Abstract
Response to: Maya JJ, Ruiz SJ, Blanco VM et al. Current status of carbapenemases in Latin America. Expert Rev. Anti Infect Ther. 11(7), 657–667 (2013).
Dear Editor
We would like to congratulate the authors who reported the impact of carbapenemases in Latin America Citation[1]. Currently, polymyxins are considered the latest treatment option to fight these microorganisms, which limits therapy and increases the cost of treatment Citation[2].
We emphasize that in Brazil, the National Agency for Sanitary Surveillance (ANVISA) has been monitoring the first reported cases of carbapenemase New Delhi metallo-beta-lactamase (NDM) since 2010. This investigation assumed larger proportions when in December 2012, the National Agency for Sanitary Surveillance, ANVISA, issued a statement that warned about the existence of possible cases in Brazil, since Uruguay, Colombia and Paraguay had already reported its presence in their territories.
On 1 April 2013, a risk communication report was issued, which stated that a case of NDM-producing bacteria had been found in Porto Alegre, state of Rio Grande do Sul (Brazil). From this date on, other communications were issued with the confirmation of new cases Citation[101]. On 29 April 2013, they disclosed the confirmation of four cases in Porto Alegre, of which three were colonized and one infected, with one death Citation[102]. On 10 September 2013, the identification of two cases of patients colonized with NDM collected in Rio de Janeiro in August of this year was reported Citation[103]. In this same period, two cases in Brasilia were formally identified. shows the data on the first cases identified in different regions of Brazil Citation[104].
Table 1. Microorganisms confirmed with New Delhi metallo-beta-lactamase in Brazil in 2013.
Recently, the first case of colonization with OXA-48 like was demonstrated in Brazil, in the state of Rio Grande do Sul, in a male patient who after 30 days in the ICU due to a prostatectomy, had a rectal swab positive for blaOXA-48-producing Enterobacter cloacae Citation[3].
This communication aims to disclose and warn against the presence of these agents in Brazil, and thus, reinforce the fact that measures are needed to control these microorganisms. Simple measures that do not require large investments, such as hand hygiene, cleaning and disinfection of surfaces, rational use of antimicrobials and implementation of care protocols for the prevention of healthcare-related infections, significantly contribute to their control Citation[105]. Other measures that rely on planning and investments are equally important: we need to revisit the minimal hospital lab structure, the valid methods for phenotype identification and sensitivity tests, as well as the cutoff to be used in the country. It is also necessary to discuss the criteria for sending samples to reference laboratories (LACENs) for molecular biology tests in order to assess the data generated in the country.
We emphasize that, although the continuous use of such routines is acknowledged as important by infection control professionals, their implementation and monitoring become more dependable only in the presence of outbreaks. Therefore, it is necessary to make professionals aware of the change in attitude concerning the development of preventive strategies for the aforementioned pathologies. The training and refresher courses provided to the teams on prevention and control, as well as supervision of the actions are of utmost importance and the responsibility of the Municipal and State Hospital Infection Control Committees Citation[4]. Measures for promotion and assessment of the microbiology performed in hospitals are the responsibility of ANVISA, together with the Ministry of Health.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.
No writing assistance was utilized in the production of this manuscript.
References
- Maya JJ, Ruiz SJ, Blanco VM et al. Current status of carbapenemases in Latin America. Expert Rev. Anti Infect. Ther. 11(7), 657–667 (2013).
- Girardello R, Gales AC. Polymyxin resistance: old antimicrobials, last therapeutic options. Rev. Epidemiol. Control Infect. 2(2), 66–69 (2012).
- Rozales FP, Ribeiro VB, Magagnim CM et al. Oxa-48-like: description of the first case in Brazil. Annals of the 27th Congress of Microbiology. Natal (RN), Brazil (2013) ( In Press).
- Carneiro M, Persch MS, Souza JG, Krummenauer EC, Machado JAA. What is the distance between saying and doing? Int. J. Infect. Control 8(2) (2012).
Websites
- BRAZIL. National Agency of Sanitary Surveillance. Risk Statement N. 001/2013. Circulation of microorganisms with resistance mechanism called “New Delhi Metalobetalactamase” or NDM in Brazil (2013). http://portal.anvisa.gov.br/wps/content/Anvisa+Portal/Anvisa/Inicio/Servicos+de+Saude/Assunto+de+Interesse/Informes+e+Alertas/Anvisa+esclarece+sobre+casos+de+enterobacterias+NDM-1+em+Porto+Alegre (Accessed 02 December 2013)
- BRAZIL. National Agency of Sanitary Surveillance. Risk Statement N. 002/2013. Update on Risk Statement N. 001/2013 - GVIMS / GGTES-ANVISA, which deals with the Circulation of micro-organisms with resistance mechanism called “New Delhi Metalobetalactamase” or NDM in Brazil (2013). http://portal.anvisa.gov.br/wps/wcm/connect/6a9c2c804f8f09db8379f79a71dcc661/comunicado+de+risco+n+2+de+29-04-13-+sobre+NDM-1.pdf?MOD=AJPERES (Accessed 29 September 2013)
- BRAZIL. National Agency of Sanitary Surveillance. Risk Statement N. 003/2013. Update on Risk Statement 002/2013 - GVIMS / GGTES-ANVISA, which deals with the circulation of micro-organisms with resistance mechanism called “New Delhi Metalobetalactamase” or NDM in different regions of Brazil (2013). www.riscobiologico.org/lista/20130912_04.pdf (Accessed 29 September 2013)
- BRAZIL. Ministry of Health. Executive Secretariat. Departament of Informatics of SUS (2013). http://formsus.datasus.gov.br/site/popup_unidade_detalhe.php?id_aplicacao=8934&id_unidade=1714774 (Accessed 30 September 2013)
- BRAZIL. National Agency of Sanitary Surveillance. Patient safety: hand hygiene (2011). www.anvisa.gov.br/servicosaude/manuais/paciente_hig_maos.pdf (Accessed 29 September 2013)