Enterococci are an uncommon cause of CNS infection. A 20 month-old boy, diagnosed with hydrocephalus with ventriculoperitoneal shunt and history of lengthy hospitalization and use of wide spectrum antibiotics, was admitted to the pediatric intensive care unit diagnosed with ventriculitis. On the 14th day of empirical antibiotic therapy (vancomycin and meropenem) the child presented fever while the CSF sample culture evidenced vancomycin-resistant Enterococcus faecium. The patient received intravenous linezolid achieving cerebrospinal fluid sterilization. Conclusion: Intravenous linezolid appears to be a safe and effective therapy for vancomycin-resistant enterococcus ventriculoperitoneal shunt infection.

Introdução: O teste de suscetibilidade a antimicrobianos representa um dos testes de maior importância clínica realizados pelo laboratório de microbiologia. Devido ao grande número de antimicrobianos e à complexidade dos mecanismos de resistência desenvolvidos pelas bactérias, fica muito difícil hoje a detecção de problemas nos testes de suscetibilidade pela simples avaliação dos resultados obtidos. Sendo assim, é extremamente importante que haja uma avaliação constante da qualidade destes testes. Objetivo: O objetivo do presente estudo foi avaliar a qualidade dos discos de antimicrobianos comercializados no Brasil. Material e métodos: Foram avaliados discos de 18 antimicrobianos obtidos de cinco diferentes fontes comerciais, os quais foram testados frente a quatro cepas bacterianas oriundas da ATCC, pelo método de difusão em ágar, seguindo as recomendações do National Committee for Clinical Laboratory Standards (NCCLS). Cada teste foi repetido 20 vezes. Resultados: Nenhuma das marcas apresentou desempenho satisfatório para o uso na rotina de um laboratório de microbiologia. O melhor desempenho foi apresentado pela marca Cecon®, com 89,6% de concordância. A marca Sensifar® apresentou taxa de concordância geral semelhante (90,8%). A marca com o pior desempenho foi a Pimenta Abreu®, com apenas 58,6% de concordância. Conclusão: Os resultados do presente estudo indicam que os discos de antimicrobianos comercializados no Brasil são de baixa qualidade, possivelmente refletindo a falta de controle de qualidade na produção e/ou estocagem dos produtos antes da sua distribuição. Esses dados chamam a atenção para a necessidade de implantação de sistemas efetivos de fiscalização da comercialização desses produtos e de programas criteriosos de controle de qualidade por parte dos laboratórios que os utilizam.

Background: The antimicrobial susceptibility test is one of the most important clinical test carried out in the microbiology laboratory. Due to the great number of antimicrobial agents and the complexity of resistance mechanisms evolved, it has become very difficult to detect problems in these tests by simply evaluating the results obtained. Consequently, a quality control program must be performed continuously. Objective: The objective of the present study was to evaluate the quality of the antimicrobial susceptibility disks used in Brazil. Methods: Eighteen antimicrobial susceptibility disks manufactured from five commercial trade marks were evaluated. These antimicrobial disks were tested against four ATCCs and following the National Committee for Clinical Laboratory Standards (NCCLS) procedures for disk-diffusion. Each test was repeated 20 times. Results: None of the trade marks presented a satisfactory performance for routine use in a microbiology laboratory. The best performance was presented by Cecon®, with 89,6% of overall agreement. Sensifar® disks showed a similar overall concordance of 90,8%. The trade mark with the least adequate performance was Pimenta Abreu®, with only 58,6% overall agreement. Conclusion: The results from this study indicate that the disks commercialized in Brazil are inappropriate to be used in clinical microbiology laboratories showing lack of quality control during the process of production and/or storage. They also show the importance of the implementation of both external and internal quality control programs.

We report for the first time in Brazil, a patient from whom an Enterococcus faecalis VanA phenotype was isolated. Glycopeptide resistance is not commonly observed in Enterococcus faecalis, so this finding is of great concern since this species is responsible for 90% of enterococcal infections in Brazil. The isolate was recovered from a surveillance rectal swab culture from a patient with acute lymphocytic leukemia (ALL). Identification to the species level was performed by conventional biochemical tests and Vitek GPI cards. Antimicrobial susceptibility testing was evaluated by use of broth microdilution and Etest (AB BIODISK, Solna, Sweden) methods. The isolate was identified as E. faecalis and was considered resistant to both vancomycin (MIC, > 256 mug/mL) and teicoplanin (MIC, 256 mug/mL). The isolate also showed high level resistance to gentamicin and streptomycin (MICs, > 1024 mug/mL), but was considered susceptible to ampicillin (MIC, 4 mug/mL). Although the frequency of enterococcal infections is very low in most Latin America countries, the finding of glycopeptide (VanA) resistance in E. faecalis increases concern about apreading antimicrobial resistance in this region.