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1.
Rev. Soc. Bras. Med. Trop ; 53: e20200064, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136871

ABSTRACT

Abstract INTRODUCTION: Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon. METHODS: In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, bla GES, bla NDM, bla SPM, bla IMP, bla VIM, and bla OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. RESULTS: Seventy-four (50.3%) isolates were positive for bla NDM, eight (5.4%) for bla KPC, and one (1.2%) for both bla NDM and bla KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response. CONCLUSIONS: Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.


Subject(s)
Humans , Bacterial Proteins/genetics , beta-Lactamases/genetics , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Brazil , DNA, Bacterial , Microbial Sensitivity Tests , Polymerase Chain Reaction , Prevalence , Drug Resistance, Multiple, Bacterial/genetics , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/genetics
2.
Rev. Soc. Bras. Med. Trop ; 53: e20190526, 2020. tab, graf
Article in English | ColecionaSUS, LILACS, ColecionaSUS, SES-SP | ID: biblio-1136834

ABSTRACT

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.


Subject(s)
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
3.
Rev. chil. infectol ; 36(3): 304-311, jun. 2019. tab, graf
Article in Spanish | LILACS | ID: biblio-1013788

ABSTRACT

Resumen Introducción: La expresión de β-lactamasas CTX-M pertenecientes a los grupos 1 y 9 en Klebsiella pneumoniae produce grados altos de resistencia a ceftazidima, y presentan una amplia distribución mundial. Objetivo: Identificar y caracterizar los genes blaCTX-M-Grupo1 y blaCTX-M-Grupo9 en aislados de K. pneumoniae resistentes a ceftazidima en un hospital de San José de Cúcuta, Colombia. Material y Método: Se diseñaron partidores para la identificación de K. pneumoniae y los genes blaCTX-M mediante reacción de polimerasa en cadena (RPC). Posteriormente se realizó el análisis de la relación genética de estos aislados por medio de la RPC basada en secuencias repetitivas (RPC-REP). Resultados: Treinta y ocho por ciento de los 24 aislados identificados por RPC como K. pneumoniae presentaron los genes blaCTX-M-3, blaCTX-M-15 y blaCTX-M-32 (Grupo CTX-M-1) y 42% los genes blaCTX-M14, blaCTX-M-24 y blaCTX-M-27 (Grupo CTX-M-9). El análisis filogenético agrupó los aislados de K. pneumoniae en cuatro clusters, mostrando correlación en los clusters I, II y IV, al comparar los perfiles genéticos con el tipo de muestra y grupo de genes. Discusión: Se encontró una frecuencia similar de los genes blaCTX-M-Grupo1 y blaCTX-M-Grupo 9 en aislados de K. pneumoniae resistentes a ceftazidima. La correlación entre la RPC-REP con los grupos de CTX-M y el tipo de muestra reveló la presencia de tres patrones clonales.


Background: The expression of CTX-M β-lactamases belonging to groups 1 and 9 in Klebsiella pneumoniae produces high levels of resistance to ceftazidime, and they have a wide distribution worldwide. Aim: To identify and characterize the blaCTX-M-Group1 and blaCTX-M-Group9 genes in K. pneumoniae isolates resistant to ceftazidime in a hospital in San José de Cúcuta, Colombia. Material and Methods: Primers were designed for the identification of K. pneumoniae and blaCTX-M genes by PCR. Subsequently, the genetic relationship of these isolates was analyzed by REP-PCR. Results: A 38% of the 24 isolates identified by PCR as K. pneumoniae showed blaCTX-M-3. blaCTX-M-15 y blaCTX-M-32 genes (Group CTX-M-1) and 42% blaCTX-M14. blaCTX-M-24 y blaCTX-M-27 genes (Group CTX-M-9). The phylogenetic analysis grouped the K. pneumoniae isolates into 4 clusters, showing correlation in clusters I, II and IV, when comparing the genetic profiles with the type of sample and group of genes. Discussion: We found a similar frequency of blaCTX-M-Group 1 and blaCTX-M-Group 9 genes in isolates of K. pneumoniae resistant to ceftazidime. The correlation between the REP-PCR with the CTX-M groups and the type of sample revealed the presence of three clonal patterns.


