Brazilian Journal of Infectious Diseases最新文献

{"title":"HYDROALCOHOLIC EXTRACT OF PUNICA GRANATUM L. (POMEGRANATE) LEAF AND ITS ANTIMICROBIAL EFFECT AGAINST ORAL PATHOGENS","authors":"Luciana Cláudia Diniz Tavares,&nbsp;Mariana Simões,&nbsp;Bernardo Canedo,&nbsp;Ana Bárbara Polo,&nbsp;Ana Carolina Morais Apolônio","doi":"10.1016/j.bjid.2026.104667","DOIUrl":"10.1016/j.bjid.2026.104667","url":null,"abstract":"<div><h3>Introduction/Objectives</h3><div>Dental biofilm (DB) is a complex microbial structure associated with caries and periodontal disease, representing a major focus of oral microbiology research. Bacteria such as <em>Streptococcus mutans</em> and <em>Streptococcus sobrinus</em> are cariogenic due to their acid production, which promotes enamel demineralization. Preventing DB formation is challenging given its structural and microbial complexity, along with genetic and environmental factors. In this context, natural products have been investigated as alternatives to synthetic antimicrobials due to their lower toxicity, better biocompatibility, and reduced cost. <em>Punica granatum</em> (pomegranate) is known for its antimicrobial activity, attributed to phenolic compounds such as tannins and flavonoids. Although the fruit, seeds, and flowers have been studied, the leaves of <em>P. granatum</em> remain poorly explored. This study aimed to develop a hydroalcoholic extract from pomegranate leaves (HPE) and evaluate its antibacterial and antibiofilm activity against oral microorganisms.</div></div><div><h3>Methods</h3><div><em>P. granatum</em> leaves were collected, macerated in 50% hydroalcoholic solution, and evaporated. The HPE was tested against bacterial and fungal strains relevant to dentistry using MIC and MBC tests according to CLSI (2022). Activity against <em>S. mutans</em> and <em>S. sobrinus</em> biofilms was evaluated through adhesion and disruption assays. Characterization was performed using Raman spectroscopy and AFM. Cytotoxicity was tested on J774A1 cells (MTT assay).</div></div><div><h3>Results</h3><div>The HPE showed significant antimicrobial activity, with MICs ranging from 0.39 to 6.25 µg/mL for bacteria and 1.56 µg/mL for yeasts. It demonstrated bactericidal activity against most strains. It inhibited <em>S. sobrinus</em> adhesion by up to 66.27% (2 × MIC) and showed biofilm-disrupting efficacy similar to azithromycin. The extract displayed low cytotoxicity and homogeneous structure, with viability higher than the control at all concentrations.</div></div><div><h3>Conclusion</h3><div>The HPE exhibited relevant antimicrobial and antibiofilm potential, with low toxicity and high efficacy against oral pathogens. Although the results are promising, further studies are needed to elucidate its mechanisms of action and validate its clinical application as a complementary therapy in dentistry.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104667"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454294","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":"SUSCEPTIBILITY PROFILE TO PLANT EXTRACTS OF CANDIDA SPP. ISOLATES FROM URINE IN RECENT YEARS IN A UNIVERSITY HOSPITAL OF MINAS GERAIS","authors":"Laura Lavorato Soldati ,&nbsp;João Joaquim de Matos ,&nbsp;Larissa Negrão Rebelo de Almeida ,&nbsp;Maria de Lourdes Junqueira ,&nbsp;Caroline Priamo Gama ,&nbsp;Danilo de Souza Costa ,&nbsp;Ademar Alves da Silva Filho ,&nbsp;Francis Moreira Borges ,&nbsp;Priscila de Faria Pinto","doi":"10.1016/j.bjid.2026.104703","DOIUrl":"10.1016/j.bjid.2026.104703","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>In the hospital environment, several factors that lead to microbial dysbiosis contribute to the development of fungal infections caused by yeasts of the genus <em>Candida</em>, with the emergence of resistance already documented. Plant extracts have become potential sources for the discovery of bioactive compounds with antimicrobial activity, as new alternatives for the treatment of antifungal-resistant infections are urgently needed. The objective of this study was to evaluate the antifungal potential of plant extracts against <em>Candida</em> species resistant to commercial antifungal agents, isolated from urine samples of hospitalized patients with candiduria in a university hospital in Minas Gerais.