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Rev. Soc. Bras. Med. Trop ; 53: e20190526, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136834


Abstract INTRODUCTION: This study investigated the genetic environment of bla KPC-2 in Klebsiella pnemoniae multi-drug resistant clinical isolates. METHODS: Four carbapenemase gene isolates resistant to carbapenems, collected from infected patients from two hospitals in Brazil, were investigated using polymerase chain reaction and plasmid DNA sequencing. RESULTS: The bla KPC-2 gene was located between ISKpn6 and a resolvase tnpR in the non-Tn4401 element (NTEKPC-IId). It was detected on a plasmid belonging to the IncQ1 group. CONCLUSIONS To our knowledge, this is the first report of the presence of the bla KPC-2 gene in the NTEKPC-IId element carried by plasmid IncQ1 from infections in Brazil.

Humans , beta-Lactamases/genetics , Klebsiella Infections/microbiology , Klebsiella pneumoniae/genetics , Anti-Bacterial Agents/pharmacology , Plasmids/genetics , DNA, Bacterial/genetics , Microbial Sensitivity Tests , Polymerase Chain Reaction , Drug Resistance, Multiple, Bacterial , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/enzymology
Einstein (Säo Paulo) ; 17(4): eGS4444, 2019. tab
Article in English | LILACS | ID: biblio-1001916


ABSTRACT Objective: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. Methods: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). Results: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. Conclusion: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.

RESUMO Objetivo: Estimar os custos médicos diretos da terapia medicamentosa de pacientes com infecção por carbapenemase por Klebsiella pneumoniae carbapenemase (KPC) em contexto hospitalar. Métodos: Estudo de custo de doença realizado com desenho de coorte prospectiva, com adultos hospitalizados infectados por KPC. A coleta de dados foi realizada usando instrumento composto por dados sociodemográficos, medicamentos clínicos e prescritos. As estimativas dos custos diretos associados a cada tratamento foram derivadas da perspectiva dos pagadores, no caso dos hospitais públicos federais do Brasil, e incluíram apenas custos de medicamentos, os quais basearam-se no preço médio disponível na Price Database Health do Brasil. Nenhuma taxa de desconto foi utilizada para o custo dos medicamentos. Os custos foram calculados em dólares norte-americanos (US$). Resultados: Um total de 120 pacientes hospitalizados participou do estudo. O custo total da droga desses pacientes internados foi de US$ 367,680.85. O grupo antimicrobianos de uso sistêmico foi responsável por 59,5% dos custos totais. O custo direto estimado de forma conservadora, por paciente, foi de aproximadamente US$ 4,100.00, e cerca de 60% destes se deram durante o período de infecção. Conclusão: Os achados deste estudo apontam um risco econômico importante relacionado a KPC, o qual todos os setores de saúde terão que enfrentar. A incidência mundial em elevação destas bactérias representa carga crescente, e a maioria dos sistemas de saúde é incapaz de resolvê-la. Há necessidade imperativa de se desenvolverem protocolos e novos antimicrobianos para o tratamento de KPC, com o objetivo de reorganizar os recursos para aumentar a efetividade dos serviços de saúde.

Humans , Male , Female , beta-Lactamases , Klebsiella Infections/economics , Prospective Studies , Hospitalization/economics , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/enzymology , Anti-Bacterial Agents/economics , Bacterial Proteins , Klebsiella Infections/microbiology , Klebsiella Infections/drug therapy , Health Care Costs , Hospitalization/statistics & numerical data , Inpatients , Middle Aged , Anti-Bacterial Agents/administration & dosage
Rev. Soc. Bras. Med. Trop ; 52: e20180352, 2019. tab
Article in English | LILACS | ID: biblio-1041560


Abstract INTRODUCTION: The emergence of New Delhi metallo-β-lactamase (NDM) is concernig because it reduces the antibiotic therapy options for bacterial infections. METHODS: Resistant and virulent genes from an isolate of Klebsiella pneumoniae derived from a patient with sepsis in a hospital in Recife-PE, Brazil, were investigated using PCR and DNA sequencing. RESULTS: bla NDM-1, aac(6')-Ib-cr and acrB resistance genes, and cps and mrkD virulence genes were detected. CONCLUSIONS To our knowledge, this is the first report on bla NDM-1 in Recife-PE. This detection alerts researchers to the need to control the spread of bla NDM-1 resistance gene by this bacterium in Brazil.