Subject(s)
Humans , Bacterial Proteins/genetics , beta-Lactamases/genetics , Drug Resistance, Bacterial/genetics , Molecular Typing , Klebsiella pneumoniae/genetics , Phylogeny , Bacterial Proteins/isolation & purification , beta-Lactamases/isolation & purification , Ceftazidime , Polymerase Chain Reaction , Colombia , Klebsiella pneumoniae/isolation & purification , Anti-Bacterial Agents
4.
Arq. bras. med. vet. zootec. (Online) ; 71(2): 584-593, mar.-abr. 2019. tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1011254

ABSTRACT

Klebsiella pneumoniae é um patógeno oportunista, responsável por diversos tipos de infecções nosocomiais, e é considerado um microrganismo multirresistente. Dados na literatura que forneçam informações a respeito da resistência desse microrganismo a antimicrobianos em amostras de animais são escassos. Dessa forma, o objetivo deste trabalho foi avaliar o perfil e o seu aumento das resistências a antimicrobianos dentro da medicina veterinária. Um total de 67 isolados de K. pneumoniae, provenientes de diferentes sítios de isolamento de animais domésticos (39/67) e silvestres (28/67), foi confirmado por sequenciamento do gene 16S rRNA. O maior percentual de isolamento de K. pneumoniae foi de amostras de urina, com 16% (11/67), fezes, com 15% (10/67), e pulmão, com 13,5% (09/67). No perfil de resistência, foram testadas 11 categorias de antibióticos, sendo a maior taxa de resistência ao metronidazol 97% (65/67), à ampicilina 94% (63/67), à amoxicilina 93% (62/67), às sulfonamidas 93% (62/67), à colistina 93% (62/67) e à nitrofurantoína 88% (59/67). Aqueles que apresentaram menor taxa de resistência foram: meropenem 3% (2/67), imipenem 6% (4/67) e amicacina 16% (11/67). Todos os isolados foram considerados bactérias multirresistentes (MRD), com o índice de resistência múltipla aos antibióticos (IRMA) variando de 0,15 a 0,85 e com 60 tipos de padrões de resistência. O resultado deste estudo reforça que os animais são reservatórios de K. pneumoniae multirresistentes.(AU)


Klebsiella pneumoniae is an opportunistic pathogen responsible for several types of nosocomial infections and is considered a multiresistant microorganism. Data in the literature that provide information regarding the resistance of this microorganism to antimicrobials in animal samples are scarce. Thus, the objective of this work was to evaluate the profile and its increase of antimicrobial resistance within Veterinary Medicine. A total of 67 K. pneumoniae isolates from different domestic (39/67) and wild (28/67) isolation sites were confirmed by sequencing the 16S rRNA gene. The highest percentage of K. pneumoniae isolation was from urine samples with 16% (11/67), faeces 15% (10/67) and lung 13.5% (09/67). In the resistance profile, 11 categories of antibiotics were tested, with the highest resistance to metronidazole being 97% (65/67), ampicillin 94% (63/67), amoxicillin 93% (62/67), sulfonamides 93% (62 / 67), 93% colistin (62/67), and 88% nitrofurantoin (59/67). The ones with the lowest resistance were: meropenem 3% (2/67), imipenem 6% (4/67) and amikacin 16% (11/67). All isolates were considered multiresistant bacteria (MDR), with the Multiple Resistance to Antibiotics Index (IRMA) ranging from 0.15 to 0.85 and with 60 types of resistance patterns. The result of this study reinforces that the animals are reservoirs of multiresistant K. pneumoniae.(AU)


Subject(s)
Animals , Drug Resistance, Bacterial , Klebsiella pneumoniae/isolation & purification , Animals, Domestic/microbiology , Animals, Wild/microbiology
5.
Braz. j. med. biol. res ; 52(3): e8186, 2019. tab, graf
Article in English | LILACS | ID: biblio-989465

ABSTRACT

Klebsiella pneumoniae is one of the main pathogenic bacteria that causes nosocomial infections, such as pneumonia, urinary tract infection, and sepsis. Therefore, the rapid and accurate detection of K. pneumoniae is important for the timely treatment of infectious patients. This study aimed to establish a loop-mediated isothermal amplification (LAMP) method for the rapid and sensitive detection of K. pneumoniae-specific gene ureR_1 (Gene ID: 11847803). The ureR_1 gene was obtained through local and online BLAST, and the specific primers were designed for its detection. Positive reactions were observed on all 140 K. pneumoniae clinical isolates while all the 82 non-K. pneumoniae clinical isolates were negative. Plasmids with the specific gene and the mouse blood with K. pneumoniae were used for sensitivity analysis. The detection limit of the LAMP was 1 bacterium/reaction. The results showed that the LAMP targeted to ureR_1 is a fast, specific, sensitive, inexpensive, and suitable method for the detection of K. pneumoniae.


