Changing the epidemiology of carbapenem-resistant Pseudomonas aeruginosa in a Brazilian teaching hospital: the replacement of São Paulo metallo-β-lactamase-producing isolates

Cavalcanti, Felipe Lira de Sá; Almeida, Anna; Vilela, Marinalda Anselmo; Morais, Márcia Maria Camargo de; Morais, Marcos Antônio de

doi:10.1590/s0074-02762012000300019

Cited by 15 publications

(12 citation statements)

References 14 publications

(9 reference statements)

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“…While the mortality rate was high in this study, it concurs with the findings from many other studies that have shown mortality rates that are up to six-times higher among patients who acquire MDRPA infections (15) (21) (22) . These findings suggest that death may have been mediated by more serious presentations of these infections or it may have been caused by underlying diseases, and they underline the need for adequate early antimicrobial therapy for these infections.…”

Section: Discussionsupporting

confidence: 92%

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units

Matos

Conceição

et al. 2016

Rev. Soc. Bras. Med. Trop.

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Introduction:The spread of multidrug-resistant Pseudomonas aeruginosa in Brazilian hospitals has greatly impacted upon the morbidity and mortality of individuals in intensive care units. Given the lack of information regarding the dynamics of multidrug resistance in northern Brazil, we analyzed the clinical and microbiological features of nosocomial infections caused by P. aeruginosa. Methods: Between January 2010 and March 2012, we conducted a retrospective cohort study of P. aeruginosa isolates from 54 patients who were hospitalized in intensive care units. The clinical and epidemiologic variables were analyzed, including the patients' demographic data and comorbidities, and the lengths of the intensive care unit stays, the classification of the infections as nosocomial, the use of invasive procedures, antimicrobial therapy, and the patients' outcomes. We undertook susceptibility tests, molecular detection of the metallo-β-lactamase genes, and genotypic analyses of the isolates using the repetitive element-polymerase chain reaction. Results: Multidrug resistance occurred most frequently among isolates from adults who had been hospitalized for an average of 87.1 days. The use of mechanical ventilation and urinary catheters were risk factors for infection. The four isolates that harbored the blaSPM-1-like gene showed >95% genetic similarity. Conclusions: This study's findings show that P. aeruginosa has a high death rate, and that inadequate treatment and invasive procedures are risk factors for infection. This is the first report describing the detection of the blaSPM-1-like gene in northern Brazil. These results highlight the need for better monitoring and a greater understanding of nosocomial infections and their public health impacts.

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Section: Discussionsupporting

confidence: 92%

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units

Matos

Conceição

et al. 2016

Rev. Soc. Bras. Med. Trop.

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“…Besides to be associated with severe infections, resistance to carbapenems in P. aeruginosa often results in the production of MBL 43 . Our results showed that the carbapenem-resistant P. aeruginosa were prevalent throughout the hospital with genes that encoding these enzymes in 16.1% of the strains, being 10.7% of genotype bla SPM-1 and 5.4% of genotype bla VIM .…”

Section: Discussionmentioning

confidence: 68%

Carbapenem-resistant Pseudomonas aeruginosa : association with virulence genes and biofilm formation

Gonçalves

Dantas

Ferreira

et al. 2017

Brazilian Journal of Microbiology

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Pseudomonas aeruginosa is an opportunistic pathogen that causes frequently nosocomial infections, currently becoming more difficult to treat due to the various resistance mechanisms and different virulence factors. The purpose of this study was to determine the risk factors independently associated with the development of bacteremia by carbapenem-resistant P. aeruginosa, the frequency of virulence genes in metallo-β-lactamases producers and to evaluate their ability to produce biofilm. We conducted a case–control study in the Uberlândia Federal University – Hospital Clinic, Brazil. Polymerase Chain Reaction was performed for metallo-β-lactamases and virulence genes. Adhesion and biofilm assays were done by quantitative tests. Among the 157 strains analyzed, 73.9% were multidrug-resistant, 43.9% were resistant to carbapenems, 16.1% were phenotypically positive for metallo-β-lactamases, and of these, 10.7% were positive for blaSPM gene and 5.3% positive for blaVIM. The multivariable analysis showed that mechanical ventilation, enteral/nasogastric tubes, primary bacteremia with unknown focus, and inappropriate therapy were independent risk factors associated with bacteremia. All tested strains were characterized as strongly biofilm producers. A higher mortality was found among patients with bacteremia by carbapenem-resistant P. aeruginosa strains, associated independently with extrinsic risk factors, however it was not evident the association with the presence of virulence and metallo-β-lactamases genes.

