Complexo Burkholderia cepacia em pacientes com fibrose cística: caracterização das espécies, avaliação do perfil de susceptibilidade aos antimicrobianos e da diversidade genética

• Autor(a) principal: Conceição Neto, Orlando Carlos da
• Data de Publicação: 2013
• Tipo de documento: Dissertação
• Idioma: por
• Título da fonte: Biblioteca Digital de Teses e Dissertações da UERJ
• Texto Completo: http://www.bdtd.uerj.br/handle/1/14433
• topic: Burkholderia cepacia Complex; Cystic Fibrosis; Resistance; PFGE; Complexo Burkholderia cepacia; Fibrose Cística; Resistência; PFGE; CNPQ::CIENCIAS BIOLOGICAS::MICROBIOLOGIA

The Burkholderia cepacia complex (BCC) is a group of 17 closely related species that are associated with pulmonary deterioration and increased mortality in patients with Cystic Fibrosis (CF). These species differ from each other in prevalence, clinical status and virulence. Little is known about the profile of antimicrobial resistance. Once the infection, the therapeutic approach and the control measures currently adopted are based on BcC, without considering each particular species. The aim of this study was to determine the prevalence of BcC species in patients from two reference centers in Rio de Janeiro, as well as establishing antimicrobial resistance profiles and assess the molecular diversity among them. One hundred samples of BcC isolates from 38 CF patients from January 2010 to February 2012 were identified by phenotypic methods and by sequencing the recA gene. The MIC for amikacin, aztreonam, ceftazidime, trimethoprim /sulfamethoxazole and tobramycin were determined by microdilution species and genotyping was carried out by PFGE with the enzyme SpeI. B. vietnamiensis (44%) was the most prevalent species, followed by B. cenocepacia IIIA (36%), B. multivorans (10%), B. cenocepacia IIIB (1%) and B. stabilis (1%). Five percent of the samples were not identified. B. vietnamiensis was identified in over half of patients (58.3%). There were differences in susceptibility profiles among BcC species. B. cenocepacia IIIA showed the highest rates of antimicrobial resistance, particularly to trimethoprim/ sulfamethoxazole (80.5%), primary antimicrobial used to treat infections caused by BcC. Samples with MDR profiles were observed for all species, highlighting the profile A, simultaneously resistant to five antibiotics, observed in 58.8% of B.cenocepacia IIIA samples. The analysis of genetic polymorphism showed that despite B. vietnamiensis was the most prevalent species, the occurrence of nine clonal groups suggests that these strains acquisition has taken place from a common environmental source. For B. cenocepacia IIIA, 52.9% of the samples were assigned to the same clonal group (BcA), shared among nine patients treated at a single referral center. Eighty percent of these samples also showed resistance to all antimicrobials tested. The data show that, even with the use of molecular techniques, the identification of BcC on species level is difficult; that B. cenocepacia IIIA is characterized by higher levels of resistance to other species and that the cross transmission between individuals points to the need for the establishment of BcC surveillance in reference centers.