title: The challenges of antimicrobial resistance in Brazil.
abstract: Brazil is a country with continental proportions with high geographic and economic diversity. Despite its medical centers of excellence, antimicrobial resistance poses a major therapeutic challenge. Rates of methicillin-resistant Staphylococcus aureus are up to 60% and are related to an endemic Brazilian clone. Local resistance to vancomycin in Enterococci was first related to Enterococcus faecalis, which differs from European and American epidemiology. Also, local Klebsiella pneumoniae and Escherichia coli isolates producing extended-spectrum β-lactamases have a much higher prevalence (40%-50% and 10%-18%, respectively). Carbapenem resistance among the enterobacteriaceae group is becoming a major problem, and K. pneumoniae carbapenemase isolates have been reported in different states. Among nonfermenters, carbapenem resistance is strongly related to SPM-1 (Pseudomonasaeruginosa) and OXA-23 (Acinetobacter baumannii complex) enzymes, and a colistin-only susceptible phenotype has also emerged in these isolates, which is worrisome. Local actions without loosing the global resistance perspective will demand multidisciplinary actions, new policies, and political engagement.
authors.affiliation: Pathology Department, DLC_LIM 03, Hospital das Clínicas da Universidade de São Paulo, São Paulo, Brazil. frossi@hcnet.usp.br
authors.forename: Flávia
authors.initials: F
authors.lastname: Rossi
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D001938:Brazil / Q000453:epidemiology; D024881:Drug Resistance, Bacterial; D004755:Enterobacteriaceae / Q000145:classification / Q000187:drug effects; D006090:Gram-Negative Bacteria / Q000145:classification / Q000187:drug effects*; D006095:Gram-Positive Cocci / Q000145:classification / Q000187:drug effects*; D006801:Humans; D008826:Microbial Sensitivity Tests
chemical_list: D000900:Anti-Bacterial Agents