title: Staphylococcus hominis subsp. novobiosepticus strains causing nosocomial bloodstream infection in Brazil.
abstract: OBJECTIVE
  To report the isolation of six Staphylococcus hominis subsp. novobiosepticus (SHN) strains from hospitalized patients with bloodstream infections in two Brazilian hospitals and to characterize their susceptibility profile to several antimicrobials.
  
  
  METHODS
  Species identification was performed by biochemical methods and sodA gene sequencing. The MICs of antimicrobials were determined by broth and agar dilution methods and by Etest. Isolates were typed by PFGE and PCR amplification was used to detect the ccr gene complex and the mec class. Morphometric evaluation of cell wall was performed by transmission electron microscopy (TEM).
  
  
  RESULTS
  Susceptibility profiles indicated that the majority of isolates (five) were multidrug-resistant. Overlapping and multiplex PCR showed that five out of the six strains harboured SCCmec type III with class A mec and type 3 ccr. The initial vancomycin MIC value of 4 mg/L for these strains increased to 16-32 mg/L after growth for 10 days in BHI broth supplemented with this antimicrobial. TEM indicated that vancomycin resistance was associated with cell wall thickening and to another mechanism not fully elucidated. Only one SHN strain was oxacillin- and vancomycin-susceptible. The nosocomial infections in at least five of the patients from both hospitals were caused by a single clone of SHN.
  
  
  CONCLUSIONS
  It is very important to consider SHN strains as the cause of nosocomial infections. The clinical implications resulting from the pattern of multidrug resistance in these strains may be complicated by the emergence of vancomycin resistance.
authors.affiliation: Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Av. dos Bandeirantes 3900, Brazil.
authors.forename: Izabel Cristina Vanzato
authors.initials: IC
authors.lastname: Palazzo
authors.forename: Pedro A
authors.initials: PA
authors.lastname: d'Azevedo
authors.forename: Carina
authors.initials: C
authors.lastname: Secchi
authors.forename: Antonio Carlos C
authors.initials: AC
authors.lastname: Pignatari
authors.forename: Ana Lúcia da Costa
authors.initials: AL
authors.lastname: Darini
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology*; D001426:Bacterial Proteins / Q000235:genetics; D015373:Bacterial Typing Techniques; D001938:Brazil / Q000453:epidemiology; D002473:Cell Wall / Q000648:ultrastructure; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology*; D016172:DNA Fingerprinting; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D005838:Genotype; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D046529:Microscopy, Electron, Transmission; D016133:Polymerase Chain Reaction; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000382:microbiology*; D041181:Staphylococcus hominis / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D013482:Superoxide Dismutase / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; C095500:SodA protein, Bacteria; D013482:Superoxide Dismutase