Humans , Female , Bacterial Proteins/genetics , Virulence/genetics , beta-Lactamases/genetics , Drug Resistance, Multiple, Bacterial/genetics , Klebsiella pneumoniae/genetics , Anti-Bacterial Agents/pharmacology , Microbial Sensitivity Tests , Polymerase Chain Reaction , Sequence Analysis, DNA , Sepsis/microbiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/enzymology
Braz. j. microbiol ; 49(4): 885-890, Oct.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-974312


ABSTRACT In this study, the performance of the "RESIST-3 O.K.N. K-SeT" (Coris BioConcept, Gembloux, Belgium) immunochromatographic assay was evaluated in 132 Klebsiella pneumoniae comprising 102 carbapenem resistant and 30 carbapenem susceptible isolates. Genotypically known isolates of Gram negative bacteria (n = 22) including various species were also tested by the assay as controls. The isolates tested by the immunochromatographic assay and also were run PCR for bla KPC, bla IMP, bla VIM, bla NDM, and bla OXA-48. The rates of bla NDM, bla OXA-48, and bla KPC in carbapenem resistant isolates were found at 52.9%, 39.2%, and 2.0%, respectively. Both bla NDM and bla OXA-48 were found in six (5.9%) isolates. The results of the assay showed 100% concordance with those obtained by PCR in 132 K. pneumoniae. The agreement between the two methods was found to be identical at the isolate level. The assay also correctly detected all genotypically known isolates of Escherichia coli, Serratia marcescens, Citrobacter freundii, Enterobacter cloacae, K. pneumoniae carrying bla KPC, bla NDM, and/or bla OXA-48. On the other hand, the assay did not exhibit any cross-reaction in control isolates harboring bla IMP and bla VIM. We conclude that the RESIST-3 O.K.N. K-SeT is a reliable, rapid, and user friendly test and we recommend it for routine diagnostic laboratories.

Humans , Bacterial Proteins/analysis , beta-Lactamases/analysis , Klebsiella Infections/microbiology , Immunoassay/methods , Klebsiella pneumoniae/enzymology , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Turkey , beta-Lactamases/metabolism , Carbapenems/pharmacology , Polymerase Chain Reaction , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/chemistry , Anti-Bacterial Agents/pharmacology
West Indian med. j ; 67(4): 344-349, Oct.-Dec. 2018. tab
Article in English | LILACS | ID: biblio-1045862


ABSTRACT Objective: To determine the role of extended-spectrum β-lactamases in carbapenem-resistant Gram-negative bacteria from south-western Nigeria. Methods: Twenty-seven carbapenem-resistant isolates that were found to be non-carbapenemase producers (15 Escherichia coli, 9 Klebsiella pneumoniae and 3 Pseudomonas aeruginosa) were further studied. These isolates were subjected to analysis including phenotypic and genotypic detection of various β-lactamases, efflux activity, outer membrane protein, plasmids replicon typing, detection of transferable genes and resistances and typing using random amplified polymorphic DNA tests. Results: No isolates demonstrated de-repression of efflux, but all showed either complete loss or reduced production of outer membrane proteins. Transconjugants from these strains contained various genes including plasmid-mediated quinolone resistance and extended-spectrum beta-lactamases. All the transconjugants carried the blaCTX-M-15 gene. The transconjugants had varying minimum inhibitory concentrations of carbapenems ranging from 0.03 μg/ml to 8 μg/ml. Varying resistances to other antimicrobial agents were also transferred with the plasmids. The donor isolates were not clonally related by molecular typing. Conclusion: Resistance to carbapenem antibiotics in this sample was not mediated only by carbapenemases but also by production of extended-spectrum β-lactamases (largely CTX-M-15), accompanied by protein loss. This was an important mechanism underpinning carbapenem resistance in these clinical isolates of various species.

