title: Multidrug-resistant nontuberculous mycobacteria isolated from cystic fibrosis patients.
abstract: Worldwide, nontuberculous mycobacteria (NTM) have become emergent pathogens of pulmonary infections in cystic fibrosis (CF) patients, with an estimated prevalence ranging from 5 to 20%. This work investigated the presence of NTM in sputum samples of 129 CF patients (2 to 18 years old) submitted to longitudinal clinical supervision at a regional reference center in Rio de Janeiro, Brazil. From June 2009 to March 2012, 36 NTM isolates recovered from 10 (7.75%) out of 129 children were obtained. Molecular identification of NTM was performed by using PCR restriction analysis targeting the hsp65 gene (PRA-hsp65) and sequencing of the rpoB gene, and susceptibility tests were performed that followed Clinical and Laboratory Standards Institute recommendations. For evaluating the genotypic diversity, pulsed-field gel electrophoresis (PFGE) and/or enterobacterial repetitive intergenic consensus sequence PCR (ERIC-PCR) was performed. The species identified were Mycobacterium abscessus subsp. bolletii (n = 24), M. abscessus subsp. abscessus (n = 6), Mycobacterium fortuitum (n = 3), Mycobacterium marseillense (n = 2), and Mycobacterium timonense (n = 1). Most of the isolates presented resistance to five or more of the antimicrobials tested. Typing profiles were mainly patient specific. The PFGE profiles indicated the presence of two clonal groups for M. abscessus subsp. abscessus and five clonal groups for M. abscesssus subsp. bolletii, with just one clone detected in two patients. Given the observed multidrug resistance patterns and the possibility of transmission between patients, we suggest the implementation of continuous and routine investigation of NTM infection or colonization in CF patients, including countries with a high burden of tuberculosis disease.
authors.affiliation: Programa de Pós Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Pedro Henrique Campanini
authors.initials: PH
authors.lastname: Cândido
authors.affiliation: Programa de Pós Graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.
authors.forename: Luciana de Souza
authors.initials: Lde S
authors.lastname: Nunes
authors.affiliation: Departamento de Microbiologia, Imunologia e Parasitologia, Faculdade de Ciências Médicas, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Elizabeth Andrade
authors.initials: EA
authors.lastname: Marques
authors.affiliation: Instituto Fernandes Figueira, Rio de Janeiro, Brazil.
authors.forename: Tânia Wrobel
authors.initials: TW
authors.lastname: Folescu
authors.affiliation: Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Fábrice Santana
authors.initials: FS
authors.lastname: Coelho
authors.affiliation: Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Vinicius Calado Nogueira
authors.initials: VC
authors.lastname: de Moura
authors.affiliation: Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Marlei Gomes
authors.initials: MG
authors.lastname: da Silva
authors.affiliation: Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Karen Machado
authors.initials: KM
authors.lastname: Gomes
authors.affiliation: Instituto de Pesquisa Evandro Chagas, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.
authors.forename: Maria Cristina da Silva
authors.initials: MC
authors.lastname: Lourenço
authors.affiliation: Programa de Pós Graduação em Clínica Médica, Hospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil.
authors.forename: Fábio Silva
authors.initials: FS
authors.lastname: Aguiar
authors.affiliation: Instituto de Doenças do Tórax, Rio de Janeiro, Brazil.
authors.forename: Fernanda
authors.initials: F
authors.lastname: Chitolina
authors.affiliation: Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Derek T
authors.initials: DT
authors.lastname: Armstrong
authors.affiliation: Departamento de Microbiologia, Imunologia e Parasitologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil.
authors.forename: Sylvia Cardoso
authors.initials: SC
authors.lastname: Leão
authors.affiliation: Instituto Biomédico, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil.
authors.forename: Felipe Piedade Gonçalves
authors.initials: FP
authors.lastname: Neves
authors.affiliation: Instituto de Doenças do Tórax, Rio de Janeiro, Brazil.
authors.forename: Fernanda Carvalho de Queiroz
authors.initials: FC
authors.lastname: Mello
authors.affiliation: Instituto de Microbiologia, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil rsduarte@ufrj.br.
authors.forename: Rafael Silva
authors.initials: RS
authors.lastname: Duarte
mesh_terms: D000293:Adolescent; D000890:Anti-Infective Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics; D001938:Brazil; D018834:Chaperonin 60 / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000150:complications*; D012321:DNA-Directed RNA Polymerases / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D014644:Genetic Variation; D005838:Genotype; D006801:Humans; D008297:Male; D058889:Molecular Typing; D009165:Mycobacterium Infections, Nontuberculous / Q000382:microbiology*; D009170:Nontuberculous Mycobacteria / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D013183:Sputum / Q000382:microbiology
chemical_list: D000890:Anti-Infective Agents; D001426:Bacterial Proteins; D018834:Chaperonin 60; C074119:heat-shock protein 65, Mycobacterium; D012321:DNA-Directed RNA Polymerases; C105078:RNA polymerase beta subunit