Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

Alvim, André Luiz Silva; Couto, Braulio; Gazzinelli, Andréa

doi:10.1590/s1980-220x2018001903474

Cited by 8 publications

(11 citation statements)

References 21 publications

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“…The K. pneumoniae species corresponded to the majority of the bla KPC gene carriers, followed by Escherichia coli and Enterobacter cloacae, as reported in other studies worldwide 16,17 . Similar results were found in a study carried out in Belo Horizonte, in which most of the infections were caused by KPC carrying Klebsiella pneumoniae 2 .…”

Section: Discussionsupporting

confidence: 89%

“…Healthcare-associated infections are defined as infections that manifest themselves during hospitalization or after discharge. These infections represent a serious global public health issue, as they lead to longer hospitalization, higher healthcare costs, and increased morbidity and mortality rates [1][2] . Members of the Enterobacteriaceae family, mainly the species Klebsiella pneumoniae, Enterobacter cloacae, and Escherichia coli, are well-known on account of their high capacity to acquire resistant mechanisms as well as their frequent association with severe opportunistic infections in hospitalized patients, mainly in immunosuppressed individuals with underlying diseases such as wounds, intra-abdominal infections, urinary tract infections and sepsis [3][4] .…”

Section: Introductionmentioning

confidence: 99%

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Investigation of blaKPC and blaNDM genes in enterobacteriaceae received in a public health laboratory

Martins¹,

Alves²,

Marques³

et al. 2021

ACS

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Introduction: KPC and NDM carbapenemases production is an important enzymatic mechanism of resistance to carbapenens in bacteria belonging to the Enterobacteriaceae family. These enzymes degrade virtually all beta-lactam antibiotics and are encoded by the blaKPC and blaNDM genes, which can be in mobile genetic elements such as plasmids and transposons. Objectives: This study evaluated the positivity rate of the presence of blaKPC and blaNDM genes in carbapenem-resistant enterobacteria received at the Instituto Adolfo Lutz (IAL) of São José do Rio Preto, Brazil and determined the epidemiological data related to the patients whose isolates were recovered. Methods: From June 2015 to April 2019, bacterial isolates were obtained from different hospitals located in five municipalities in São José do Rio Preto region. In the bacteriology and molecular biology laboratory, DNA extraction and real-time PCR were performed to investigate the blaKPC and blaNDM genes. Afterwards, epidemiological data were surveyed such as the municipality of origin, age, and gender of the patients whose bacterial isolates were recovered. Results: A total of 934 enterobacteria isolates were recovered from the different hospitals. Of these; 93.4% were positive for blaKPC, with 96.3%, 1.85%, and 1.85% of the isolates belonged to the Klebsiella genus, Enterobacter genus, and Escherichia coli species, respectively. Also, 52.5% and 84.4% of the isolates were obtained from women and elderly patients, respectively. The blaNDM gene was detected only in three isolates, two of which originated from surveillance cultures. Conclusion: Therefore, KPC-producing enterobacteria are widespread in all health units of the five municipalities that were studied, suggesting that the blaKPC-carrying Klebsiella sp. isolates may be endemic in these institutions. Additionally, there is a significant role of surveillance cultures in preventing the spread of resistance genes, as observed for blaNDM in this study.

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Section: Discussionsupporting

confidence: 89%

Section: Introductionmentioning

confidence: 99%

Investigation of blaKPC and blaNDM genes in enterobacteriaceae received in a public health laboratory

Martins¹,

Alves²,

Marques³

et al. 2021

ACS

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“…It is estimated that more than 30,000 isolates of carbapenem non-susceptible Enterobacterales occur in the United States annually, and up to 81.5% of these are associated with KPC ( Sader et al., 2018a ; Gupta et al., 2019 ). Reported mortality among patients infected with KPC strains is up to 62% ( Alvim et al., 2019 ).…”

Section: Drug Resistance and Genes Encoding Carbapenemasesmentioning

confidence: 99%

Efficacy and In Vitro Activity of Novel Antibiotics for Infections With Carbapenem-Resistant Gram-Negative Pathogens

Cruz-López

Martínez-Meléndez

Morfín‐Otero

et al. 2022

Front. Cell. Infect. Microbiol.