RESUMEN Objetivo: Determinar el papel de las betalactamasas de espectro extendido en la resistencia al carbapenem en las bacterias gramnegativas en Nigeria. Métodos: Veintisiete aislados resistentes al carbapenem que fueron hallados productores de no carbapenemasas (15 Escherichia coli, 9 Klebsiella pneumoniae, y 3 Pseudomonas aeruginosa) fueron estudiados con mayor profundidad. Estos aislados fueron sometidos a análisis incluyendo la detección fenotípica y genotípica de varias betalactamasas, la actividad de eflujo, las porinas de la membrana externa, la tipificación del replicón plasmídico, la detección de genes transferibles y resistencias y tipificación usando pruebas de ADN polimórficas amplificadas aleatorias. Resultados: Ninguno de los aislamientos mostró desrepresión de eflujo, pero todos demostraron la pérdida completa o la producción reducida de porinas externas de la membrana. Los transconjugantes de estas cepas contenían varios genes incluyendo resistencia a la quinolona mediada por plásmidos y betalactamasas de espectro extendido. Todos los transconjugantes portaban el gen blaCTX-M-15. Los transconjugantes tenían diversas concentraciones inhibitorias mínimas de carbapenemas que oscilaban entre 0.03 μg/ml y 8 μg/ml. Varias resistencias a otros agentes antimicrobianos fueron también transferidas con los plásmidos. Los aislamientos del donante no estuvieron relacionados clonalmente por tipificación molecular. Conclusión: La resistencia al antibiótico carbapenem en esta muestra no fue mediada solamente por las carbapenemasas, sino también por la producción de betalactamasas de espectro extendido (en gran parte CTX-M-15), acompañado por pérdida de porina. Éste era un mecanismo importante que sustentaba la resistencia al carbapenem en estos aislados clínicos de varias especies.

Humans , Pseudomonas aeruginosa/drug effects , beta-Lactamases/biosynthesis , Escherichia coli/drug effects , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Phenotype , Pseudomonas aeruginosa/enzymology , Drug Resistance, Microbial , Microbial Sensitivity Tests , Escherichia coli/enzymology , Genotype , Klebsiella pneumoniae/enzymology , Nigeria
Medwave ; 18(2): e7191, 2018.
Article in English, Spanish | LILACS | ID: biblio-912086


Las carbapenemasas son uno de los mecanismos enzimáticos de resistencia antimicrobiana, que compromete la mayor parte de los antibióticos betalactámicos. Por lo general, su producción se debe al uso indiscriminado de antimicrobianos. A nivel mundial, la expansión de este mecanismo de resistencia es inminente y las medidas de control son limitadas. Con el objeto de discutir los problemas relacionados a este mecanismo emergente de resistencia, reportamos un caso de Klebsiella pneumoniae productora de carbapenemasas en Huancayo, la Región de la Sierra Central de Perú.

Carbapenemases are one of the major mechanisms of antimicrobial resistance, usually due to the indiscriminate use of antibiotics. The expansion of this mechanism of resistance at world level is imminent and control measures are limited. In the region of the Central Sierra of Peru - Huancayo, we report a case of carbapenemase-producing Klebsiella pneumoniae, with the purpose of discussing the problems related to this emerging mechanism of antibiotic resistance.

Humans , Male , Adult , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Peru , Bacterial Proteins/metabolism , beta-Lactamases/metabolism , Klebsiella Infections/microbiology , Drug Resistance, Bacterial , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/enzymology
Rev. chil. infectol ; 34(5): 476-484, oct. 2017. tab, graf
Article in Spanish | LILACS | ID: biblio-899745


Resumen En la actualidad, la diseminación de enterobacterias productoras de carbapenemasas se considera un grave problema en clínica debido al fracaso en el tratamiento de las infecciones que ellas producen. Entre las carbapenemasas, la enzima KPC se ha diseminado mundialmente y ha sido identificada en las principales especies de enterobacterias relacionadas con infecciones asociadas a la atención en salud, con claro predominio de Klebsiella pneumoniae a nivel mundial. El gen blaKPC es transportado, principalmente, por el transposón Tn4401, detectado en diversas especies de enterobacterias con distintos secuencio-tipo (ST) y diferente origen geográfico. Adicionalmente, se han descrito nuevas plataformas genéticas que se distinguen del Tn4401 original debido a inserciones y deleciones de otros genes. Los plásmidos que albergan el gen blaKPC pueden ser del tipo conjugativo y no conjugativo movilizable, y además contener otros determinantes genéticos de resistencia. Las cepas productoras de KPC pueden presentar diversos niveles de resistencia a los carbapenémicos, debido a la participación de mecanismos adicionales como diferente grado de expresión de porinas y bombas de expulsión asociados con la producción de β-lactamasas de espectro extendido y/o AmpC. Sin embargo, las carbapenemasas, con KPC como la enzima más frecuente, otorgan grados de resistencia más elevados.

