  TY  - JOUR
AU  - Julianna G. B. Olivella, 
AU  - Bianca de O. Fonseca, 
AU  - Adenilson de S. da Fonseca, 
AU  - Eduardo A. R. de Castro, 
AU  - Alexandre R. Bello, 
AU  - JosÃ© Augusto A. Pereira, 
PY  - 2023/07/17
Y2  - 2024/10/12
TI  - Prevalence of carbapenem-resistant Enterobacteriaceae in in- and out-of-hospital environments 
JF  - Ïã¸ÛÁùºÏ²Ê¿ª½±½á¹û
JA  - BJHBS
VL  - 22
IS  - 1
SE  - Original Articles
DO  - 10.12957/bjhbs.2023.76939
UR  - /bjhbs/article/view/55
SP  - 15-22
AB  - &lt;p&gt;&lt;span class=&quot;TextRun SCXW57893490 BCX0&quot; lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot; data-contrast=&quot;auto&quot;&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;Introduction: Healthcare is recognized as a condition of high selective pressure (SP) due to the use of antimicrobials. The emergence of community bacterial species resistant to the antimicrobials &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;most &lt;/span&gt;&lt;span class=&quot;NormalTextRun CommentStart SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;ex&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;tensively&lt;/span&gt; &lt;span class=&quot;NormalTextRun CommentStart SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;used&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; in hospitals is of concern, as is the case with Gram-negative rods producing extended-spectrum beta-lactamases (ESBL). Hospital colonization by carbapenem-resistant Enterobacteria (CRE) can persist for many months after hospital discharge, and their encoding genes can be transferred among &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;different species&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;. &lt;/span&gt;&lt;span class=&quot;NormalTextRun SpellingErrorV2Themed SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;Methododology&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;: Because of the scarcity of options due to resistance to carbapenems, we &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;sought&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; to evaluate the occurrence of CRE in stool samples from outpatients and inpatients of a University Hospital, for whom clinical and epidemiological data were obtained from the analysis of medical records. After parasitological examination, stool samples from outpatients and inpatients were diluted in saline (1:20, 1:1000 and 1:2000) solution and 0.1 mL seeding was performed on MacConkey Agar (MA) &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;containing&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; gentamicin 8 &lt;/span&gt;&lt;span class=&quot;NormalTextRun SpellingErrorV2Themed SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;Î¼g&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;/mL and MA &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;containing&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; cephalexin 32 &lt;/span&gt;&lt;span class=&quot;NormalTextRun SpellingErrorV2Themed SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;Î¼g&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;/&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;mL.&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; Once isolated, strains were &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;identified&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; by biochemical tests and AST (with imipenem, ertapenem, and meropenem) was performed according to CLSI (2020). Results: We isolated carbapenem-resistant strains of enterobacteria in 13 (43.3%) of the 30 inpatients and in 13 (29%) of the 31 outpatients (p&amp;gt;0.05). In 7 (23.3%) of the 30 inpatients and in 5 (16.1%) of the 31 outpatients, we isolated CRE at 1:1000 or 1:5000 dilutions of stool samples, which correspond to â€œmicrobial loadsâ€. Ten bacterial species were isolated in the CRE related to the 13 inpatients and 13 outpatients, among whom we &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;identified&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; two or more species in 9 (69.2%) and 10 (76.9%), respectively. Even &lt;/span&gt;&lt;span class=&quot;NormalTextRun AdvancedProofingIssueV2Themed SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;taking into account&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; the limitations of the study due to the possibility of &lt;/span&gt;&lt;span class=&quot;NormalTextRun CommentStart SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;bias&lt;/span&gt; &lt;span class=&quot;NormalTextRun CommentStart SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;arising&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; from the absence of data in the medical records, the detection &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;of &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;intestinal colonization with CRE in non-hospitalized individuals is of concern and may jeopardize the implementation of rational empirical therapy in patients of that community. Conclusion: I&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;t is possible that, as was the case of ESBL-producing strains decades ago, infections by carbapenem-resistant strains have &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;become endemic in the community.&lt;/span&gt;&lt;/span&gt; &lt;span class=&quot;TextRun SCXW57893490 BCX0&quot; lang=&quot;EN-US&quot; xml:lang=&quot;EN-US&quot; data-contrast=&quot;auto&quot;&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;In general, this development is a cause of concern, for plasmid-associated antimicrobial resistance strains, &lt;/span&gt;&lt;span class=&quot;NormalTextRun AdvancedProofingIssueV2Themed SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;due to &lt;/span&gt;&lt;span class=&quot;NormalTextRun AdvancedProofingIssueV2Themed SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;the fact that&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; an often-recognized &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;plasmid-associated &lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;fitness&lt;/span&gt;&lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt; of bacterial cell&lt;/span&gt; &lt;span class=&quot;NormalTextRun CommentStart SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;favors&lt;/span&gt; &lt;span class=&quot;NormalTextRun SCXW57893490 BCX0&quot; data-ccp-parastyle=&quot;HTML Preformatted&quot;&gt;persistence of the strains, even in the absence of antimicrobial (co-)selective pressures.&lt;/span&gt;&lt;/span&gt;&lt;span class=&quot;EOP SCXW57893490 BCX0&quot; data-ccp-props=&quot;{&amp;quot;201341983&amp;quot;:0,&amp;quot;335551550&amp;quot;:6,&amp;quot;335551620&amp;quot;:6,&amp;quot;335559739&amp;quot;:0,&amp;quot;335559740&amp;quot;:240}&quot;&gt;&amp;nbsp;&lt;/span&gt;&lt;/p&gt;
ER  -