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“…For hospitals in the same city, J acome et al (2012a) detected a lower frequency of 20.7 % of isolates resistant to carbapenems and ceftazidime, and 46.2 % when only phenotypically MBL-positive strains were considered. Cavalcanti et al (2012), for another university hospital located in Recife, identified a higher percentage of the bla SPM-1 gene (83.6 %) in the imipenem-and ceftazidime-resistant P. aeruginosa strains investigated. This variation observed between studies may be related to the fact that each was performed in different hospitals.…”

Section: Discussionmentioning

confidence: 90%

Detection of bla SPM-1, bla KPC, bla TEM and bla CTX-M genes in isolates of Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. from cancer patients with healthcare-associated infections

Jácome

Alves

Jácome-Júnior

et al. 2016

Journal of Medical Microbiology

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Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. are three of the pathogens most frequently involved in infections of cancer patients, and the production of b-lactamases is a major mechanism of resistance due to its wide diversity of existing enzymes. Therefore, the aim of the present study was to investigate the microbiological profile and data related to patients and infections, and to search for b-lactamase genes in bacterial isolates from hospitalized cancer patients in a hospital in Recife, Pernambuco, Brazil. A total of 169 isolates were recovered between 2012 and 2014, of which 58 were P. aeruginosa, 36 were Acinetobacter spp. and 75 were Klebsiella spp. A high percentage of carbapenem resistance was observed in P. aeruginosa and Acinetobacter spp. Among the carbapenem-resistant bacteria, the bla SPM-1 gene was detected in P. aeruginosa (35.5 %) and Acinetobacter spp. (3.8 %), while bla KPC was detected in P. aeruginosa (25.8 %) only. Among the third-and fourth-generation cephalosporin-resistant strains, in Klebsiella spp. we detected the genes bla TEM (30.6 %), bla CTX-M (58.3 %) and bla KPC (5.6 %), and in Acinetobacter spp. only bla TEM (25.9 %). This the first report of an Acinetobacter baumannii bla SPM-1 gene carrier that has been isolated in Brazil. The most frequent cancer types were bowel tumour [14.8 %; 95 % confidence interval (CI 95 % ) 9.8-21.1 %], breast cancer (13.6 %; CI 95 % 8.8-19.7 %) and prostate cancer (11.2%; CI 95 % 6.9-17.0 %). These results therefore provide knowledge of susceptibility profile and resistance mechanisms and thus can contribute to the strategic formulation of hospital infection control plans and the rational use of antimicrobials, reducing mortality from infection levels in cancer patients. frequency and severity of infections may be related to the use of potent cytotoxic drugs and increasingly invasive diagnostic tools (Maschmeyer & Haas, 2008;Wang et al., 2011). INTRODUCTIONGiven this vulnerability among patients with cancer, this population is more susceptible to community and healthcare-associated infections (HAIs). According to a recent survey by the Centers for Disease Control and Prevention (CDC), one in 25 hospitalized patients [4.0 %; 95 % confidence interval (CI 95 % ), 3.7-4.4] is battling an HAI, defined as those infections acquired in hospital or healthcare service unit that first appear 48 h or more after hospital admission or within 30 days after discharge following in-patient care (Revelas, 2012;Magill et al., 2014). Other causes for concern in many healthcare centres for patients with cancer are the high bacterial resistance rates and the rise of opportunistic multidrug-resistant (MDR) pathogens such as Pseudomonas aeruginosa and Acinetobacter baumannii (Pongas et al., 2012;Fukuta et al., 2013;Marín et al., 2014).Gram-positive bacteria are described as the most frequent cause of HAIs in cancer patients, especially through bloodstream infection (Wisplinghoff et al., 2003;Maschmeyer & Haas, 2008;Wang et al., 2011; Kosmidis & Chandrasekar...

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Changing the epidemiology of carbapenem-resistant Pseudomonas aeruginosa in a Brazilian teaching hospital: the replacement of São Paulo metallo-β-lactamase-producing isolates

Cited by 15 publications

References 14 publications

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units

Clinical and microbiological features of infections caused by Pseudomonas aeruginosa in patients hospitalized in intensive care units

Carbapenem-resistant Pseudomonas aeruginosa : association with virulence genes and biofilm formation

Detection of bla SPM-1, bla KPC, bla TEM and bla CTX-M genes in isolates of Pseudomonas aeruginosa, Acinetobacter spp. and Klebsiella spp. from cancer patients with healthcare-associated infections

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