KPC-producing Klebsiella pneumoniae (KPC-Kp) has become an important public health issue. The previous intestinal colonization by KPC-Kp has been an important risk factor associated with the progression to infections. The objective of this study was to assess the genetic characterization of KPC-Kp isolates recovered from human rectal swabs in Brazil. We selected 102 KPC-Kp isolates collected during 2009–2013 in 11 states. Antimicrobial susceptibility was determined by disk diffusion, E-test, and broth microdilution. The resistance and virulence genes were investigated by PCR. Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). The isolates were mostly resistant to β-lactams, sulfonamides, chloramphenicol, quinolones, and aminoglycosides but susceptible to fosfomycin/trometamol, polymyxin B, and tigecycline. The bla_KPC-2 was mostly associated with Tn4401b. Besides that, the isolates carried bla_CTX-M, bla_SHV, bla_TEM, and aac(6′)-Ib in high frequency and aac(3′)IIa and qnr genes in moderate frequency. The PFGE revealed 26 pulsotypes and MLST performed in representative strains revealed 23 sequence types, 45% belonging to clonal complex 258 (CC258). Isolates of CC258 were found in all states. Seventy percent of the 102 KPC-Kp isolates belonged to CC258-associated pulsotypes. We describe the dissemination of KPC-2-Kp associated with Tn4401b belonging to CC258 colonizing patients in Brazil, which is also prevalent in infected patients, suggesting a clear colonization–infection correlation.

Background: Globally, Pseudomonas aeruginosa is a high-priority opportunistic pathogen which displays several intrinsic and acquired antimicrobial resistance (AMR) mechanisms, leading to challenging treatments and mortality of patients. Moreover, its wide virulence arsenal, particularly the type III secretion system (T3SS) exoU⁺ virulotype, plays a crucial role in pathogenicity and poor outcome of infections. In depth insights into the molecular epidemiology of P. aeruginosa, especially the prevalence of high-risk clones (HRCs), are crucial for the comprehension of virulence and AMR features and their dissemination among distinct strains. This study aims to evaluate the prevalence and distribution of HRCs and non-HRCs among Brazilian isolates of P. aeruginosa. Methods: A systematic review and meta-analysis were conducted on studies published between 2011 and 2023, focusing on the prevalence of P. aeruginosa clones determined by multilocus sequence typing (MLST) in Brazil. Data were extracted from retrospective cross-sectional and case-control studies, encompassing clinical and non-clinical samples. The analysis included calculating the prevalence rates of various sequence types (STs) and assessing the regional variability in the distribution of HRCs and non-HRCs. Results: A total of 872 samples were analyzed within all studies, of which 298 (34.17%) were MLST typed, identifying 78 unique STs. HRCs accounted for 48.90% of the MLST-typed isolates, with ST277 being the most prevalent (100/298—33.55%), followed by ST244 (29/298—9.73%), ST235 (13/298—4.36%), ST111 (2/298—0.67%), and ST357 (2/298—0.67%). Significant regional variability was observed, with the Southeast region showing a high prevalence of ST277, while the North region shows a high prevalence of MLST-typed samples and HRCs. Conclusions: Finally, this systematic review and meta-analysis highlight the role of P. aeruginosa clones in critical issue of AMR in P. aeruginosa in Brazil and the need of integration of comprehensive data from individual studies.

