World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in context
Summary: Background: Carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) are listed by World Health Organization (WHO) as priority antimicro...
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2025-03-01
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| Series: | The Lancet Regional Health. Americas |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2667193X25000146 |
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| author | Laura C. Antochevis Camila M. Wilhelm Beatriz Arns Daniel Sganzerla Letícia O. Sudbrack Thais C.R.L. Nogueira Ricardo D. Guzman Amanda S. Martins Daniela S. Cappa Ândrea C. dos Santos Joseani C. Pascual Vitor Hugo Perugini Eliana C. Vespero Maria Helena P. Rigatto Dariane C. Pereira Larissa Lutz Robson S. Leão Elizabeth A. Marques Danielle M. Henrique André A.M. Coelho Lígia L. Frutuoso Erika E. de A Sousa Luiz F. Abreu Guimarães Adriana L.P. Ferreira Anna Carla Castiñeiras Marcelle D. Alves João Paulo Telles Carolina H. Yamada Francieli P. de Almeida Evelyne S. Girão Paulo C.P. de Sousa Antonio G.N.D. de Melo Elisa T. Mendes Verônica de F.D. Rocha Euclimeire da S. Neves Marcello T. Ribeiro Carlos Ernesto Ferreira Starling Maura S. Oliveira Jorge L.M. Sampaio Andreza F. Martins Afonso L. Barth Alexandre P. Zavascki Jéssica Nesello dos Santos Charles Francisco Ferreira Tarsila Vieceli Julival Ribeiro Fagundes Raquel Nascimento Matias Shisue Karina Katagiri Olavo José Vicente Neto Rafaela Kuczynski da Rocha Claudia Maria Dantas de Maio Carrilho Mila Muraro de Almeida Heloisa da Silva Rosa Valéria Paes Lima Tazio Vanni Simone Aranha Nouer Elizabeth Mendes Alves Jorge Luiz Nobre Rodrigues André Jhonathan Dantas Gyselle de Souza Rebouças Jailton Santos de Oliveira |
| author_facet | Laura C. Antochevis Camila M. Wilhelm Beatriz Arns Daniel Sganzerla Letícia O. Sudbrack Thais C.R.L. Nogueira Ricardo D. Guzman Amanda S. Martins Daniela S. Cappa Ândrea C. dos Santos Joseani C. Pascual Vitor Hugo Perugini Eliana C. Vespero Maria Helena P. Rigatto Dariane C. Pereira Larissa Lutz Robson S. Leão Elizabeth A. Marques Danielle M. Henrique André A.M. Coelho Lígia L. Frutuoso Erika E. de A Sousa Luiz F. Abreu Guimarães Adriana L.P. Ferreira Anna Carla Castiñeiras Marcelle D. Alves João Paulo Telles Carolina H. Yamada Francieli P. de Almeida Evelyne S. Girão Paulo C.P. de Sousa Antonio G.N.D. de Melo Elisa T. Mendes Verônica de F.D. Rocha Euclimeire da S. Neves Marcello T. Ribeiro Carlos Ernesto Ferreira Starling Maura S. Oliveira Jorge L.M. Sampaio Andreza F. Martins Afonso L. Barth Alexandre P. Zavascki Jéssica Nesello dos Santos Charles Francisco Ferreira Tarsila Vieceli Julival Ribeiro Fagundes Raquel Nascimento Matias Shisue Karina Katagiri Olavo José Vicente Neto Rafaela Kuczynski da Rocha Claudia Maria Dantas de Maio Carrilho Mila Muraro de Almeida Heloisa da Silva Rosa Valéria Paes Lima Tazio Vanni Simone Aranha Nouer Elizabeth Mendes Alves Jorge Luiz Nobre Rodrigues André Jhonathan Dantas Gyselle de Souza Rebouças Jailton Santos de Oliveira |
| author_sort | Laura C. Antochevis |
| collection | DOAJ |
| description | Summary: Background: Carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) are listed by World Health Organization (WHO) as priority antimicrobial-resistant bacteria. Data on WHO Priority Antimicrobial resistance Phenotype (WPAP) bacteria from low- and middle-income countries are scarce. In this study, we investigated the occurrence of WPAP in healthcare-associated bloodstream infections (BSI) in Brazil, an upper-middle-income country in South America. Methods: ASCENSION was a prospective, multicentre, observational study conducted in 14 hospitals from four of five Brazilian regions. Enterobacterales, A. baumannii, P. aeruginosa, S. aureus and E. faecium BSIs in hospitalised patients were analysed. The primary outcome was the frequency of WPAP among all bacteria of interest. Secondary outcomes were incidence-density of bacteria isolates in hospitalised patients, WPAP proportions within bacterial species, and 28-day mortality. PCR for carbapenemase genes was performed in carbapenem-resistant Gram-negative bacteria. Findings: Between August 15, 2022, and