Subject(s)
Nucleic Acid Amplification Techniques/methods , Genes, Bacterial , Klebsiella pneumoniae/genetics , Plasmids/isolation & purification , Plasmids/genetics , Temperature , Time Factors , Polymerase Chain Reaction/methods , Reproducibility of Results , Sequence Analysis, DNA , DNA Primers/isolation & purification , DNA Primers/genetics , Limit of Detection , Klebsiella pneumoniae/isolation & purification
6.
Einstein (Säo Paulo) ; 17(4): eGS4444, 2019. tab
Article in English | LILACS | ID: biblio-1001916

ABSTRACT

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.


Subject(s)
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
7.
Braz. j. microbiol ; 49(4): 885-890, Oct.-Dec. 2018. tab, graf
Article in English | LILACS | ID: biblio-974312

ABSTRACT

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.


Subject(s)
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
8.
Rev. Soc. Bras. Med. Trop ; 51(5): 676-679, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-1041483

ABSTRACT

Abstract INTRODUCTION The spread of multidrug-resistant Gram-negative bacilli is a health threat, limiting therapeutic options and increasing morbimortality rates. METHODS: This study aimed to evaluate the antimicrobial susceptibility profile of 1805 Klebsiella pneumoniae isolates collected from Hospital Universitário de Santa Maria between January 2015 and December 2016. RESULTS: Resistance to colistin (239.3%), meropenem (74.2%), ciprofloxacin (68%), gentamicin (35.1%), tigecycline (33.9%), imipenem (29.7%), ertapenem (26.8%), and amikacin (21.4%) was found increased. CONCLUSIONS: Infection control measures in the hospitals are necessary for reducing the spread of multidrug-resistant microorganisms and preventing efficacy loss of these drugs.


Subject(s)
Humans , Male , Female , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Hospitals, University/statistics & numerical data , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Brazil , Microbial Sensitivity Tests , Retrospective Studies , Drug Resistance, Bacterial , Klebsiella pneumoniae/isolation & purification , Middle Aged
9.
Braz. j. otorhinolaryngol. (Impr.) ; 84(5): 532-539, Sept.-Oct. 2018. tab, graf
Article in English | LILACS | ID: biblio-974360

ABSTRACT

Abstract Introduction: Peritonsillar abscess is the most common deep neck infection. The infectious microorganism may be different according to clinical factors. Objective: To identify the major causative pathogen of peritonsillar abscess and investigate the relationship between the causative pathogen, host clinical factors, and hospitalization duration. Methods: This retrospective study included 415 hospitalized patients diagnosed with peritonsillar abscess who were admitted to a tertiary medical center from June 1990 to June 2013. We collected data by chart review and analyzed variables such as demographic characteristics, underlying systemic disease, smoking, alcoholism, betel nut chewing, bacteriology, and hospitalization duration. Results: A total of 168 patients had positive results for pathogen isolation. Streptococcus viridans (28.57%) and Klebsiella pneumoniae (23.21%) were the most common microorganisms identified through pus culturing. The isolation rate of anaerobes increased to 49.35% in the recent 6 years (p = 0.048). Common anaerobes were Prevotella and Fusobacterium spp. The identification of K. pneumoniae increased among elderly patients (age > 65 years) with an odds ratio (OR) of 2.76 (p = 0.03), and decreased in the hot season (mean temperature > 26 °C) (OR = 0.49, p = 0.04). No specific microorganism was associated with prolonged hospital stay. Conclusion: The most common pathogen identified through pus culturing was S. viridans, followed by K. pneumoniae. The identification of anaerobes was shown to increase in recent years. The antibiotics initially selected should be effective against both aerobes and anaerobes. Bacterial identification may be associated with host clinical factors and environmental factors.