The dissemination of carbapenemase-producing Enterobacteriaceae is currently considered a serious clinical problem due to the failure in the treatment of infections produced by them. Among the carbapenemases, the enzyme KPC has spread worldwide and has been identified in the main enterobacterial species related with healthcareassociated infections, although Klebsiella pneumoniae is the predominant specie. The blaKPC gene is transported, mainly by the transposon Tn4401, detected in various enterobacterial species of different sequence types (ST) and geographical origin. In addition, new genetic platforms that are distinguished, from Tn4401 because of insertions or deletions of other genes have been described. Plasmids containing the blaKPC gene can be conjugative and mobilizable non-conjugative plasmids, and can carry other genetic determinants of resistance. The KPC-producing strains may have different levels of resistance to carbapenems, due to the involvement of additional mechanisms such as different expression levels of porins and efflux pumps associated with the production of extended spectrum β-lactamases and/or AmpC. However, the carbapenemases, with KPC as the most common enzyme, provide higher levels of resistance.

Bacterial Proteins/biosynthesis , beta-Lactamases/biosynthesis , Klebsiella pneumoniae/enzymology , Bacterial Proteins/genetics , beta-Lactamases/genetics , Microbial Sensitivity Tests , Drug Resistance, Bacterial/genetics , Carbapenem-Resistant Enterobacteriaceae , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/genetics , Anti-Bacterial Agents/pharmacology
Medicina (B.Aires) ; 77(2): 105-110, Apr. 2017. tab
Article in Spanish | LILACS | ID: biblio-894441


Se realizó un estudio de vigilancia en un Hospital Universitario de la Ciudad Autónoma de Buenos Aires con el fin de determinar la prevalencia de colonización por cepas de Klebsiella pneumoniae productora de carbapenemasa, bacterias de gran importancia epidemiológica. A tal fin, se investigó su presencia en cultivos de hisopados rectales de todos los pacientes internados. Se realizaron dos cortes de prevalencia en los cuales se encontraron tasas de hasta 25%. Además, se analizaron las siguientes variables en toda la población estudiada: procedencia (domicilio u otro centro de cuidados crónicos), edad, internación prolongada, uso de antibióticos por al menos 72 horas previas al hisopado, internación en unidad de terapia intensiva, requerimientos de hemodiálisis, necesidad de cirugía, alimentación enteral mediante sonda nasogástrica, asistencia respiratoria mecánica por más de 4 días y evaluación funcional según escala de Karnofsky. La variable asociada a la colonización con mayor significación estadística fue el uso de sonda nasogástrica para alimentación enteral. Además, se observó que el tiempo de internación fue significativamente mayor y la clase funcional fue peor en los pacientes colonizados. En cuanto al uso previo de antibióticos se obtuvieron valores cercanos a la significación estadística, aunque sin alcanzarla. Con base en las variables evaluadas se implementaron medidas de contingencia con el fin de controlar la diseminación del microorganismo. Finalmente, se realizó un tercer corte de prevalencia durante la implementación de dichas medidas, el cual mostró una disminución en la transmisión horizontal del microorganismo.

A surveillance study was conducted at a University Hospital in Buenos Aires City aimed to assess the rates of colonization with carbapenemase-producing strains of Klebsiella pneumoniae, which are bacteria of utmost epidemiological importance. To this end, rectal swabs collected from all inpatients were cultured for the presence of these bacteria. Two point prevalence surveys showed high prevalence rates (up to 25%). The following variables were evaluated in all inpatients: place of origin (home or other chronic care center), age, prolonged hospitalization, antibiotics for at least 72 hours prior to swabbing, intensive care unit requirements for at least 24 hours, mechanical ventilation assistance for more than 4 days, hemodialysis requirements, need for surgery, enteral feeding through a nasogastric tube, and functional evaluation according to the Karnofsky performance scale. The variable associated with the highest statistical significance was the use of nasogastric enteral feeding. Also, the length of stay was significantly higher and the functional status was significantly worse in colonized patients. As for the prior use of antibiotics, results were close to statistical significance but without reaching it. Measures were implemented in order to control the spread of the microorganism in the acute setting and beyond. Upon implementation of such measures, a third prevalence survey was performed that showed a decrease in the horizontal transmission of the microorganism.