August 14, 2023, 1350 isolates (1220 BSI episodes) were included. WPAP accounted for 38.8% (n = 524; 95% Confidence Interval 32.0–46.1) of all isolates, with CRE (19.3%) as the most frequent, followed by CRAB (9.6%), MRSA (4.9%), VRE (2.7%), and CRPA (2.4%). Incidence-density of all and WPAP isolates were 1.91 and 0.77/1000 patients-day, respectively. Carbapenem-resistant Klebsiella pneumoniae (CRKP) was the most common CRE, corresponding to 14.2% of all BSIs. A. baumannii isolates presented the highest proportion of WPAP (87.8%). Mortality rates were higher in patients with BSIs by WPAP than non-WPAP isolates. KPC (64.4%) was the predominant carbapenemase in CRE, followed by NDM (28.4%) and KPC + NDM co-production (7.1%). OXA-23 was the most frequent in CRAB. Interpretation: A high frequency of WPAP bacteria, particularly CRKP and CRAB, were found in healthcare-associated BSIs in Brazil, posing them as a major public health problem in this country. Funding: National Council for Scientific and Technological Development, Brazil. |
| format | Article |
| id | doaj-art-08338bd3d0a64c30b1c4aca55ba758e1 |
| institution | Kabale University |
| issn | 2667-193X |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | The Lancet Regional Health. Americas |
| spelling | doaj-art-08338bd3d0a64c30b1c4aca55ba758e12025-01-31T05:12:40ZengElsevierThe Lancet Regional Health. Americas2667-193X2025-03-0143101004World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in contextLaura C. Antochevis0Camila M. Wilhelm1Beatriz Arns2Daniel Sganzerla3Letícia O. Sudbrack4Thais C.R.L. Nogueira5Ricardo D. Guzman6Amanda S. Martins7Daniela S. Cappa8Ândrea C. dos Santos9Joseani C. Pascual10Vitor Hugo Perugini11Eliana C. Vespero12Maria Helena P. Rigatto13Dariane C. Pereira14Larissa Lutz15Robson S. Leão16Elizabeth A. Marques17Danielle M. Henrique18André A.M. Coelho19Lígia L. Frutuoso20Erika E. de A Sousa21Luiz F. Abreu Guimarães22Adriana L.P. Ferreira23Anna Carla Castiñeiras24Marcelle D. Alves25João Paulo Telles26Carolina H. Yamada27Francieli P. de Almeida28Evelyne S. Girão29Paulo C.P. de Sousa30Antonio G.N.D. de Melo31Elisa T. Mendes32Verônica de F.D. Rocha33Euclimeire da S. Neves34Marcello T. Ribeiro35Carlos Ernesto Ferreira Starling36Maura S. Oliveira37Jorge L.M. Sampaio38Andreza F. Martins39Afonso L. Barth40Alexandre P. Zavascki41Jéssica Nesello dos SantosCharles Francisco FerreiraTarsila VieceliJulival Ribeiro FagundesRaquel Nascimento MatiasShisue Karina KatagiriOlavo José Vicente NetoRafaela Kuczynski da RochaClaudia Maria Dantas de Maio CarrilhoMila Muraro de AlmeidaHeloisa da Silva RosaValéria Paes LimaTazio VanniSimone Aranha NouerElizabeth Mendes AlvesJorge Luiz Nobre RodriguesAndré Jhonathan DantasGyselle de Souza RebouçasJailton Santos de OliveiraLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Universidade do Sul de Santa Catarina, Tubarão, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, Porto Alegre, BrazilInova Medical Research, Porto Alegre, BrazilNúcleo de Controle de Infecção Hospitalar, Hospital de Base do Distrito Federal, Brasília, BrazilNúcleo de Controle de Infecção Hospitalar, Hospital de Base do Distrito Federal, Brasília, BrazilHospital de Base do Distrito Federal, Brasília, BrazilHospital São Lucas, Porto Alegre, BrazilHospital São Lucas, Porto Alegre, BrazilHospital São Lucas, Porto Alegre, BrazilHospital Universitário, Universidade Estadual de Londrina, Londrina, BrazilHospital Universitário, Universidade Estadual de Londrina, Londrina, BrazilHospital Universitário, Universidade Estadual de Londrina, Londrina, BrazilInfectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Serviço de Diagnóstico Laboratorial, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilServiço de Diagnóstico Laboratorial, Hospital de Clínicas de Porto Alegre, Porto Alegre, BrazilHospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BrazilHospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BrazilHospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, BrazilHospital Universitário de Brasília, Brasília, BrazilHospital Universitário de Brasília, Brasília, BrazilHospital Universitário de Brasília, Brasília, BrazilHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilHospital