1887

Abstract

This study evaluated the predictors of mortality and the impact of inappropriate therapy on the outcomes of patients with bacteraemia and ventilator-associated pneumonia (VAP). Additionally, we evaluated the correlation of the type III secretion system (TTSS) effector genotype with resistance to carbapenems and fluoroquinolones, mutations in the quinolone resistance-determining regions (QRDRs), metallo-β-lactamase and virulence factors. A retrospective cohort was conducted at a tertiary hospital in patients with multidrug-resistant (MDR) bacteraemia (157 patients) and VAP (60 patients). The genes for , , , and and virulence genes (, , , , , and ) were detected; sequencing was conducted for QRDR genes on fluoroquinolone-resistant strains. The multivariate analyses showed that the predictors independently associated with death in patients with bacteraemia were cancer and inappropriate therapy. Carbapenem resistance was more frequent among strains causing VAP (53.3 %), and in blood we observed the genotype (66.6 %) and genotype (33.3 %). The gene was found in all isolates, whilst the frequency was low for (9.4 %). Substitution of threonine to isoleucine at position 83 in was the most frequent mutation among fluoroquinolone-resistant strains. Our study showed a mutation at position 91 in the gene (Glu91Lys) associated with a mutation in (Thre83Ile) in a strain of extensively drug-resistant , with the genotype, that has not yet been described in Brazil to the best of our knowledge. This comprehensive analysis of resistance mechanisms to carbapenem and fluoroquinolones and their association with TTSS virulence genes, covering MDR in Brazil, is the largest reported to date.

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2015-03-01
2019-11-14
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