 17 (11%) were blaKPC-2 producers (4 also coproduced blaGES-1). The beta-lactamases found in 22 (18%) of the 123 ceftazidime-avibactam resistant <em>P. aeruginosa</em> isolates were: NDM-1 (n = 5), KPC-2 (n = 5), VIM-2 (n = 5), SPM-1 (n = 1), SPM-1+GES-1 (n = 1), IMP-16 (n = 1), IMP-56 (n = 1), KPC-2+GES-1 (n = 1), NDM-1+VEB-9 (n = 1), and NDM-1+VEB-14 (n = 1).</div></div><div><h3>Conclusion</h3><div>The results demonstrated that both ceftazidime-avibactam and ceftolozane-tazobactam maintain excellent <em>in vitro</em> activity (&gt; 80%) against clinical isolates of <em>P. aeruginosa</em>. Although the presence of carbapenemases was relatively low among the isolates studied, ceftazidime-avibactam was 5 times more potent (MIC90) compared to ceftolozane-tazobactam, which may be partly explained by the presence of these beta-lactamases identified in the evaluated isolates.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104629"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"ANALYSIS OF PHARMACEUTICAL INTERVENTIONS IN ANTIMICROBIALS AFTER IMPLEMENTATION OF A CLINICAL PHARMACIST SPECIALIZED IN THE ANTIMICROBIAL STEWARDSHIP PROGRAM","authors":"Tatiana Aporta Marins,&nbsp;Moacyr Silva Junior,&nbsp;Emy Akiyama Gouveia,&nbsp;Maria Daniela Di Dea Bergamasco,&nbsp;Roberta Gonsalez dos Santos,&nbsp;Silvana Maria de Almeida","doi":"10.1016/j.bjid.2026.104630","DOIUrl":"10.1016/j.bjid.2026.104630","url":null,"abstract":"<div><h3>Introduction</h3><div>Inappropriate use of antimicrobials is a global challenge and contributes to increased microbial resistance and clinical complications. Effective management of these drugs is essential to optimize treatment and preserve the efficacy of antimicrobials. Antimicrobial Stewardship Programs (ASP) aim to ensure the appropriate use of antimicrobials (ATM) and achieve better clinical and microbiological outcomes, and several studies demonstrate the essential role of the clinical pharmacist in this context. Our objective was to evaluate pharmaceutical interventions in antimicrobials after the implementation of a clinical pharmacist dedicated to the ASP and specialized in infectious diseases.</div></div><div><h3>Methods</h3><div>A retrospective and quantitative analysis of pharmaceutical interventions in antimicrobials was conducted in the years 2023, 2024, and the first quarter of 2025. Data were collected monthly, recording the reasons for interventions, total number and monthly average of interventions, and the adherence rate of medical teams.</div></div><div><h3>Results</h3><div>Among the three main reasons for pharmacotherapeutic interventions were duration of therapy, dose, and indication. In 2023, 3,353 interventions were recorded, with a monthly average of 279 and an adherence rate of 74.7%. In 2024, the total number of interventions increased to 4,298, with a monthly average of 358 and an adherence rate of 81.1%. In the first quarter of 2025, 1,389 interventions were performed, resulting in a monthly average of 463 and an adherence rate of 88.3%. These data demonstrate an increase over time in both the number of monthly interventions and the adherence of medical teams.</div></div><div><h3>Conclusion</h3><div>The implementation of a specialist clinical pharmacist dedicated to antimicrobial management resulted in a substantial increase in pharmacotherapeutic interventions and in the adherence of medical teams. These results indicate that the presence of a professional specialized in the Antimicrobial Stewardship Program is essential to improve clinical practice and promote the appropriate use of antimicrobials, contributing to the fight against microbial resistance. Continuity and expansion of this model are recommended to further optimize clinical outcomes and patient safety.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104630"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454193","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}