Humans , Male , Female , Aged , Aged, 80 and over , beta-Lactamases/biosynthesis , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/enzymology , Argentina , Prevalence , Epidemiological Monitoring , Hospitals, University , Length of Stay
J. bras. nefrol ; 38(2): 269-270, graf
Article in Portuguese | LILACS | ID: lil-787879


Resumo Um homem de 60 anos de idade foi submetido a transplante renal em 2013 devido à insuficiência renal crônica causada por hipertensão. Ele teve episódios recorrentes de infecção do trato urinário e veio para o hospital devido a 4 dias de febre, dor abdominal, ardência para urinar e náusea. Análise do sedimento urinário revelou um quadro de infecção (> 50 leucócitos/campo de grande aumento associado à bacteriúria maciça). O sedimento urinário revelou elementos alongados com um alargamento na parte central do corpo da estrutura.

Abstract A 60 year-old man was submitted to kidney transplantation in 2013 due to chronic renal insufficiency caused by hypertension. He had recurrent episodes of urinary tract infection and came to the hospital due to a 4 day-long fever, abdominal pain, burning urination and nausea. Routine urinalysis revealed a picture of infection (> 50 leucocytes/high power field associated to massive bacteriuria). The urine sediment revealed elongated like elements with an enlarged part in the middle of the structure body.

Humans , Male , Middle Aged , Spheroplasts/enzymology , Urinary Tract Infections/microbiology , Urinary Tract Infections/urine , beta-Lactamases , Klebsiella pneumoniae/enzymology , Urine/microbiology
Braz. j. microbiol ; 46(2): 501-504, Apr-Jun/2015. tab, graf
Article in English | LILACS | ID: lil-749737


The emergence of β-lactamase-producing Enterobacteriaceae in the last few decades has become major challenge faced by hospitals. In this study, isolates of Klebsiella pneumoniae carbapenemase-2 (KPC-2)-producing K. pneumoniae from a tertiary hospital in Mato Grosso do Sul, Brazil, were characterized. Bacterial identification was performed by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF; Bruker Daltonics, Germany) mass spectrometry. The minimum inhibitory concentrations of carbapenems were determined using the agar dilution method as recommended by the Clinical Laboratory Standards Institute guidelines. Carbapenemase production was detected using the modified Hodge test (MHT) and polymerase chain reaction (PCR), followed by DNA sequencing. Of 360 (12.2%) K. pneumoniae isolates obtained between May 2009 and May 2010, 44 (12.2%) were carbapenem nonsusceptible. Of these 44 isolates, thirty-six K. pneumoniae isolates that were positive by MHT and PCR carried the blaKPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.

Humans , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , beta-Lactamases , Brazil , DNA, Bacterial/genetics , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests , Polymerase Chain Reaction , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Tertiary Care Centers , beta-Lactamases/genetics
Rev. Soc. Bras. Med. Trop ; 48(3): 358-360, May-Jun/2015. tab
Article in English | LILACS | ID: lil-749882


Infections due to multidrug-resistant organisms continue to increase, and therapeutic options remain scarce. Given this challenge, it has become necessary to use older antimicrobials for treatment of these pathogens. We report three patients with lower urinary tract infections caused by Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae who were successfully treated with a seven-day course of oral fosfomycin monotherapy.