Resumo Introdução: O Abscesso Peritonsilar é a infecção cervical profunda mais comum. O microrganismo infeccioso pode ser diferente de acordo com os fatores clínicos. Objetivo: Identificar o principal agente causador do abscesso peritonsilar e investigar a relação entre o patógeno causador, os fatores clínicos do hospedeiro e a duração da hospitalização. Método: Este estudo retrospectivo incluiu 415 pacientes hospitalizados diagnosticados com abscesso peritonsilar que foram internados em um centro médico terciário de junho de 1990 a junho de 2013. Coletamos dados através da análise dos arquivos médicos dos pacientes e analisamos variáveis como características demográficas, doença sistêmica subjacente, tabagismo, alcoolismo, hábito de mascar noz de betel, bacteriologia e duração da hospitalização. Resultados: Um total de 168 pacientes apresentaram resultados positivos para isolamento de patógenos. Streptococcus viridans (28,57%) e Klebsiella pneumoniae (23,21%) foram os microrganismos mais comuns identificados pela cultura da secreção. A taxa de isolamento de anaeróbios aumentou para 49,35% nos últimos 6 anos (p = 0,048). Os anaeróbios comuns foram Prevotella e Fusobacterium spp. A identificação de K. pneumoniae aumentou em pacientes idosos (idade > 65 anos) com razão de chances (Odds Ratio - OR) de 2,76 (p = 0,03) e diminuiu na estação do calor (temperatura média > 26 °C) (OR = 0,49, p = 0,04). Nenhum microrganismo específico foi associado à hospitalização prolongada. Conclusão: O patógeno mais comumente identificado através da cultura de secreção foi S. viridans, seguido por K. pneumoniae. A identificação de anaeróbios mostrou ter aumentado nos últimos anos. Os antibióticos selecionados inicialmente devem ser efetivos contra aeróbios e anaeróbios. A identificação bacteriana pode estar associada a fatores clínicos e fatores ambientais do hospedeiro.


Subject(s)
Humans , Adolescent , Adult , Middle Aged , Young Adult , Peritonsillar Abscess/microbiology , Gram-Positive Bacterial Infections/microbiology , Fusobacterium necrophorum/isolation & purification , Gram-Positive Bacteria/isolation & purification , Klebsiella Infections , Peritonsillar Abscess/diagnosis , Peritonsillar Abscess/therapy , Retrospective Studies , Risk Factors , Gram-Positive Bacterial Infections/therapy , Prevotella , Viridans Streptococci/isolation & purification , Fusobacterium Infections/microbiology , Klebsiella pneumoniae/isolation & purification , Anti-Bacterial Agents/therapeutic use
10.
Rev. Assoc. Med. Bras. (1992) ; 64(8): 736-742, Aug. 2018. tab, graf
Article in English | LILACS | ID: biblio-976843

ABSTRACT

SUMMARY INTRODUCTION Healthcare associated infections (HAI) are the most frequent complication of hospitalized patients. The aim of this study was to describe the clinical and epidemiological characteristics of critically ill post-surgical patients with a diagnosis of healthcare associated infections, after a pattern of sedoanalgesia of at least 4 days. METHODS All patients over 18 years of age with a unit admission of more than 4 days were consecutively selected. The study population was the one affected by surgical pathology where sedation was based as analgesic the opioid remifentanil for at least 96 hours in continuous perfusion. Patients who died during admission to the unit and those with combined analgesia (peripheral or neuroaxial blocks) were excluded. Data analysis was performed using the statistical package Stata version 7.0. RESULTS The patients admitted to the Post-Surgical Critical Care Unit (PCU) during study were 1789 and the population eligible was comprised of 102 patients. 56.86% of patients suffered IACS. The most frequent IACS was pneumonia associated with mechanical ventilation (30.96 per 1000 days of mechanical ventilation), Pseudomonas aeruginosa being the most frequently isolated germ. The germs with the greatest involvement in multiple drug resistance (MDROs) were enterobacteria, mainly Klebsiella pneumoniae resistant to extended-spectrum beta-lactamases (ESBL). CONCLUSIONS Pneumonia associated with mechanical ventilation is the most prevalent HAI and Pseudomonas aeruginosa is the main etiological agent. The groups of antibiotics most frequently used were cephalosporin and aminoglycosides. It is necessary to implement the prevention strategies of the different HAI, since most of them are avoidable.


