RESUMEN
BACKGROUND: Klebsiella infections are reported from neonatal intensive care units (NICUs) worldwide, but data on their incidence and genetic diversity remain scarce. OBJECTIVE: We determined the incidence and genetic diversity of Klebsiella infections in NICU patients in Rio de Janeiro. METHODS: This was a prospective study including newborns admitted to NICU in three hospitals during April 2005-November 2006 and March 2008-February 2009. Klebsiella pneumoniae isolates were genotyped by multilocus sequence typing (MLST) and extended spectrum ß-lactamases (ESBL) were characterized. RESULTS: Klebsiella infections occurred in 38 of 3984 patients (incidence rate, 9.5/1000 admissions); 14 (37%) of these 38 newborns died. Two clonal groups, CC45 and CC1041, caused 11 cases (42% of K. pneumoniae infection). Ten (32%) of the isolates causing infection produced ESBL, 9 of which (83%) carried blaCTX-M-15, all belonging to clonal complex (CC) 45 and CC1041. Nine of these ESBL-producing isolates were confined to only one of the NICUs. MAJOR CONCLUSIONS: The high incidence of Klebsiella infections in NICU in Rio de Janeiro appeared to be due to a combination of frequent sporadic infections caused by multiple K. pneumoniae genotypes and small outbreaks caused by dominant multidrug-resistant clones.
Asunto(s)
Infección Hospitalaria/microbiología , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/aislamiento & purificación , Proteínas Bacterianas/genética , Proteínas Bacterianas/metabolismo , Femenino , Variación Genética , Genotipo , Humanos , Lactante , Recién Nacido , Klebsiella pneumoniae/clasificación , Klebsiella pneumoniae/genética , Masculino , Tipificación de Secuencias Multilocus , Estudios Prospectivos , Población Urbana , beta-Lactamasas/genética , beta-Lactamasas/metabolismoAsunto(s)
Farmacorresistencia Bacteriana/genética , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/genética , Plásmidos/genética , Antibacterianos/uso terapéutico , Brasil , Colistina/uso terapéutico , Proteínas de Escherichia coli/genética , Humanos , Imipenem/uso terapéutico , Masculino , Persona de Mediana Edad , beta-LactamasasRESUMEN
The spread of carbapenemase-producing Gram-negative rods is an emerging global problem. Although most infections due to carbapenemase producers are limited to healthcare institutions, reports of the occurrence of clinically relevant carbapenemase producers in sewage and polluted rivers are increasingly frequent. Polluted rivers flowing to oceans may contaminate coastal waters with multidrug-resistant bacteria, potentially threatening the safety of recreational activities in these locations. Here we assessed the occurrence of carbapenemase producers in water from touristic beaches located in Rio de Janeiro, Brazil, showing distinct pollution patterns. The presence of enterobacteria was noted, including the predominantly environmental genus Kluyvera spp., producing either Klebsiella pneumoniae carbapenemase (KPC) or Guyana extended-spectrum (GES)-type carbapenemases and often associated with quinolone resistance determinants. An Aeromonas sp. harbouring blaKPC and qnrS was also observed. These findings strengthen the role of aquatic matrices as reservoirs and vectors of clinically relevant antimicrobial-resistant bacteria, with potential to favour the spread of these resistance threats throughout the community.
