Klebsiella pneumoniae with multiple antimicrobial resistance

Abstract

A Klebsiella pneumoniae strain was isolated from the urine of a patient at one of the centers participating in the 2001 edition of the MYSTIC program in Brazil. The initial phenotypic findings of the isolated K. pneumoniae presented an unusual MIC of 8 microg/mL to meropenem, 2 microg/mL to imipenem, elevated MICs to broad spectrum cephalosporins (ceftazidime/cefotaxime/cefepime MIC > 256 microg/mL), aminoglycosides (gentamycin > 256 microg/mL and tobramycin = 48 microg/mL), piperacillin/tazobactam (MIC > 256 microg/mL) and susceptibility to ciprofloxacin (MIC = 0.25 microg/mL). The strain also tested positive for ESBL production with double-disk and E-test methodologies. More detailed investigation revealed that the strain produced a SHV-4 type enzyme and also lacked a 36 kDa outer membrane porin.

Diversity of genotypes in CTX-M-producing Klebsiella pneumoniae isolated in different hospitals in Brazil

“…17 In Brazil, there has been some reports of multi-drug resistant hospital-acquired K. Pneumoniae. 18,19 In our study, 71 (84%) were ESBL positive by the double-disk synergy test and the Etest® and this value is considered high. This highlights the importance of investigating resistance mechanisms in hospitals.…”

Pharmacodynamic profiling of imipenem, meropenem and ertapenem against clinical isolates of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella spp. from Brazil

“…It is noteworthy that previous reports of ESBLproducing K. pneumoniae isolates in Brazil with porin loss have been identified in the same epidemiological environment [21,22]. Although we cannot rule out the presence of carbapenemases in these strains, this possibility should be rare and, if at all present, it should be at a low grade and with a lower affinity for imipenem and meropenem (this is under investigation).…”

Nosocomial bloodstream infections caused by Klebsiella pneumoniae: impact of extended-spectrum β-lactamase (ESBL) production on clinical outcome in a hospital with high ESBL prevalence

“…First, we do not have information regarding the specific situation in Brazil, such as genotyping results or type of ESBL. Only case reports were described [ 20 , 21 ]. Second, we performed a retrospective cohort study instead of a case-control study because it was not our objective to establish the risk factors for the acquisition of ESBL infection.…”