Universitário Clementino Fraga Filho, Universidade Federal do Rio de Janeiro, Rio de Janeiro, BrazilInfectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, Porto Alegre, Brazil; Laboratório Weinmann - Grupo Fleury, Porto Alegre, BrazilHospital Universitário Evangélico Mackenzie, Curitiba, BrazilHospital Universitário Evangélico Mackenzie, Curitiba, BrazilHospital Universitário Evangélico Mackenzie, Curitiba, BrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, BrazilHospital Universitário Walter Cantídio, Universidade Federal do Ceará, Fortaleza, BrazilFaculdade de Medicina, Universidade Federal do Ceará, Fortaleza, BrazilHospital PUC-Campinas, Campinas, Brazil; Pós Graduação Ciências da Saúde, PUC-Campinas, Campinas, BrazilInstituto Couto Maia, Salvador, BrazilInstituto Couto Maia, Salvador, BrazilInstituto Couto Maia, Salvador, BrazilHospital Lifecenter, Belo Horizonte, BrazilHospital Sírio Libanês, São Paulo, BrazilFaculdade de Ciências Farmacêuticas, Universidade de São Paulo, São Paulo, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Programa de Pós-graduação em Ciências Médicas, Universidade Federal do Rio Grande do Sul, Porto Alegre, BrazilLaboratório de Pesquisa em Resistência Bacteriana (LABRESIS), Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Infectious Diseases Service, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Infectious Diseases and Infection Control Service, Hospital Moinhos de Vento, Porto Alegre, Brazil; Department of Internal Medicine, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Corresponding author. Hospital de Clínicas de Porto Alegre, Infectious Diseases Service, Porto Alegre, 90035-903, Brazil.Summary: Background: Carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus faecium (VRE) are listed by World Health Organization (WHO) as priority antimicrobial-resistant bacteria. Data on WHO Priority Antimicrobial resistance Phenotype (WPAP) bacteria from low- and middle-income countries are scarce. In this study, we investigated the occurrence of WPAP in healthcare-associated bloodstream infections (BSI) in Brazil, an upper-middle-income country in South America. Methods: ASCENSION was a prospective, multicentre, observational study conducted in 14 hospitals from four of five Brazilian regions. Enterobacterales, A. baumannii, P. aeruginosa, S. aureus and E. faecium BSIs in hospitalised patients were analysed. The primary outcome was the frequency of WPAP among all bacteria of interest. Secondary outcomes were incidence-density of bacteria isolates in hospitalised patients, WPAP proportions within bacterial species, and 28-day mortality. PCR for carbapenemase genes was performed in carbapenem-resistant Gram-negative bacteria. Findings: Between August 15, 2022, and August 14, 2023, 1350 isolates (1220 BSI episodes) were included. WPAP accounted for 38.8% (n = 524; 95% Confidence Interval 32.0–46.1) of all isolates, with CRE (19.3%) as the most frequent, followed by CRAB (9.6%), MRSA (4.9%), VRE (2.7%), and CRPA (2.4%). Incidence-density of all and WPAP isolates were 1.91 and 0.77/1000 patients-day, respectively. Carbapenem-resistant Klebsiella pneumoniae (CRKP) was the most common CRE, corresponding to 14.2% of all BSIs. A. baumannii isolates presented the highest proportion of WPAP (87.8%). Mortality rates were higher in patients with BSIs by WPAP than non-WPAP isolates. KPC (64.4%) was the predominant carbapenemase in CRE, followed by NDM (28.4%) and KPC + NDM co-production (7.1%). OXA-23 was the most frequent in CRAB. Interpretation: A high frequency of WPAP bacteria, particularly CRKP and CRAB, were found in healthcare-associated BSIs in Brazil, posing them as a major public health problem in this country. Funding: National Council for Scientific and Technological Development, Brazil.http://www.sciencedirect.com/science/article/pii/S2667193X25000146Antimicrobial resistanceEnterobacteralesKlebsiella pneumoniaeAcinetobacter baumanniiPseudomonas aeruginosaStaphylococcus aureus |
