Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins

uring the last 30 years there has been a dissemination of plasmid-mediated beta-lactamases in Enterobacteriaceae in Brazil. Extended spectrum beta-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in Sao Paulo, the largest city in Brazil. New Delhi metallo-beta-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.(C) 2016 Sociedade Brasileira de Microbiologia. Published by Elsevier Editora Ltda.