</div></div><div><h3>Methods</h3><div>Yeasts were isolated and identified between March 2021 and January 2023. For yeasts resistant to one or more commercial antifungal agents, susceptibility tests were carried out using five different plant extracts (<em>Amaranthus viridis</em>, <em>Stachys lanata</em>, <em>Glycyrrhiza inflata</em>, <em>Pothomorphe umbellata</em>, and <em>Renealmia petasites</em>) in serial concentrations, by broth microdilution technique, to determine the minimum inhibitory concentration (MIC) of the extract capable of inhibiting fungal growth.</div></div><div><h3>Results</h3><div>Between 2021 and 2023, 42 yeast isolates of different species showed resistance to one or more tested antifungal drugs and were recovered to evaluate the antifungal potential of the plant extracts. The MIC value was higher than the maximum concentration tested (&gt; 1000 µg/mL) for four of the five extracts (<em>R. petasites</em>, <em>S. lanata</em>, <em>A. viridis</em>, and <em>G. inflata</em>), suggesting that these did not show significant activity against <em>Candida</em> strains resistant to commercial antifungals. Only the extract of <em>P. umbellata</em> showed moderate inhibitory and fungicidal activity against some <em>Candida</em> strains (26.2%), including 5 strains of <em>C. glabrata</em> (19.2%), 5 strains of <em>C. parapsilosis</em> (71.4%), and one strain of <em>C. kefyr</em> (100%).</div></div><div><h3>Conclusion</h3><div>This study identified a potential antifungal activity for the <em>P. umbellata</em> extract, which remains to be further explored. This finding reinforces the importance of searching for active molecules and potential new drugs, which may provide alternatives to overcome therapeutic limitations, poor bioavailability, and toxicity of current antifungals, as well as the increasing resistance among fungal species.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104703"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453840","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":"ENVIRONMENTAL MONITORING OF VANCOMYCIN-RESISTANT ENTEROCOCCI IN BEACHES OF NITERÓI-RJ","authors":"Ellen Katy Minervino ,&nbsp;Maria Antônia Wasserman ,&nbsp;Julia Peixoto Albuquerque ,&nbsp;Laura Maria Andrade de Oliveira ,&nbsp;Natália Costa da Silva ,&nbsp;Tatiana de Castro Abreu Pinto ,&nbsp;Carmen Baur Vieira ,&nbsp;Felipe Piedade Gonçalves Neves ,&nbsp;Lucia Martins Teixeira ,&nbsp;Rachel Leite Ribeiro ,&nbsp;Aline Rosa Vianna de Souza","doi":"10.1016/j.bjid.2026.104691","DOIUrl":"10.1016/j.bjid.2026.104691","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>The genus <em>Enterococcus</em> stands out as one of the main causes of healthcare-associated infections (HAIs), with vancomycin-resistant <em>Enterococcus faecium</em> (VREfm) considered high-priority pathogens in terms of antimicrobial resistance (AMR) by the World Health Organization (WHO). They are sentinel microorganisms for the spread of AMR in the One Health context and can be found in marine environments. Considering these aspects, this study aimed to characterize the phenotypic and genotypic antimicrobial resistance of enterococci isolated from coastal waters of representative beaches of the Guanabara Bay (Icaraí and Jurujuba) and the oceanic region (Piratininga) of Niterói-RJ.