RESUMO INTRODUCCIÓN Las infecciones asociadas a cuidados de salud (IACS) constituyen la complicación más frecuente de los pacientes hospitalizados. El objetivo de este estudio es describir las características clínicas y epidemiológicas de los pacientes críticos postquirúrgicos con diagnóstico de infección asociada a cuidados de salud, tras una pauta de sedoanalegia de al menos 4 días. MÉTODOS Se seleccionaron de manera consecutiva todos los pacientes mayores de 18 años con un ingreso en la Unidad de Reanimación Postquirúrgica (URP) superior a 4 días. La población de estudio fue aquella afectada por patología quirúrgica de cualquier origen donde la sedación se basó en cualquier hipnótico y como analgésico el opioide remifentanilo durante al menos 96 horas en perfusión continua. Se excluyeron los pacientes que fallecieron durante su ingreso en la unidad y aquellos pacientes con analgesia combinada (bloqueos periféricos o neuroaxiales). El análisis de los datos se realizó con paquete estadístico Stata versión 7.0. RESULTADOS El número de pacientes que ingresaron en la URP durante el periodo de estudio fueron de 1789. Tras aplicar los criterios de inclusión y exclusión, la población elegible quedó constituida por 102 pacientes. Un 56,86% de pacientes padecieron IACS. La IACS más frecuente fue la neumonía asociada a ventilación mecánica (30,96 por 1000 días de ventilación mecánica) siendo Pseudomona aeruginosa el germen más frecuentemente aislado. Los gérmenes con mayor implicación en las multirresistencias (MDROs) fueron las enterobacterias, principalmente Klebsiella pneumoniae resistente a betalactamasas de espectro extendido (BLEE). CONCLUSIONES La neumonía asociada a ventilación mecánica es la IACS más prevalente y Pseudomona aeruginosa es el principal agente etiológico. Los grupos de antibióticos más frecuentemente empleados fueron cefalosporinas y aminoglucósidos. Es necesario implementar las estrategias de prevención de las distintas IACS, ya que la mayoría de ellas son evitables.


Subject(s)
Humans , Male , Female , Aged , Postoperative Complications/epidemiology , Cross Infection/epidemiology , Remifentanil/administration & dosage , Analgesics, Opioid/administration & dosage , Postoperative Complications/microbiology , Pseudomonas aeruginosa/isolation & purification , Spain/epidemiology , Time Factors , Midazolam/administration & dosage , Propofol/administration & dosage , Cross Infection/microbiology , Prospective Studies , Risk Factors , Critical Illness , APACHE , Pneumonia, Ventilator-Associated/microbiology , Pneumonia, Ventilator-Associated/epidemiology , Deep Sedation/adverse effects , Deep Sedation/methods , Hospitalization/statistics & numerical data , Hypnotics and Sedatives/administration & dosage , Anesthesia, Local/adverse effects , Anesthesia, Local/methods , Klebsiella pneumoniae/isolation & purification , Middle Aged
11.
Braz. j. infect. dis ; 22(3): 235-238, May-June 2018. graf
Article in English | SES-SP, LILACS, SES-SP, SESSP-IDPCPROD, SES-SP | ID: biblio-974217

ABSTRACT

ABSTRACT Herein we report a fatal case of donor-derived transmission of XDR-resistant carbapenemase-producing Klebsiella pneumoniae (KPC-Kp) in cardiac transplantation. A 59-year-old male patient with non-obstructive hypertrophic cardiomyopathy underwent heart transplantation. On day 5 post-operation, blood cultures from the donor were positive for colistin-resistant carbapenemase-producing K. pneumoniae (ColR KPC-Kp) susceptible only to amikacin. Recipient blood cultures were also positive for ColR KPC-Kp with the same sensitivity profile as the donor isolate with an identical PFGE pattern. The patient was treated with double-carbapenems and amikacin. The patient evolved to pericarditis, osteomyelitis, and pulmonary necrosis, all fragment cultures positive for the same agent. The patient developed septic shock, multiple organ failure and died on day 50 post-transplantation. Based on current microbiological scenario worldwide the possibility of transmitting multidrug resistant (MDR) organisms should be considered.


