title: [Molecular characterization of carbapenem-resistant and metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from blood cultures from children and teenagers with cancer].
abstract: BACKGROUND
  The objective of this study was to evaluate the prevalence and dissemination of carbapenem-resistant and metallo-beta-lactamase-producing Pseudomonas aeruginosa isolated from blood-stream samples (2000-2005) that were collected from patients admitted to the Institute of Pediatric Oncology, UNIFESP (IOP-GRAACC).
  
  
  RESULTS
  Fifty-six P. aeruginosa samples were isolated from 49 patients. Thirty-two of these samples were classified as carbapenem-resistant using the disc diffusion method and were subjected to the PCR reaction in order to detect MBL genes. Eighteen of these 32 isolates showed the blaSPM-1 gene. Eight samples selected in different years over the study period presented the same genetic profile according to pulsed-field gel electrophoresis. The antimicrobial therapy was considered adequate for only 23.5% of the patients with bacteremia due to P. aeruginosa carrying the blaSPM-1 gene, and a high lethality rate of 70.6% was observed during the 30-day period after bacteremia and an inadequate initial antibiotic regimen.
  
  
  CONCLUSIONS
  We detected the presence of a clone of carbapenem-resistant P. aeruginosa carrying blaSPM-1 that persisted in blood culture samples over a six-year period at the institution, with high lethality, thus justifying rigorous epidemiological surveillance and a rearrangement of the antimicrobial therapy regimens at the institution.
authors.affiliation: Laboratório Especial em Microbiologia Clínica, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, SP.
authors.forename: Thais Avila
authors.initials: TA
authors.lastname: Fernandes
authors.forename: Carlos Alberto Pires
authors.initials: CA
authors.lastname: Pereira
authors.forename: Antônio Sergio
authors.initials: AS
authors.lastname: Petrili
authors.forename: Antônio Carlos Campos
authors.initials: AC
authors.lastname: Pignatari
mesh_terms: D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D016470:Bacteremia / Q000382:microbiology*; D001938:Brazil; D015780:Carbapenems / Q000494:pharmacology*; D002648:Child; D052978:Disk Diffusion Antimicrobial Tests; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005838:Genotype; D006801:Humans; D008297:Male; D009369:Neoplasms / Q000382:microbiology*; D016133:Polymerase Chain Reaction; D011552:Pseudomonas Infections / Q000188:drug therapy / Q000382:microbiology*; D011550:Pseudomonas aeruginosa / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics; D012189:Retrospective Studies; D018440:beta-Lactam Resistance / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; C476155:beta-lactamase SPM-1, Pseudomonas aeruginosa; D001618:beta-Lactamases