Apesar do uso de plantas medicinais para tratamento de problemas de saúde ser tradicionalmente aceito, esta prática da medicina popular ainda encontra resistência por profissionais da saúde, sobretudo sob a alegação da falta de comprovação de seus efeitos. Durante o surto de Covid-19, houve aumento significativo do estresse, sintomas ansiosos e insônia e o uso de plantas medicinais e fitoterápicos surge como uma alternativa terapêutica. O objetivo deste estudo foi realizar uma revisão da literatura sobre a eficácia de plantas medicinais como terapia alternativa e/ou complementar para transtornos de ansiedade e insônia. As plantas investigadas foram selecionadas a partir do Formulário de Fitoterápicos e Memento Fitoterápico da Farmacopeia Brasileira, sendo utilizados como descritores o nome científico da planta e os termos “anxiety” e “insomnia” com recorte temporal de 2015 a 2020. 230 resultados foram encontrados, 42 selecionados (27 em humanos e 15 em animais). Foi possível demonstrar efeitos ansiolíticos para as plantas capim santo (Cymbopogon citratus), lavanda (Lavandula officinalis), melissa (Melissa officinalis), maracujá (Passiflora incarnata) e valeriana (Valeriana officinalis) e sedativos para melissa, maracujá e valeriana. A kava-kava (Piper methysticum) demonstrou apenas efeito sedativo e a camomila (Matricaria chamomilla) apresentou eficácia clínica ansiolítica. Portanto, a potencial aplicação clínica dessas plantas é indicada para tratamento dos sintomas de ansiedade e insônia, ajudando a reduzir os sintomas psicológicos decorrentes da pandemia de Covid-19. Contudo, vale ressaltar a necessidade da padronização dos procedimentos metodológicos e avanço da fitoterapia na prática médica.

Background: The search for substances that can overcome microorganisms’ resistance and enhance the antimicrobial activity of given products has attracted the attention of researchers. Eucalyptus wood vinegar (WV) is a promising product for developing alternative antimicrobials. Objectives: This study aimed to evaluate whether the production of WV in the co-pyrolysis of eucalyptus wood with aromatic herbs would incorporate compounds from them into WV and if that would enhance its antimicrobial action. Methodology: WV was produced alone and through co-pyrolysis with marjoram (Origanum majorana), Peruvian oregano (Origanum vulgare), rosemary (Salvia rosmarinus), thyme (Thymus vulgaris), and Turkish oregano (Origanum onites) at a proportion of 25% of herbs to the bone-dry wood weight. The antimicrobial effects were assessed against strains of gram-negative and -positive bacteria, and Candida glabrata. Microorganisms’ colony growth in agar had their absorbances recorded after inoculation and incubation. Chemical characterization of the new products was performed by gas chromatography and mass spectrometry (GC/MS). Results: After coproduction, there were relevant chemical changes concerning the original WV. Thymol, for instance, was incorporated into the WV through co-pyrolysis with marjoram, Peruvian and Turkish oregano, and thyme. The coproducts were more efficient than the WV produced only with wood, with thyme-incorporated products having the highest efficiency. This can be attributed to the increase and incorporation of the substances after coproduction, and particularly the role of thymol in enhancing the antimicrobial action. Conclusion: Given the results, the co-production of WV with eucalyptus wood and aromatic herbs has the potential to provide alternative antimicrobial products.

Introduction. Efforts to understand the burden of antibiotic use in low- and middle-income countries such as Brazil are essential for developing strategies that are effective and appropriate in the context of endemic multidrug-resistant organisms. Aim. This study aims to determine antimicrobial-prescribing practices among patients hospitalized in intensive care units (ICUs) for adults in Brazil. Methodology. A 1-day point prevalence multicentre survey was conducted in 58 adult ICUs across the five regions of Brazil. The institutions were categorized according to their type and size. Detailed antimicrobial prescription data were prospectively provided to all patients hospitalized on the day of data collection. Results. A total of 620 patients were included in the study, of whom 63.9% were receiving at least one antimicrobial. Of these, 34.6% were treated for an infection, but only 39.9% of the cases were based on microbiological criteria. Empirical treatment was applied to 72.3% of the patients. Significant differences in antibiotic usage were observed across the different hospitals included in the study. Overall, treatment was most commonly directed towards pneumonia (51.8%) and bloodstream infections (29.6%). Glycopeptides (19.4%) and carbapenems (18.5%) were the most prescribed in teaching hospitals, while in non-teaching hospitals, carbapenems (17.8%) and broad-spectrum cephalosporins (16.8%) were most frequently used. Conclusion. Our study reveals alarming data on antibiotic use in adult ICUs in Brazil, with high frequencies of severe healthcare-associated infections acquired in these units, where patients are frequently subjected to empirical treatment.