Aged , Aged, 80 and over , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/therapeutic use , Fosfomycin/therapeutic use , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/drug effects , Urinary Tract Infections/drug therapy , Disk Diffusion Antimicrobial Tests , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , Treatment Outcome , Urinary Tract Infections/microbiology , beta-Lactamases
Article in English | IMSEAR | ID: sea-157097


Backgound & objectives: resistance to carbapenems in Gram-negative bacteria conferred by NDM-1 is a global health problem. We investigated the occurrence of NDM-1 in clinical isolates of gram-negative bacilli in a tertiary care hospital in Kashmir valley, India. Methods: Gram-negative bacilli from different clinical isolates were included in the study. Antimicrobial susceptibility was performed by Kirby Bauer disk diffusion method and interpreted using Clinical Laboratory Standards Institute (CLSI) guidelines. Isolates resistant to carbapenems were subjected to different phenotypic test such as modified hodge test (MHT), boronic acid and oxacillin based MHT (bA-MHT and OXA-MHT), combined disk test and minimum inhibitory concentration (MIC) with imipenem and imipenem -EDTA for determination of class B metallo enzymes. Presence of blaNDM-1 gene was established by PCR and confirmed by sequencing. Results: Of the total 1625 gram-negative isolates received, 100 were resistant to imipenem. Of the 100 isolates, 55 (55%) were positive by modified Hodge test indicating carbapenemase production. Of the 100 isolates tested by MHT, BA-MHT and OXA-MHT, 29 (29%) isolates belonged to Class A and 15 (15%) to Class B, while 56 (56%) isolates were negative. Of the 15 class B metallo beta lactamase producers, nine carried the blaNDM-1 gene. NDM-1 was found among escherichia coli (2 isolates), Klebsiella pneumoniae (2 isolates), Citrobacter freundii (3 isolates), Acinetobacter spp (1 isolate), and one isolate of Pseudomonas aeruginosa. Isolates were resistant to all antibiotic tested except polymyxin B and tigecycline. Interpretation & conclusions: Our study showed the presence of clinical isolates expressing NDM-1 in Srinagar, Jammu & Kashmir, India. These isolates harbour plasmid mediated multiple drug resistant determinants and can disseminate easily across several unrelated genera. To halt their spread, early identification of these isolates is mandatory.

Acinetobacter/drug effects , Acinetobacter/enzymology , Carbapenems/pharmacology , Citrobacter freundii/drug effects , Citrobacter freundii/enzymology , Disk Diffusion Antimicrobial Tests , Drug Resistance, Multiple, Bacterial/drug effects , Drug Resistance, Multiple, Bacterial/genetics , Escherichia coli/drug effects , Escherichia coli/enzymology , Gram-Negative Bacteria/drug effects , Gram-Negative Bacteria/enzymology , Gram-Negative Bacteria , Humans , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/enzymology , Microbial Sensitivity Tests , Pseudomonas aeruginosa/drug effects , Pseudomonas aeruginosa/enzymology , Tertiary Care Centers , beta-Lactamases/biosynthesis , beta-Lactamases/genetics , beta-Lactamases/isolation & purification
ABCD arq. bras. cir. dig ; 27(3): 168-171, Jul-Sep/2014. graf
Article in English | LILACS | ID: lil-720377


BACKGROUND: Animal models are useful to evaluate the efficacy of antimicrobials in experimental sepsis. AIM: To elucidate the steps of producing an experimental model for the treatment of extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae sepsis METHODS: Several ESBL inoculums ranging from 1.5x109 colony-forming units per milliliter (CFU/mL) to 2.0x1010 CFU/mL were administered by peritoneal injection in adults Wistar rats. Outcomes and microbiological data of quantitative peritoneal and blood cultures were observed in untreated animals. Animals which received 2.0x1010 CFU/mL inoculums were treated with single meropenem dose (30mg/kg) after one hour and those which received 1.0x1010 CFU/mL inoculums were treated immediately with three doses of meropenem 50 mg/kg. Outcomes were observed for 24 hours after inoculation. RESULTS: Solutions with 1.5 x109 and 6.0x109 CFU/mL were not lethal within 24 hours. Inoculums of 1.0x1010 CFU/mL were lethal in 80% and solutions with 2.0x1010 CFU/mL were lethal in 100% of animals. ESBL lethal sepsis (1.0x1010CFU/mL) was treated immediately with 50 mg/kg of meropenem every eight hours for 24 hours and presented 40% mortality compared with 80% mortality of the control group (p=0.033). Quantitative cultures of peritoneal fluid presented 104 CFU/mL or less for treated animals compared to more than 105 for untreated animals (p=0.001). CONCLUSION: Inoculums of 1.0x1010CFU/mL achieved the best results to study a model of lethal sepsis and this model of treatment of carbapenem-susceptible Enterobacteriaceae can serve as control to further evaluation of treatment of carbapenemase-producing Enterobacteriaceae models. .