Subject(s)
Humans , Male , Middle Aged , Tissue Donors , Klebsiella Infections/transmission , Heart Transplantation/adverse effects , Transplant Recipients , Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Klebsiella pneumoniae/isolation & purification , Klebsiella Infections/drug therapy , Risk Factors , Colistin/pharmacology , Fatal Outcome , Drug Resistance, Multiple, Bacterial , Anti-Bacterial Agents/pharmacology
12.
Braz. j. infect. dis ; 22(3): 239-242, May-June 2018.
Article in English | LILACS | ID: biblio-974204

ABSTRACT

ABSTRACT Febrile Neutropenia represents a medical emergency and the use of appropriate antimicrobial therapy is essential for a better outcome. Although being time-consuming, conventional cultures and antimicrobial susceptibility tests remain the golden standard practices for microbiology identification. Final reports are typically available within several days. Faster diagnostic tools, such as species identification trough Matrix Assisted Laser Desorption Ionization-Time of Flight (MALDI-TOF) and molecular techniques might help to shorten time to diagnostic and also guide definitive therapy in this scenario. Here we present a case in which the use of a diagnostic molecular workflow combining MALDI-TOF and real-time PCR for relevant genes codifying antibiotic resistant integrated with instant communication report, led to a tailored and more appropriate treatment in a patient presenting with febrile neutropenia.


Subject(s)
Humans , Male , Middle Aged , Ceftazidime/administration & dosage , Azabicyclo Compounds/administration & dosage , Febrile Neutropenia/microbiology , Febrile Neutropenia/drug therapy , beta-Lactamase Inhibitors/administration & dosage , Klebsiella pneumoniae/drug effects , Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization , Reverse Transcriptase Polymerase Chain Reaction , Drug Resistance, Multiple, Bacterial , Drug Combinations , Precursor Cell Lymphoblastic Leukemia-Lymphoma/complications , Klebsiella pneumoniae/isolation & purification
13.
Medwave ; 18(2): e7191, 2018.
Article in English, Spanish | LILACS | ID: biblio-912086

ABSTRACT

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.


Subject(s)
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
15.
Braz. j. microbiol ; 49(supl.1): 93-100, 2018. tab, graf
Article in English | LILACS | ID: biblio-974332

ABSTRACT

Abstract Klebsiella pneumoniae is important human and animal pathogen that causes a wide spectrum of infections. In this study, isolates from cattle nasal swabs samples were identified by 16S rRNA, and to evaluate the antimicrobial susceptibility, virulence gene carrying levels, and multilocus sequence typing of K. pneumoniae isolates. 33 isolates of K. pneumoniae were isolated and identified in 213 nasal swabs samples, of which 12 were hypervirulent K. pneumoniae strains. Extended Spectrum Beta-Lactamases genes were found in 93.4% of the strains. Of which, TEM was the most prevalent (93.4%), followed by CTX-M and SHV were 57.6% and 39.4%, respectively. A main mutation pattern of quinoloneresistance-determining region, Thr83-Ieu and Asp87-Asn in gyrA and Ser87-Ile in parC, was detected in 33 K. pneumoniae isolates. All the isolates harbored at least two virulence factor genes, with ureA (97.0%) and wabG (91.0%) exhibiting high carriage rates in 33 K. pneumoniae isolates. MLST revealed 7 sequence types, of which 3 STs (2541, 2581 and 2844) were newly assigned. Using eBURST, ST2844 and ST2541 were assigned to new clonal complex 2844. Our study provides evidence and biological characteristics of K. pneumoniae isolates from cattle upper respiratory tract in Southwest China.


Subject(s)
Animals , Cattle , Bacterial Proteins/genetics , Klebsiella Infections/veterinary , Cattle Diseases/microbiology , Drug Resistance, Multiple, Bacterial , Virulence Factors/genetics , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/drug effects , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/metabolism , Klebsiella Infections/microbiology , China , Virulence Factors/metabolism , Multilocus Sequence Typing , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/metabolism
17.
Rev. inf. cient ; 97(5): i:966-f:976, 2018. tab
Article in Spanish | LILACS, CUMED | ID: biblio-1005935