</div></div><div><h3>Methods</h3><div>A total of 37 water samples collected between 2022 and 2023 were analyzed. The samples were identified by mass spectrometry (MALDI-TOF MS), followed by disk diffusion and Minimum Inhibitory Concentration (MIC) determination by E-test, to assess the phenotype of vancomycin resistance. For genotypic analysis, detection of vancomycin resistance genes (vanA, vanB, and vanC1) was performed, followed by Sanger sequencing.</div></div><div><h3>Results</h3><div>Among the results obtained, five distinct species were identified, with <em>E. faecium</em> being prevalent (48.65%), followed by <em>E. faecalis</em> (24.32%), <em>E. casseliflavus</em> (10.81%), <em>E. hirae</em> (10.81%), and <em>E. gallinarum</em> (5.41%). Regarding isolation sites: Jurujuba Beach (22) &gt; Icaraí (8) &gt; Piratininga (7). Of the 20 samples subjected to disk diffusion testing, 17 were sensitive and 3 intermediate to vancomycin. All were susceptible to teicoplanin. Although the <em>vanA</em> gene was not found, the <em>vanB</em> gene was detected in 3 samples: VREfm (MIC: 4 μg/mL) and <em>E. gallinarum</em> (MIC: 3 μg/mL, vanC1) isolated from Icaraí, and VREfm (MIC: 0.38 μg/mL) isolated from Jurujuba, the latter with sequence confirmed and &gt; 99% identity with the <em>vanB</em> gene of <em>E. faecium</em>.</div></div><div><h3>Conclusion</h3><div>Although the strains are not expressing vancomycin resistance <em>in vitro</em>, the presence of <em>vanB</em> in isolates from coastal waters is concerning, as this phenotype may be expressed <em>in vivo</em>, and vancomycin is one of the last-resort antimicrobials for treating infections caused by <em>E. faecium.</em> Therefore, continuous environmental surveillance of vancomycin resistance genes in these bacteria is essential, given their potential to pose a public health threat.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104691"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453914","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 ANTIBIOTIC CONSUMPTION IN BRAZIL: INCREASE IN HOSPITAL PRESCRIPTIONS AND FUTURE IMPLICATIONS","authors":"Davi de Souza Pinheiro","doi":"10.1016/j.bjid.2026.104676","DOIUrl":"10.1016/j.bjid.2026.104676","url":null,"abstract":"<div><h3>Introduction</h3><div>The COVID-19 pandemic placed pressure on healthcare systems and led to expanded and empirical use of antibiotics, despite being a viral infection. Fear of coinfections, lack of microbiological diagnosis, and off-protocol use of drugs such as azithromycin and ceftriaxone contributed to this increase. This study evaluates the pattern of hospital antibiotic prescriptions within the Brazilian Unified Health System (SUS) during the pandemic and its implications for antimicrobial resistance.</div></div><div><h3>Methods</h3><div>Ecological, descriptive study based on data from the SUS Hospital Information System (SIH/SUS) and the Health Price Database (BPS). Hospitalizations with recorded administration of systemic antibacterials (ATC code J01) between January 2019 and December 2023 were included. Data were aggregated by year, geographic region, and active substance. Frequency of use, average cost per hospitalization, and temporal trends were evaluated. Antibiotics showing the greatest growth were identified and compared across Brazil’s five regions.</div></div><div><h3>Results</h3><div>Between 2019 and 2023, there was a significant increase in hospital antibiotic use in Brazil, peaking in 2021. In 2020, ceftriaxone use rose 35% compared with 2019, while azithromycin increased by 120%, especially in field hospitals and emergency units. The average cost per hospitalization involving antibiotics rose from R$ 4,200 in 2019 to R$ 6,150 in 2021. In 2022 and 2023, usage stabilized but did not return to pre-pandemic levels. The Southeast and Northeast regions accounted for 65% of total hospital antibiotic consumption during the period evaluated.