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- Portuguese in vitro antibiotic susceptibilities favor current nontuberculous mycobacteria treatment guidelinesPublication . Durão, Vera; Silva, Anabela; Macedo, Rita; Durão, Paulo; Santos-Silva, André; Duarte, RaquelSetting: Nontuberculous mycobacteria (NTM) are increasingly recognized as causative agents of opportunistic infections in humans for which effective treatment is challenging. There is, however, very little information on the prevalence of NTM drug resistance in Portugal. Objective and Design: Our aim was to analyze the drug susceptibility testing (DST) performed in NTM at the Portuguese National Health Institute Dr. Ricardo Jorge from February 2003 to February 2016. A total of 262 DST were included in the analysis. Results: Most (94%) M. avium intracellulare complex isolates showed in vitro susceptibility to clarithromycin. All M. kansasii isolates were susceptible to rifampicin and ethambutol and 97.1% were susceptible to isoniazid. The majority of rapidly-growing mycobacteria (RGM) demonstrated in vitro susceptibility to amikacin, clarithromycin and cefoxitin. However, in RGM there was a marked increase on the relative risk of having sulfamethoxazole resistance in isolates resistant to ciprofloxacin compared to susceptible isolates. Conclusion: Tested NTM in Portugal revealed in vitro susceptibility to most of the antimicrobials currently recommended for treatment. However, our results also suggest that sulfamethoxazole should be avoided in treatment of RGM resistant to ciprofloxacin (or vice versa). Further trials that correlate the in vitro DST results with the clinical outcome are needed in order to reach conclusions on efficient antimicrobial therapy.
- Characterization and Biofilm Assessment of haemophilus influenzae Isolates from Patients with Chronic Obstructive Pulmonary Disease and Otitis MediaPublication . Cunha Batista, Beatriz; Bajanca-Lavado, Maria Paula; Jordão, LuísaHaemophilus influenzae is a commensal microorganism of the human nasopharynx, responsible for both invasive and non-invasive diseases. This work focused on the study of 93 H. influenzae isolates, collected between 2013 and 2018, from patients with two epidemiologically relevant non-invasive diseases: Chronic Obstructive Pulmonary Disease (COPD) and Otitis Media (OM). Phenotypical and molecular characterizations were performed for the isolates, regarding capsular typing, β-lactamase production, antibiotic susceptibility, genetic diversity by MLST, presence/absence of virulence factors (pilA, hifA, hmw1A, hmw2A, hia and ompP5) and ability to produce biofilms. COPD isolates were collected from adults (100%), while 98.2% of OM isolates were collected from children. Non-typeable H. influenzae (NTHi) was the aetiological agent in COPD (97.4%) and OM (100%). Regarding antibiotic susceptibility, it should be noticed that 15.1% of the isolates were β-lactamase producers. MLST revealed a high genetic diversity among COPD and OM isolates, with 31 STs in 41 analysed isolates. pilA and ompP5 genes were present in more than 50% of COPD and OM isolates. hifA and hia genes were identified in less than half of the isolates, with a higher prevalence of these among OM isolates. hmw1A and hmw2A genes were respectively identified in 25.5% and 32.7% of OM isolates, while both hmw genes were present in 76.3% of COPD isolates. Biofilm production was observed for 14.0% and 29.0% of all isolates after 24h and 48h, respectively. No relationship between biofilm production and clinical source could be established, as well as with the presence of virulence factors (pilA, hmw1A e hmw2A) involved in biofilm production. COPD and OM are frequently associated with NTHi. Since no vaccines are available, monitoring of these diseases is highly recommended, as these constitute a Public Health threat associated with a high economic and social burden.