| spellingShingle | Laura C. Antochevis Camila M. Wilhelm Beatriz Arns Daniel Sganzerla Letícia O. Sudbrack Thais C.R.L. Nogueira Ricardo D. Guzman Amanda S. Martins Daniela S. Cappa Ândrea C. dos Santos Joseani C. Pascual Vitor Hugo Perugini Eliana C. Vespero Maria Helena P. Rigatto Dariane C. Pereira Larissa Lutz Robson S. Leão Elizabeth A. Marques Danielle M. Henrique André A.M. Coelho Lígia L. Frutuoso Erika E. de A Sousa Luiz F. Abreu Guimarães Adriana L.P. Ferreira Anna Carla Castiñeiras Marcelle D. Alves João Paulo Telles Carolina H. Yamada Francieli P. de Almeida Evelyne S. Girão Paulo C.P. de Sousa Antonio G.N.D. de Melo Elisa T. Mendes Verônica de F.D. Rocha Euclimeire da S. Neves Marcello T. Ribeiro Carlos Ernesto Ferreira Starling Maura S. Oliveira Jorge L.M. Sampaio Andreza F. Martins Afonso L. Barth Alexandre P. Zavascki Jéssica Nesello dos Santos Charles Francisco Ferreira Tarsila Vieceli Julival Ribeiro Fagundes Raquel Nascimento Matias Shisue Karina Katagiri Olavo José Vicente Neto Rafaela Kuczynski da Rocha Claudia Maria Dantas de Maio Carrilho Mila Muraro de Almeida Heloisa da Silva Rosa Valéria Paes Lima Tazio Vanni Simone Aranha Nouer Elizabeth Mendes Alves Jorge Luiz Nobre Rodrigues André Jhonathan Dantas Gyselle de Souza Rebouças Jailton Santos de Oliveira World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in context The Lancet Regional Health. Americas Antimicrobial resistance Enterobacterales Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa Staphylococcus aureus |
| title | World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in context |
| title_full | World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in context |
| title_fullStr | World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in context |
| title_full_unstemmed | World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in context |
| title_short | World Health Organization priority antimicrobial resistance in Enterobacterales, Acinetobacter baumannii, Pseudomonas aeruginosa, Staphylococcus aureus and Enterococcus faecium healthcare-associated bloodstream infections in Brazil (ASCENSION): a prospective, multicentre, observational studyResearch in context |
| title_sort | world health organization priority antimicrobial resistance in enterobacterales acinetobacter baumannii pseudomonas aeruginosa staphylococcus aureus and enterococcus faecium healthcare associated bloodstream infections in brazil ascension a prospective multicentre observational studyresearch in context |
| topic | Antimicrobial resistance Enterobacterales Klebsiella pneumoniae Acinetobacter baumannii Pseudomonas aeruginosa Staphylococcus aureus |
| url | http://www.sciencedirect.com/science/article/pii/S2667193X25000146 |
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worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT charlesfranciscoferreira worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT tarsilavieceli worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT julivalribeirofagundes worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT raquelnascimentomatias worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT shisuekarinakatagiri worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT olavojosevicenteneto worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT rafaelakuczynskidarocha worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT claudiamariadantasdemaiocarrilho worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT milamurarodealmeida worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT heloisadasilvarosa worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT valeriapaeslima worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT taziovanni worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT simonearanhanouer worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT elizabethmendesalves worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT jorgeluiznobrerodrigues worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT andrejhonathandantas worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT gyselledesouzareboucas worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud AT jailtonsantosdeoliveira worldhealthorganizationpriorityantimicrobialresistanceinenterobacteralesacinetobacterbaumanniipseudomonasaeruginosastaphylococcusaureusandenterococcusfaeciumhealthcareassociatedbloodstreaminfectionsinbrazilascensionaprospectivemulticentreobservationalstud |