</div></div><div><h3>Conclusion</h3><div>The increase in antibiotic use during the COVID-19 pandemic in Brazil reflected clinical uncertainty and the adoption of non-evidence-based practices, with frequent empirical prescriptions lacking bacterial coinfection confirmation. This scenario contributed to the risk of antimicrobial resistance, worsened by persistently high consumption even after the acute pandemic phase. Regional disparities indicate differences in protocol adherence and diagnostic access. Therefore, there is an urgent need for rational use programs, stewardship strategies, team training, and expansion of access to microbiological testing.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104676"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454068","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":"LONGITUDINAL ANALYSIS (2018 TO 2023) OF THE IN VITRO ACTIVITY OF CEFTAZIDIME-AVIBACTAM AGAINST CLINICAL ISOLATES OF KLEBSIELLA PNEUMONIAE COLLECTED FROM BRAZILIAN CENTERS FOR THE ATLAS SURVEILLANCE PROGRAM","authors":"Lorena Cristina Correa Fehlberg,&nbsp;Camilla Natal De Gaspari,&nbsp;Daniela V Pachito","doi":"10.1016/j.bjid.2026.104635","DOIUrl":"10.1016/j.bjid.2026.104635","url":null,"abstract":"<div><h3>Introduction</h3><div>Ceftazidime-avibactam (CAZ-AVI) is a β-lactam/β-lactamase inhibitor combination approved for the treatment of multidrug-resistant Gram-negative bacteria. It shows activity against β-lactamases of Classes A, C, and D (Oxa-48), but not against metallo-β-lactamases (MBLs). In this study, the <em>in vitro</em> activity of CAZ-AVI was evaluated against clinical isolates of Klebsiella pneumoniae, both KPC producers and non-producers, collected as part of the global ATLAS surveillance program.</div></div><div><h3>Methods</h3><div>A total of 1137 non-duplicate isolates of K. pneumoniae, collected from different infection sites in hospitals in Brazil between 2018 and 2023, were evaluated. Susceptibility testing was determined using broth microdilution and susceptibility profiles were analyzed according to BrCAST (2025) breakpoints. Carbapenemase-encoding genes were investigated by PCR followed by sequencing.</div></div><div><h3>Results</h3><div>Overall, CAZ-AVI was the antibiotic with the best <em>in vitro</em> activity (93.4% susceptibility; MIC50/90, 0.5/4.0 mg/L) compared to meropenem (58.3% susceptibility; MIC50/90, 0.125/&gt;16 mg/L) and colistin (84.4% susceptibility; MIC50/90, 0.25/&gt;8 mg/L). CAZ-AVI maintained potent <em>in vitro</em> activity each year, with MIC50 values of 0.25 mg/L (2018) and 0.5 mg/L (2019, 2020, 2022, 2023) and MIC90 values of 2.0 mg/L (2018, 2019) and 4.0 mg/L (2020–2023). In 2018 and 2023, 100% and 90.3% of isolates, respectively, were susceptible to CAZ-AVI. Susceptibility to colistin (∼85%) and gentamicin (∼62%) remained stable over the years, but a significant decrease was observed for meropenem (77% in 2018 – 57.4% in 2023) and cefepime (50% in 2018 – 35.8% in 2023). Of the isolates, 402 (35.3%) were positive for KPC (KPC-2, 94.7%). Among these, susceptibility to CAZ-AVI was 94.5% (MIC50/90, 1.0/4.0 mg/L). Of the 75 (6.6%) isolates resistant to CAZ-AVI, 51 were positive only for NDM-1, 21 showed coproduction of carbapenemases (20 for KPC-2+NDM-1 and one for KPC-2+IMP-1), one isolate was positive only for KPC, one isolate positive only for IMP-1, and one isolate in which carbapenemases were not detected.</div></div><div><h3>Conclusion</h3><div>The results demonstrated that CAZ-AVI showed potent <em>in vitro</em> activity against the K. pneumoniae isolates evaluated, including those positive for KPC. Resistance to CAZ-AVI observed in this study was associated with the production of MBLs, especially NDM-1, as well as the coproduction of KPC+NDM.