Clinical and microbiological characterization of KPCproducing Klebsiella pneumoniae infections in Brazil

Beirão, Elisa Maria; Furtado, Juvencio; Girardello, Raquel; Filho, Heli Ferreira; Gales, Ana Cristina

doi:10.1016/s1413-8670(11)70143-x

Cited by 10 publications

(6 citation statements)

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“…The high number of patients over 60 years of age (65.9%) and the high frequency of ICU admissions (43%) suggests that colonization by these multi-resistant bacteria is favored by the high number of invasive procedures and the prolonged use of broad-spectrum antibiotics associated with these units ( Beirão et al , 2011 ; Nordmann et al , 2011 ).…”

Section: Discussionmentioning

confidence: 99%

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KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil

Biberg

Rodrigues

Carmo

et al. 2015

Braz. J. Microbiol.

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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 bla KPC-2 gene. Thus, KPC-2producing Klebsiella pneumoniae has been present in a Brazilian hospital located in the Midwest region since at least 2009.

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Section: Discussionmentioning

confidence: 99%

“…These data confirm literature findings that Klebsiella spp. is an important causative agent of urinary tract infections in hospitalized patients ( Beirão et al , 2011 ).…”

Section: Discussionmentioning

confidence: 99%

KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil

Biberg

Rodrigues

Carmo

et al. 2015

Braz. J. Microbiol.

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“…In the specific case of LA, the prevalence of carbapenem-resistant A. baumannii has increased markedly,[31] along with the prevalence of carbapenem-resistant strains of P. aeruginosa [29] and Enterobacteriaceae. [323334] Another problem to be worry about is the description in LA of Enterobacteriaceae isolates (particularly K. pneumoniae ) that possess carbapenem-hydrolyzing enzymes belonging to the KPC family of beta-lactamases (Colombia,[32] Brazil,[33] and Argentina[34]). Related to other classes of carbapenemases (the metallo-β-lactamases), in August 2010, reports indicated the emergence of a mechanism of resistance in enterobacteria that caused outbreaks and was related to an increase in morbidity and hospital mortality in India, Pakistan and England.…”

Section: Discussionmentioning

confidence: 99%

Antibiotic prescriptions in critically-ill patients: A Latin American experience

Curcio¹

2013

Ann Med Health Sci Res

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Background:It is widely acknowledged that the presence of infection is an important outcome determinant for intensive care unit (ICU) patients. In fact, antibiotics are one of the most common therapies administered in the ICU settings.Aim:To evaluate the current usage of antibiotics in Latin American ICUs.Subjects and Methods:A one-day p-oint prevalence study to investigate the patterns of antibiotic was undertaken in 72 Latin American (LA) ICUs. Data was analyzed using the Statistix 8 statistical software, version 2.0 (USA). Results were expressed as proportions. When applicable, two tailed hypothesis testing for difference in proportions was used (Proportion Test); a P value of <0.05 was considered significant.Results:Of 704 patients admitted, 359 received antibiotic treatment on the day of the study (51%), of which 167/359 cases (46.5%) were due to hospital-acquired infections. The most frequent infection reorted was nosocomial pneumonia (74/359, 21%). Only in 264/359 patients (73.5%), cultures before starting antibiotic treatment were performed. Thirty-eight percent of the isolated microorganisms were Enterobacteriaceae extended-spectrum β-lactamase-producing, 11% methicillin-resistant Staphylococcus aureus and 10% carbapenems-resistant non-fermentative Gram-negatives. The antibiotics most frequently prescribed were carbapenems (125/359, 35%), alone or in combination with vancomycin or other antibiotic. There were no significant differences in the “restricted” antibiotic prescription (carbapenems, vancomycin, piperacillin–tazobactam, broad-spectrum cephalosporins, fluoroquinolones, tigecycline and linezolid) between patients with APACHE II score at the beginning of the antibiotic treatment <15 [83/114 (72.5%)] and ≥15 [179/245 (73%)] (P = 0.96). Only 29% of the antibiotic treatments were cultured directed (104/359).Conclusion:Carbapenems (alone or in combination) were the most frequently prescribed antibiotics in LA ICUs. However, the problem of carbapenem resistance in LA requires that physicians improve the use of this class of antibiotics. Our findings show that our web-based method for collection of one-day point prevalence was implemented successfully. However, based on the limitations of the model used, the results of this study must be taken with caution.

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“…Of the 11 cases who received polymyxin monotherapy, 73% (8/11) experienced treatment failure [8,10,18,20,23,25]. Of the nine patients treated for bloodstream infections (BSIs), six patients were treatment failures.…”

Section: Introductionmentioning

confidence: 99%

Treatment of Klebsiella Pneumoniae Carbapenemase (KPC) infections: a review of published case series and case reports

Lee

Burgess

2012

Ann Clin Microbiol Antimicrob

175

122

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The emergence of Klebsiella pneumoniae carbapenemases (KPCs) producing bacteria has become a significant global public health challenge while the optimal treatment remains undefined. We performed a systematic review of published studies and reports of treatment outcomes of KPC infections using MEDLINE (2001–2011). Articles or cases were excluded if one of the following was fulfilled: no individual patient data provided, no treatment regimen specified, no treatment outcome specified, report of colonization, or greater than three antibiotics were used to treat the KPC infection. Data extracted included patient demographics, site of infection, organism, KPC subtype, antimicrobial therapy directed at KPC-infection, and treatment outcome. Statistical analysis was performed in an exploratory manner. A total of 38 articles comprising 105 cases were included in the analysis. The majority of infections were due to K. pneumoniae (89%). The most common site of infection was blood (52%), followed by respiratory (30%), and urine (10%). Forty-nine (47%) cases received monotherapy and 56 (53%) cases received combination therapy directed at the KPC-infection. Significantly more treatment failures were seen in cases that received monotherapy compared to cases who received combination therapy (49% vs 25%; p= 0.01). Respiratory infections were associated with higher rates of treatment failure with monotherapy compared to combination therapy (67% vs 29% p= 0.03). Polymyxin monotherapy was associated with higher treatment failure rates compared to polymyxin-based combination therapy (73% vs 29%; p= 0.02); similarly, higher treatment failure rates were seen with carbapenem monotherapy compared to carbapenem-based combination therapy (60% vs 26%; p= 0.03). Overall treatment failure rates were not significantly different in the three most common antibiotic-class combinations: polymyxin plus carbapenem, polymyxin plus tigecycline, polymyxin plus aminoglycoside (30%, 29%, and 25% respectively; p=0.6). In conclusion, combination therapy is recommended for the treatment of KPC infections; however, which combination of antimicrobial agents needs to be established in future prospective clinical trials.

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Clinical and microbiological characterization of KPCproducing Klebsiella pneumoniae infections in Brazil

Cited by 10 publications

References 20 publications

KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil

KPC-2-producing Klebsiella pneumoniae in a hospital in the Midwest region of Brazil

Antibiotic prescriptions in critically-ill patients: A Latin American experience

Treatment of Klebsiella Pneumoniae Carbapenemase (KPC) infections: a review of published case series and case reports

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