ABSTRACT

Introducción: la neumonía adquirida en la comunidad (NAC) constituye un importante problema de salud en el ámbito mundial y en Cuba. Su incidencia y letalidad hacen de esta afección un verdadero reto para los servicios asistenciales. Objetivo: identificar la incidencia de Klebsiella pneumoniae aislada de muestras de esputo en pacientes con neumonía adquirida en la comunidad. Método: se realizó un estudio descriptivo y trasversal en el laboratorio de microbiología del Centro Provincial de Higiene, Epidemiología y Microbiología de Guantánamo de enero a junio del 2016. El universo de estudio estuvo formado por 88 pacientes. Se aplicó el procedimiento de laboratorio propuesto por Expósito et al. Resultados: se identificaron 72 muestras de esputo productivo, de las cuales fueron positivas al cultivo bacteriológico 56 muestras, de ellas en 34 se aísló Klebsiella pneumoniae, que resultaron la muestra en estudio, mostrando resistencia marcada a amoxicilina y ceftriaxona. Se enmarcó este microorganismo como un patógeno que emergió como responsable de la etiología de infecciones respiratorias adquiridas en la comunidad. Conclusiones: Klebsiella pneumoniae por su frecuencia de aislamiento, por los mecanismos patogénicos y de resistencia que presenta, se considera un patógeno oportunista que emerge como responsable de la etiología de infecciones respiratorias adquiridas en la comunidad(AU)


Introduction: Community-acquired pneumonia (CAP) is a major health problem worldwide and in Cuba. Its incidence and lethality make this desease a real challenge for healthcare services. Objective: to identify the incidence of Klebsiella pneumoniae isolated from sputum samples in patients with community-acquired pneumonia. Method: a descriptive and cross-sectional study was carried out in the microbiology laboratory of the Provincial Hygiene, Epidemiology and Microbiology Center of Guantanamo from January to June 2016. The universe of study consisted of 88 patients. The laboratory procedure proposed by Expósito et al. Results: 72 samples of productive sputum were identified, of which 56 samples were positive for bacterial culture, Klebsiella pneumoniae was isolated in 34, which resulted in the study sample, showing marked resistance to amoxicillin and ceftriaxone. This microorganism was framed as a pathogen that emerged as responsible for the etiology of respiratory infections acquired in the community. Conclusions: Klebsiella pneumoniae, due to its frequency of isolation, due to its pathogenic and resistance mechanisms, is considered an opportunistic pathogen that emerges as responsible for the etiology of respiratory infections acquired in the community(AU)


Introdução: A pneumonia adquirida na comunidade (PAC) é um grande problema de saúde em todo o mundo e em Cuba. Sua incidência e letalidade tornam essa doença um verdadeiro desafio para os serviços de saúde. Objetivo: identificar a incidência de Klebsiella pneumoniae isolada de amostras de escarro em pacientes com pneumonia adquirida na comunidade. Método: um estudo descritivo e transversal foi realizado no laboratório de microbiologia do Centro Provincial de Higiene, Epidemiologia e Microbiologia em Guantánamo, de janeiro a junho de 2016. O grupo de estudo consistiu de 88 pacientes. O procedimento laboratorial proposto por Expósito et al. Resultados: 72 amostras de expectoração, que eram positivos para a cultura bacteriana 56 amostras, 34 deles em Klebsiella pneumoniae, que estavam a amostra em estudo, mostrando marcada resistência à amoxicilina e ceftriaxona foi isolado identificado. Esse microrganismo foi enquadrado como um patógeno que emergiu como responsável pela etiologia das infecções respiratórias adquiridas na comunidade. Conclusões: Klebsiella pneumoniae por isolamento frequência por mecanismos patogénicos e de resistência presente, é considerado um agente patogénico oportunista que surge como responsável pela etiologia das infecções respiratórias adquiridas na comunidade(AU)


Subject(s)
Humans , Drug Resistance, Bacterial , Klebsiella pneumoniae/isolation & purification , Pneumonia , Sputum , Epidemiology, Descriptive , Cross-Sectional Studies
18.
Rev. Soc. Bras. Med. Trop ; 50(5): 685-688, Sept.-Oct. 2017. tab
Article in English | LILACS | ID: biblio-1041426