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104635"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454122","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":"ETHYLENEDIAMINETETRAACETIC ACID AS A STRATEGY TO INHIBIT BIOFILMS OF ACINETOBACTER BAUMANNII DERIVED FROM HOSPITAL INFECTION","authors":"Suelen Lopes Lussanrriaga,&nbsp;Carolina de Oliveira Nazareth,&nbsp;Marcelle Oliveira Garcia,&nbsp;Rosemarlei Quincozes,&nbsp;Natália Popiorek dos Santos,&nbsp;Daniela Fernandes Ramos","doi":"10.1016/j.bjid.2026.104626","DOIUrl":"10.1016/j.bjid.2026.104626","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>The gram-negative coccobacillus <em>Acinetobacter baumannii</em> has frequently been associated with infections occurring after the hospitalization of patients in intensive care units. Its dissemination in hospitals has been favored by its ability to form biofilms, a matrix composed of carbohydrates, proteins, nucleic acids, and other macromolecules, on surfaces and medical devices. Studies have shown that mechanisms related to reduced microbial susceptibility tend to promote cross-resistance among antibiotics, biocides, and disinfectants, contributing to longer hospital stays and increased resistance to available antimicrobials. In addition, few biocides are available on the market, and some already have intrinsic resistance documented and exacerbated by incorrect use and concentration. Even so, progress in the development of strategies for new compounds acting on devices and surfaces remains limited.</div></div><div><h3>Methods</h3><div>The study was conducted with clinical isolates from a hospital in southern Brazil. The ability to form microbial biofilms was determined as proposed by Halicki et al. (2019). Subsequently, in polystyrene plates, 10⁶ CFU/mL of each isolate was exposed to three concentrations of EDTA (12, 0.6, and 0.3 mM). After incubation for 24 hours at 37°C, the inhibitory capacity of biofilm formation was evaluated using 0.4% crystal violet as an indicator.</div></div><div><h3>Results</h3><div>Half of the isolates (5/10) were classified as moderate biofilm formers. Regarding the biofilm inhibition potential of EDTA, which has a high capacity for metal ion chelation, it was observed that the mean inhibition was 90.8% at a concentration of 12 mM, 82.2% at 0.6 mM, and 22% at 0.3 mM.</div></div><div><h3>Conclusion</h3><div>The ability of the chelating agent EDTA to interact with cations that maintain the structural stability of the bacterial outer membrane may make it more susceptible to the entry of antimicrobial agents and to cell lysis, thereby inhibiting the initial stages of biofilm formation. In this context, EDTA demonstrates potential to inhibit this important virulence mechanism of <em>A. baumannii</em>, highlighting the relevance of further studies exploring its mechanism of action and potential as a biocidal agent.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104626"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454189","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":"N-ACETYLCYSTEINE EXHIBITS POTENTIAL TO INHIBIT THE ACTIVE SITE OF UREASE FROM CLINICAL ISOLATES OF KLEBSIELLA SPP.","authors":"Ana Lídia Pires de Assis Pinto,&nbsp;Fabio Faria da Mota","doi":"10.1016/j.bjid.2026.104628","DOIUrl":"10.1016/j.bjid.2026.104628","url":null,"abstract":"<div><h3>Introduction</h3><div>Urease is a nickel-dependent enzyme linked to the pathogenesis of several bacterial species[1], including carbapenemase-producing <em>Klebsiella</em>, which are often associated with hospital infections and multidrug resistance to antimicrobials. N-acetylcysteine (NAC), a clinically approved compound with mucolytic properties, has also shown <em>in vitro</em> inhibitory activity against <em>Klebsiella pneumoniae</em> urease[2] and other bacteria[3].</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 isolates of <em>Klebsiella</em> spp.