RACIONAL: Modelos animais são importantes para avaliar a eficácia de antimicrobianos e a validação do sítio de infecção e a carga bacteriana. OBJETIVO: Definir a concentração do inóculo bacteriano, a dose e o tempo de administração de antimicrobianos a fim de validar um modelo experimental para o tratamento de Klebsiella pneumoniae produtora de betalactamase de amplo espectro em sepse letal. MÉTODO: Inóculos de Klebsiella pneumoniae produtora de betalactamase de espectro estendido de 1,5x109 unidades formadoras de colônias por mililitro (UFC/ml) a 2,0x1010 UFC/ml foram administrados via injeção peritoneal em ratos Wistar adultos. Sobrevida e dados microbiológicos de hemoculturas e culturas quantitativas de fluido peritoneal foram avaliados inicialmente em animais não tratados. Animais inoculados com 2,0x1010 UFC/ml foram tratados dose única de meropenem (30mg/kg) e animais inoculados com 1,0x1010 UFC/ml foram tratados imediatamente com meropenem (50 mg/kg) por 24 horas e os desfechos foram avaliados após 24 horas da inoculação. RESULTADOS: Soluções com 1,5 x109 e 6,0x109 UFC/ml não foram letais. Inóculos de 1,0x1010 UFC/ml e de 2,0x1010UFC/ml foram letais em 80% e 100% dos animais respectivamente. Sepse letal (1.0x1010CFU/mL) com tratamento imediato e por 24 horas apresentou 40% de mortalidade, comparada com 80% nos controles (p=0.033). Culturas quantitativas de fluido peritoneal apresentaram ≤104 UFC/ml enquanto que controles sem tratamento apresentaram >105 UFC/ml (p=0.001). CONCLUSÃO: Modelo experimental com inóculo de 1,0x1010UFC/ml submetido ao tratamento imediato e por 24 horas foi capaz de avaliar resposta microbiológica e de sobrevida podendo ser modelo de embasamento e de controle para tratamento de sepse letal por Klebsiella pneumoniae produtora de carbapenemase. .

Animals , Female , Male , Rats , Anti-Infective Agents/therapeutic use , Disease Models, Animal , Klebsiella Infections/drug therapy , Klebsiella pneumoniae/enzymology , Sepsis/drug therapy , beta-Lactamases/biosynthesis , Rats, Wistar
Einstein (Säo Paulo) ; 12(3): 282-286, Jul-Sep/2014. tab, graf
Article in English | LILACS | ID: lil-723932


Objective To analyze the profile of patients with microorganisms resistant to carbapenems, and the prevalence of the enzyme Klebsiella pneumoniae carbapenemase in interobacteriaceae. Methods Retrospective descriptive study. From the isolation in bacteriological tests ordered by clinicians, we described the clinical and epidemiological characteristics of patients with enterobacteria resistants to carbapenems at a university hospital, between March and October 2013. Results We included 47 isolated patients in this study, all exhibiting resistance to carbapenems, including 9 patients who were confirmed as infected/colonized with K. pneumoniae carbapenemase. Isolation in tracheal aspirates (12; 25.5%) predominated. The resistance to ertapenem, meropenem, and imipenem was 91.5%, 83.0% and 80.0%, respectively. Aminoglycosides was the class of antimicrobials that showed the highest sensitivity, 91.5% being sensitive to amikacin and 57.4% to gentamicin. Conclusion The K. pneumoniae carbapenemase was an important agent in graun isotaling in hospital intection. The limited therapeutic options emphasize the need for rapid laboratory detection, as well as the implementation of measures to prevent and control the spread of these pathogens. .