ABSTRACT

Abstract INTRODUCTION: The rapid global spread of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to the health system. METHODS: We evaluated the antimicrobial susceptibility profiles of 70 CRE isolated in a tertiary hospital in Brazil between August and December 2015, and determined their resistance mechanisms. RESULTS: The most prevalent microorganism was Klebsiella pneumoniae (95.7%); it showed high-level resistance to carbapenems (>98%), with sensitivity to colistin (91.4%) and amikacin (98.6%). The bla KPC gene was detected in 80% of the CRE isolates. CONCLUSIONS: Evaluation of bacterial resistance contributes to an appropriate treatment, and the reduction of morbimortality and dissemination of resistance.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Child , Adolescent , Adult , Young Adult , Enterobacteriaceae Infections/epidemiology , Tertiary Care Centers/statistics & numerical data , Carbapenem-Resistant Enterobacteriaceae/isolation & purification , Brazil/epidemiology , Microbial Sensitivity Tests , Polymerase Chain Reaction , Cross Infection/epidemiology , Enterobacter cloacae/isolation & purification , Citrobacter freundii/isolation & purification , Enterobacteriaceae Infections/microbiology , Escherichia coli/isolation & purification , Genotype , Klebsiella pneumoniae/isolation & purification , Anti-Infective Agents/pharmacology , Middle Aged
19.
Braz. j. microbiol ; 48(3): 509-514, July-Sept. 2017. tab
Article in English | LILACS | ID: biblio-889143

ABSTRACT

Abstract The production of KPC (Klebsiella pneumoniae carbapenemase) is the major mechanism of resistance to carbapenem agents in enterobacterias. In this context, forty KPC-producing Enterobacter spp. clinical isolates were studied. It was evaluated the activity of antimicrobial agents: polymyxin B, tigecycline, ertapenem, imipenem and meropenem, and was performed a comparison of the methodologies used to determine the susceptibility: broth microdilution, Etest® (bioMérieux), Vitek 2® automated system (bioMérieux) and disc diffusion. It was calculated the minimum inhibitory concentration (MIC) for each antimicrobial and polymyxin B showed the lowest concentrations for broth microdilution. Errors also were calculated among the techniques, tigecycline and ertapenem were the antibiotics with the largest and the lower number of discrepancies, respectively. Moreover, Vitek 2® automated system was the method most similar compared to the broth microdilution. Therefore, is important to evaluate the performance of new methods in comparison to the reference method, broth microdilution.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Bacterial Proteins/metabolism , beta-Lactamases/metabolism , Enterobacteriaceae Infections/microbiology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Microbial Sensitivity Tests/methods , Bacterial Proteins/genetics , beta-Lactamases/genetics , beta-Lactams/pharmacology , Drug Resistance, Bacterial , Enterobacter/drug effects , Enterobacter/genetics , Enterobacter/isolation & purification , Klebsiella pneumoniae/classification , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Polymyxin B/pharmacology
20.
Braz. j. microbiol ; 48(3): 493-498, July-Sept. 2017. tab, graf
Article in English | LILACS | ID: biblio-889153

ABSTRACT

Abstract Carbapenems are considered last-line agents for the treatment of serious infections caused by Klebsiella pneumoniae, and this microorganism may exhibit resistance to β-lactam antibiotics due to different mechanisms of resistance. We evaluated 27 isolates of K. pneumoniae resistant to carbapenems recovered from inpatients at the University Hospital of Santa Maria-RS from July 2013 to August 2014. We carried out antimicrobial susceptibility, carbapenemase detection, testing for the presence of efflux pump by broth microdilution and loss of porin by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Genetic similarity was evaluated by ERIC-PCR. High levels of resistance were verified by the minimum inhibitory concentration for the antimicrobials tested. The blaKPC gene was present in 89% of the clinical isolates. Blue-Carba and combined disk with AFB tests showed 100% concordance, while the combined disk test with EDTA showed a high number of false-positives (48%) compared with the gold-standard genotypic test. Four isolates showed a phenotypic resistance profile consistent with the overexpression of the efflux pump, and all clinical isolates had lost one or both porins. The ERIC-PCR dendrogram demonstrated the presence of nine clusters. The main mechanism of resistance to carbapenems found in the assessed isolates was the presence of the blaKPC gene.


Subject(s)
Humans , Anti-Bacterial Agents/pharmacology , Carbapenems/pharmacology , Klebsiella Infections/microbiology , Klebsiella pneumoniae/drug effects , Bacterial Proteins/genetics , Bacterial Proteins/metabolism , Drug Resistance, Bacterial , Klebsiella pneumoniae/genetics , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/metabolism , Microbial Sensitivity Tests
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