</div></div><div><h3>Methods</h3><div>Sequences were aligned, and structural models were generated with AlphaFold3 (apoenzyme) and AlphaFill (holoenzyme), with insertion of Ni²⁺ ions. Docking was performed with AutoDock Vina, and interactions were evaluated using the Protein–Ligand Interaction Profiler (PLIP). The obtained affinities were compared with those of urea as the reference natural substrate.</div></div><div><h3>Results</h3><div>Docking simulations showed strong binding for both forms: -4.8 kcal/mol for the apoenzyme and -5.2 kcal/mol for the holoenzyme. In both states, NAC interacted with a conserved set of residues. Shared interactions included hydrogen bonds with His219 and Asp360, and salt bridges with His134, His136, His219, and His272. In the apoenzyme, a specific hydrogen bond with His246 was observed, whereas in the holoenzyme, NAC formed additional hydrogen bonds with Ala363 and metal coordination with Ni²⁺ ions, absent in the apo form. Despite these subtle differences, the interaction core was highly conserved. Multiple sequence alignment of 438 urease sequences from <em>Klebsiella</em> clinical isolates confirmed that all interacting residues are highly conserved across the genus, indicating functional and structural robustness of the NAC binding interface.</div></div><div><h3>Conclusion</h3><div>These results indicate that NAC has the potential to interact with conserved urease residues, although full inhibition may depend on enzymatic maturation and the presence of metal ions. This binding potential supports the repositioning of NAC as an anti-virulence compound against infections caused by multidrug-resistant <em>Klebsiella</em> spp.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104628"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454191","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":"SCENARIO AND OBSTACLES FOR THE CONSOLIDATION OF ANTIMICROBIAL STEWARDSHIP PROGRAMS IN BRAZILIAN HOSPITALS","authors":"Ingre Paz ,&nbsp;Marcelo Carneiro ,&nbsp;Lucas Augusto Hochscheidt ,&nbsp;Bruna Eduarda Hochscheidt ,&nbsp;Juliéze Sanhudo Pereira ,&nbsp;Mariana Portela de Assis ,&nbsp;Andréia Rosane de Moura Valim ,&nbsp;Magda Machado de Miranda Costa ,&nbsp;Mara Rúbia Santos Gonçalves ,&nbsp;Eliane Carlosso Krummenauer ,&nbsp;Rochele Mosmann Menezes","doi":"10.1016/j.bjid.2026.104653","DOIUrl":"10.1016/j.bjid.2026.104653","url":null,"abstract":"<div><h3>Introduction</h3><div>Antimicrobial resistance is a global threat, directly affecting Brazil. Antimicrobial Stewardship Programs (ASPs) are essential to optimize the use of antimicrobials (AMBs), reduce costs, and minimize resistance. This study describes the profile of Brazilian hospitals without ASPs, identifying challenges and opportunities.</div></div><div><h3>Methods</h3><div>This is a cross-sectional sub-analysis of the national survey conducted between October 2022 and January 2023 by the National Health Surveillance Agency (ANVISA) and partner institutions. The convenience sample included 2,073 hospitals (27.7%) from all regions of the country, of which 584 (28.1%) did not have ASPs. Variables analyzed included hospital size (small, medium, large), location (capital/interior), presence of infection control programs, microbiology laboratories, and reasons for lack of ASPs. Statistical analysis was performed using SPSS R version 28.m.</div></div><div><h3>Results</h3><div>Among the 584 hospitals without ASPs, 195 (33.4%) did not perform any actions regarding antimicrobial use. About 18% also lacked an active hospital infection control program. Of these, 30.1% had outsourced microbiology laboratories; 96% were small hospitals, and 86.7% were located in the interior. The shortage of specialized professionals was the main barrier to ASP implementation. The absence of specific actions for antimicrobial use represents a critical gap, even with national guidelines already published. The lack of structure, especially in small and rural hospitals, compromises patient safety and contributes to the spread of resistant bacteria. These findings highlight the urgent need for targeted interventions and public policies to strengthen health infrastructure.