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Infections by Gram-negative multi-drug resistant (MDR) bacterial species are difficult to treat using available antibiotics. Overuse of carbapenems has contributed to widespread resistance to these antibiotics; as a result, carbapenem-resistant Enterobacterales (CRE), A. baumannii (CRAB), and P. aeruginosa (CRPA) have become common causes of healthcare-associated infections. Carbapenems, tigecycline, and colistin are the last resource antibiotics currently used; however, multiple reports of resistance to these antimicrobial agents have been documented worldwide. Recently, new antibiotics have been evaluated against Gram-negatives, including plazomicin (a new aminoglycoside) to treat CRE infection, eravacycline (a novel tetracycline) with in vitro activity against CRAB, and cefiderocol (a synthetic conjugate) for the treatment of nosocomial pneumonia by carbapenem-non-susceptible Gram-negative isolates. Furthermore, combinations of known β-lactams with recently developed β-lactam inhibitors, such as ceftazidime-avibactam, ceftolozane-tazobactam, ceftazidime-tazobactam, and meropenem-vaborbactam, has been suggested for the treatment of infections by extended-spectrum β-lactamases, carbapenemases, and AmpC producer bacteria. Nonetheless, they are not active against all carbapenemases, and there are reports of resistance to these combinations in clinical isolates.This review summarizes and discusses the in vitro and clinical evidence of the recently approved antibiotics, β-lactam inhibitors, and those in advanced phases of development for treating MDR infections caused by Gram-negative multi-drug resistant (MDR) bacterial species.

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“…A study performed on 70 carbapenem-resistant Enterobacteriaceae isolates at a tertiary hospital in the Rio Grande do Sul, Brazil, in 2015 showed K. pneumoniae to be the most prevalent micro-organism (95.7 %) with high-level resistance to carbapenems (>98 %) [22]. Another study in a private hospital in Belo Horizonte, MG, Brazil, including 82 patients, demonstrated that K. pneumoniae was the most frequently detected species (68 %) [23]. In a survey in one of the leading hospitals in Pelotas in 2017-2019, the bacterium K. pneumoniae was found to be most prevalent (40.27 %, n=445), and carbapenem resistance increased over the years in this species (data being published).…”

Section: Discussionmentioning

confidence: 99%

“…Another study in a private hospital in Belo Horizonte, MG, Brazil, including 82 patients, demonstrated that K. pneumoniae was the most frequently detected species (68 %) [23]. In a survey in one of the leading hospitals in Pelotas in 2017–2019, the bacterium K.…”

Section: Discussionmentioning

confidence: 99%

Phenotypic and molecular evaluation of biofilm formation in Klebsiella pneumoniae carbapenemase (KPC) isolates obtained from a hospital of Pelotas, RS, Brazil

Stallbaum

Pruski

Amaral

et al. 2021

Journal of Medical Microbiology

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Introduction. A significant cause of mortality in the intensive care unit (ICU) is multidrug-resistant (MDR) Gram-negative bacteria, such as Klebsiella pneumoniae carbapenemase (KPC). Biofilm production is a key factor in KPC colonization and persistence in the host, making the treatment difficult. Gap Statement. The aim of this study was to evaluate the antibiotic resistance, molecular and phenotypic biofilm profiles of 12 KPC isolates associated with nosocomial infection in a hospital in Pelotas, Rio Grande do Sul, Brazil. Methodology. Clinical isolates were obtained from different sources, identified and characterized by antibiotic resistance and carbapenemase synthesis following the Clinical and Laboratory Standards Institute (CLSI) guidelines. Polymerase chain reaction (PCR) was used to evaluate the presence of carbapenemase (blaKPC ) and biofilm formation-associated genes (fimA, fimH, rmpA, ecpA, mrkD and wabG). Additionally, phenotypic evaluation of in vitro biofilm formation capacity was evaluated by Congo red agar (CRA) assay and the crystal violet staining method. Results. The 12 isolates evaluated in this study presented the blaKPC gene and were positive for synthesizing carbapenemases in vitro. In the carbapenem class, 83.3 % isolates were resistant and 16.7 % intermediately resistant to imipenem and meropenem. Molecular analyses found that the fimA and wabG genes were detected in 75 % of isolates, while fimH and ecpA were detected in 42 % and mrkD were detected in 8.3 % (1). The CRA assay demonstrated that all isolates were slime producers and 91.7 % (11) of isolates were classified as strong and 8.3 % (1) as moderate biofilm producers by the crystal violet staining method. The optical density (OD540nm) for strong biofilm formers ranged from 0.80±0.05 to 2.47±0.28 and was 0.55±0.12 for moderate biofilm formers. Conclusion. Our study revealed a high level of antibiotic resistance and biofilm formation in KPC isolates obtained from a hospital in Pelotas, RS, Brazil.

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Epidemiological profile of healthcare-associated infections caused by Carbapenemase-producing Enterobacteriaceae

Cited by 8 publications

References 21 publications

Investigation of blaKPC and blaNDM genes in enterobacteriaceae received in a public health laboratory

Investigation of blaKPC and blaNDM genes in enterobacteriaceae received in a public health laboratory

Efficacy and In Vitro Activity of Novel Antibiotics for Infections With Carbapenem-Resistant Gram-Negative Pathogens

Phenotypic and molecular evaluation of biofilm formation in Klebsiella pneumoniae carbapenemase (KPC) isolates obtained from a hospital of Pelotas, RS, Brazil

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