Objetivo Analisar o perfil dos pacientes que apresentaram microrganismos com resistência aos carbapenêmicos, e a prevalência da enzima Klebsiella pneumoniae carbapenemase em enterobactérias. Métodos Estudo retrospectivo descritivo. A partir do isolamento em exames bacteriológicos solicitados pelos clínicos, descrevemos as características clínicas e epidemiológicas dos pacientes que apresentaram enterobactérias resistentes aos carbapenêmicos entre março e outubro de 2013 em um hospital universitário. Resultados Foram incluídos 47 pacientes isolados, todos apresentando resistência aos carbapenêmicos, dos quais 9 tiveram confirmação de infecção/colonização por K. pneumoniae carbapenemase. Ocorreu predomínio de isolamento em aspirados traqueais (12; 25,5%). A resistência ao ertapenem, meropenem e imipenem foi de 91,5%, 83,0% e 80,0%, respectivamente. Os aminoglicosídeos foram a classe de antimicrobianos que apresentou maior sensibilidade, sendo 91,5% sensível a amicacina e 57,4% a gentamicina. Conclusão A K. pneumoniae carbapenemase constituiu um importante patógeno hospitalar em isolamento crescente nesse nosocômio. As limitadas opções terapêuticas reforçam a necessidade de uma rápida detecção laboratorial, assim como a implementação de medidas de prevenção e controle da disseminação desses patógenos. .

Adolescent , Adult , Child , Female , Humans , Male , Young Adult , Bacterial Proteins/biosynthesis , Cross Infection/microbiology , Drug Resistance, Bacterial , Enterobacteriaceae/enzymology , Klebsiella Infections/enzymology , Klebsiella pneumoniae/enzymology , beta-Lactamases/biosynthesis , Carbapenems/therapeutic use , Enterobacteriaceae Infections/enzymology , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae/drug effects , Enterobacteriaceae/isolation & purification , Hospitals, Teaching/statistics & numerical data , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/isolation & purification , Microbial Sensitivity Tests , Polymerase Chain Reaction , Retrospective Studies
Biomédica (Bogotá) ; 34(supl.1): 16-22, abr. 2014. tab
Article in Spanish | LILACS | ID: lil-712417


Introducción. Las betalactamasas de espectro extendido (BLEE) son un fenómeno de resistencia emergente de particular incidencia en América Latina. En Colombia existe poca información sobre los factores de riesgo asociados con su adquisición. Objetivo. Determinar los factores de riesgo que están asociados a la infección o colonización por Escherichia coli o Klebsiella pneumoniae productoras de BLEE en pacientes mayores de 18 años. Materiales y métodos. Se llevó a cabo un estudio de casos y controles con relación 1:1 en pacientes con aislamientos de E. coli o K. pneumoniae productoras de BLEE en cualquier tipo de muestra durante el periodo de enero de 2009 a noviembre de 2011 en el Hospital Universitario de San José. Resultados. Se estudiaron 110 casos y 110 controles; 62,7 % correspondió a E. coli y 37,3 %, a K. pneumoniae . Como factores de riesgo independiente en el análisis multivariado se encontraron la insuficiencia renal crónica (OR=2,99; IC 95%, 1,10-8,11; p=0,031), la cirugía urológica (OR=4,78; IC 95%, 1,35-16,87; p=0,015), el antecedente de uso de antibióticos en los tres meses anteriores (OR=2,24; IC 95%, 1,09-4,60; p=0,028), el origen hospitalario de la infección (OR=2,92; IC 95%, 1,39-6,13; p=0,004) y la hospitalización previa (OR=1,59; IC 95%, 1,03-2,46; p=0,036). Conclusión. Anticiparse al patrón de resistencia del microorganismo que infecta a un paciente con base en los factores de riesgo asociados permitiría la elección de un tratamiento antibiótico empírico apropiado, con el fin de lograr la disminución de la morbimortalidad de los pacientes.


Adult , Aged , Female , Humans , Male , Middle Aged , Anti-Bacterial Agents/pharmacology , Drug Resistance, Multiple, Bacterial , Escherichia coli Infections/microbiology , Escherichia coli/enzymology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/enzymology , beta-Lactams/pharmacology , Anti-Bacterial Agents/metabolism , Case-Control Studies , Colombia , Cross Infection/epidemiology , Cross Infection/microbiology , Drug Resistance, Multiple, Bacterial/genetics , Escherichia coli Infections/epidemiology , Escherichia coli/drug effects , Escherichia coli/genetics , Escherichia coli/isolation & purification , Immunocompromised Host , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/drug effects , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Postoperative Complications/microbiology , Retrospective Studies , Risk Factors , Tertiary Care Centers , beta-Lactam Resistance/genetics , beta-Lactams/metabolism