</div></div><div><h3>Conclusion</h3><div>The study reveals significant challenges in implementing ASPs, particularly in hospitals outside major urban centers. Overcoming these barriers is crucial to strengthening the healthcare system as a whole, especially in the current global context of a “One Health” approach.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104653"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454323","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":"BAYWATCH – SURVEILLANCE OF MDR ESCHERICHIA COLI PRODUCING ESBL IN BEACHES OF NITERÓI/RJ","authors":"Maria Theresa Xavier dos Santos,&nbsp;Sabrina Rodrigues Rocha,&nbsp;Ana Luísa de Andrade Nunes,&nbsp;Aloysio de Mello Figueiredo Cerqueira,&nbsp;Carmen Baur Vieira,&nbsp;Felipe Piedade Gonçalves Neves,&nbsp;Bruno Francesco Rodrigues de Oliveira,&nbsp;Júlia Peixoto de Albuquerque","doi":"10.1016/j.bjid.2026.104646","DOIUrl":"10.1016/j.bjid.2026.104646","url":null,"abstract":"<div><h3>Introduction/Objective</h3><div>The Tricycle Protocol was created by the World Health Organization in response to the increase in bacterial resistance to antimicrobials and the spread of their genetic determinants. The initiative aims at multisectoral monitoring and surveillance of <em>Escherichia coli</em> producing extended-spectrum beta-lactamases (ESBL-Ec) under the One Health approach, which, along with other species of <em>Enterobacterales</em>, is one of the critical priority pathogens for the production and development of new antimicrobials. Thus, the objective of this study was to evaluate the occurrence and profile of ESBL-Ec strains isolated from the waters of beaches in Niterói/RJ.</div></div><div><h3>Methods</h3><div>Water samples collected from Icaraí, Piratininga, and Jurujuba, presumptive for <em>E. coli</em>, were identified by mass spectrometry. The confirmed strains were subjected to selective pressure in CHROMagar ESBL and MacConkey agar with ceftriaxone at 4.0 µg/mL. The phenotypic susceptibility analysis was performed by disk diffusion against 22 antimicrobials. Genes for resistance to beta-lactams, quinolones, integrases, and virulence genes were investigated by polymerase chain reaction. Hemolysin production was analyzed phenotypically.</div></div><div><h3>Results</h3><div>A total of 299 <em>E. coli</em> strains were isolated, of which 33 were potential ESBL producers. A high frequency of resistance to ampicillin and third-generation cephalosporins (&gt; 80%) was observed. In 30 strains, ESBL genes (blaCTX-M-1,2, blaCTX-M-8, blaCTX-M-14, blaTEM, and blaSHV) were detected, with blaCTX-M-1,2 being the most prevalent, both in Icaraí and Jurujuba. Additionally, the qnrS, intl1, and intl2 genes were also detected. Furthermore, 18 ESBL-Ec strains were classified as multidrug-resistant (MDR). Among the ESBL-Ec strains, six carried the papC gene, which encodes fimbriae associated with adhesion and colonization in extraintestinal infections, as well as the hlyA gene for hemolysins; of these, five were MDR and two showed an alpha-hemolytic phenotype.</div></div><div><h3>Conclusion</h3><div>This is the first study describing MDR ESBL-Ec strains in beach waters of Niterói. This result highlights the importance of surveillance in natural ecosystems; however, the findings of this study, where MDR ESBL-Ec strains with resistance to quinolones, presence of integrase genes, and indication of extraintestinal virulence were detected, suggest the role of this ecosystem as a platform for persistence and dissemination of these anthropogenic-origin pathogens.</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104646"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147454332","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 HEALTHCARE-ASSOCIATED INFECTION PATHOGENS IN THE PRE-, DURING-, AND POST-COVID-19 PANDEMIC PERIODS IN A LARGE PUBLIC UNIVERSITY HOSPITAL","authors":"Claudia Maria Dantas de Maio Carrilho,&nbsp;Danielle Ruiz Miyazawa,&nbsp;Vitor Hugo Perugini,&nbsp;Renata Aparecida Belei,&nbsp;Joseani Coelho Pascual,&nbsp;Herlieni de Oliveira Mota e Silva,&nbsp;Karollinne Boza,&nbsp;Adriana Cristina Galbiatti Parminondi Elias,&nbsp;Maria de Fátima Oliveira Hirth Ruiz,&nbsp;Marcos Toshiyuki Tanita,&nbsp;Marsileni Pelisson,&nbsp;Maria Cristina da Silva Paduan,&nbsp;Marcia Regina Eches Perugini","doi":"10.1016/j.bjid.2026.104706","DOIUrl":"10.1016/j.bjid.2026.104706","url":null,"abstract":"<div><h3>Introduction</h3><div>Hospital Infection Control Committees (HICC) monitor pathogens responsible for healthcare-associated infections (HAIs) and issue antimicrobial susceptibility profiles to identify the institution’s pathogens, assisting in the empirical treatment of HAIs, as well as isolating or cohorting patients when indicated.</div></div><div><h3>Objectives</h3><div>To identify the pathogens associated with HAIs and their susceptibility profiles in a university hospital during the pre, during, and post-COVID-19 pandemic periods.</div></div><div><h3>Methods</h3><div>A retrospective study was conducted at a tertiary, high-complexity university hospital with 80–100 ICU beds, which fluctuated during the pandemic. Data were collected from the hospital’s electronic system (Medview, HICC module), including all positive cultures with antibiograms from patients hospitalized for more than 3 days, from all infection sites (excluding swabs and colonizations). The analyzed periods were: 2018–2019 (I – pre-pandemic), 2021–2022 (II – pandemic), and 2023–2024 (III – post-pandemic).</div></div><div><h3>Results</h3><div>The most prevalent Gram-negative pathogens in the three periods were <em>Klebsiella pneumoniae</em>, <em>Acinetobacter baumannii</em> and <em>Pseudomonas aeruginosa</em>. The evolution of resistance in the three periods was: <em>Klebsiella pneumoniae</em>/carbapenems: 53% - 70% - 68.5%; <em>Klebsiella pneumoniae</em>/polymyxin: 58% - 49% - 31.5%; <em>Acinetobacter baumannii</em>/carbapenems: 95% - 96% - 95%; <em>Acinetobacter</em>/polymyxin: 4% - 21% - 8.5%; <em>Pseudomonas aeruginosa</em>/carbapenems: 46% - 43% - 41%. There was no resistance of <em>P. aeruginosa</em> to polymyxins. Regarding Gram-positive bacteria, <em>Enterococcus faecalis</em> maintained sensitivity to ampicillin, but resistance to vancomycin (VRE) was 9% - 31.5% - 20.5%; <em>Enterococcus faecium</em>/ampicillin: 82% - 94% - 93.5% and <em>Enterococcus faecium</em>/vancomycin: 24% - 57% - 61.5%.</div></div><div><h3>Conclusion</h3><div>The University Hospital presents a sensitivity profile with a high prevalence of <em>Acinetobacter</em> spp<em>.</em>, <em>Klebsiella pneumoniae</em> and <em>Pseudomonas aeruginosa</em> resistant to carbapenems, worsened during the pandemic period, especially <em>K. pneumoniae</em> resistant to carbapenems and <em>A. baumannii</em> to polymyxins. Regarding Gram-positive bacteria, we observed an increase in the resistance of <em>E. faecalis</em> and <em>E. faecium</em> to vancomycin (VRE). Worsening resistance data have been addressed in several publications, especially the increase in VRE infections. Preventive measures such as hand hygiene, environmental hygiene, isolation, and precautions are fundamental in controlling multidrug-resistant pathogens</div></div>","PeriodicalId":56327,"journal":{"name":"Brazilian Journal of Infectious Diseases","volume":"30 ","pages":"Article 104706"},"PeriodicalIF":2.8,"publicationDate":"2026-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147453765","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}