First report of a clinical isolate of New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae in Brazil

Ferreira, Adriano Martison; Mondelli, Alessandro Lia; Silva, J.G.S. Campos e; Javaroni, Edvaldo; Gambarini, P.S.; Garcia, Doroti de Oliveira; Camargo, Carlos Henrique

doi:10.1016/j.jhin.2016.05.019

Cited by 6 publications

(4 citation statements)

References 9 publications

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“…Today, at least eight NDM variants are known and reported from all continents worldwide 22 . Five years following its discovery in 2008, NDM was identified in Brazil 27 ; this incidence differed from that of KPC, which was reported in 1996 in the USA and then approximately 10 years later in Brazil in 2006 23,28,29 .…”

Section: Discussionmentioning

confidence: 90%

“…To our knowledge, this study is one of the first scientific reports describing K. pneumoniae isolates with blaKPC from this state. The first case of an Enterobacteriaceae (K. pneumoniae and Citrobacter freundii) with blaNDM in this region was reported in 2015 in the neighboring state of Bahia 27,31 . Additionally, a recently published article (in 2019) reported the first case of NDM in the state of Sergipe from K. pneumoniae samples collected between 2012 and 2015 30 .…”

Section: Discussionmentioning

confidence: 93%

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Prevalence of Klebsiella pneumoniae carbapenemase - and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option

Vivas

Dolabella

Barbosa

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multiresistance phenomenon. Methods: In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, blaGES, blaNDM, blaSPM, blaIMP, blaVIM, and blaOXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. Results: Seventy-four (50.3%) isolates were positive for blaNDM, eight (5.4%) for blaKPC, and one (1.2%) for both blaNDM and blaKPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response. Conclusions: Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 93%

Prevalence of Klebsiella pneumoniae carbapenemase - and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option

Vivas

Dolabella

Barbosa

et al. 2020

Rev. Soc. Bras. Med. Trop.

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“…This isolate carried a resistance gene already found in a KPC strain in 2010 in the state of Minas Gerais, highlighting the ability of microorganisms to acquire and disseminate such resistance genes. 15 …”

Section: Patient Bmentioning

confidence: 99%

Isolation of bla NDM -producing Enterobacteriaceae in a public hospital in Salvador, Bahia, Brazil

Barberino

Cruvinel

Salvino

et al. 2018

The Brazilian Journal of Infectious Diseases

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Carbapenemases have great importance in the global epidemiological scenario since infections with carbapenemase-producing bacteria are associated with high mortality, especially in hospitalized patients in intensive care units. This study describes two microorganisms producers of the New Delhi Metallo-b-lactamase, Klebsiella pneumoniae and Citrobacter freundii, from two patients admitted to a public hospital in Salvador, Bahia. These are the first clinical cases of New Delhi Metallo-b-lactamase described in microorganisms in the north and northeast Brazil. The isolates were characterized by antimicrobial susceptibility test, with resistance to all β-lactams including carbapenems, negative Modified Hodge Test and the synergy test with Ethylenediaminetetraacetic acid, Phenylboronic Acid and Cloxacillin was positive only with Ethylenediaminetetraacetic acid (difference of >5mm in the inhibition zone between the disk without and with the inhibitor). Analysis by multiplex PCR for bla, bla, bla, bla and bla enzymes confirmed the presence of bla gene. This report of two different New Delhi Metallo-b-lactamase-producing microorganisms in a different region of Brazil confirms the risk of spreading resistance genes between different species and emphasizes the need for prevention and control of infections caused by these pathogens, which have limited treatment options and have been linked to high mortality rates.

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“…In Enterobacterales, carbapenem resistance is mainly mediated by the production of Klebsiella pneumoniae carbapenemase (KPC), but emerging and infrequent carbapenemases have been also reported. 4 The New Delhi metallo-beta-lactamase (NDM) was first detected in Brazil in 2012 in the Southern region, 5 and since then, it has been reported in at least other nine states 6,7 from both clinical and surveillance specimens. Besides this increased number of NDM-producing isolates reported in Brazil, 6 data on the genetic diversity are limited, especially regarding their clonal structure and diversity of bla NDM alleles.…”

Section: Introductionmentioning

confidence: 99%

Genomic characterization of New Delhi metallo‐beta‐lactamase–producing species of Morganellaceae, Yersiniaceae, and Enterobacteriaceae (other than Klebsiella) from Brazil over 2013–2022

Camargo,

Yamada,

de Souza

et al. 2023

Microbiology and Immunology

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Over the last decade, New Delhi metallo‐beta‐lactamase (NDM) carbapenemase has silently spread in Brazil. In this study, we analyzed a large collection of Enterobacterales other than Klebsiella spp. received in our reference laboratory between 2013 and 2022. A total of 32 clinical isolates displaying different pulsed‐field gel electrophoresis profiles, and represented by 11 species in the families Enterobacteriaceae (Citrobacter freundii, Citrobacter portucalensis, Enterobacter hormaechei, and Escherichia coli), Morganellaceae (Morganella morganii, Proteus mirabilis, Proteus vulgaris, Providencia rettgeri, Providencia stuartii, and Raoultella ornithinolytica), and Yersiniaceae (Serratia marcescens) had their whole genomes sequenced and further analyzed. Antimicrobial susceptibility was determined by disk diffusion, except for polymyxin B, assessed by broth microdilution. The blaNDM‐1 allele was predominant (n = 29), but blaNDM‐5 was identified in an E. coli specimen with a novel ST, and the blaNDM‐7 allele was found in E. hormaechei ST45 and E. coli ST1049. Polymyxin was active against all but one Enterobacteriaceae isolate: an mcr‐1–producing E. coli presenting minimal inhibitory concentration (4 mg/L). Isolates producing extended‐spectrum β‐lactamases were common: cefotaximase from Munich (CTX‐M)‐15 (n = 10), CTX‐M‐2 (n = 4), and CTX‐M‐8 (n = 3) were detected, and the mcr‐1–producing E. coli was found to co‐produce both CTX‐M‐8 and CTX‐M‐55 β‐lactamases. The mcr‐9 gene was found in 5/8 E. hormaechei isolates, distributed in four different sequence types, all of them presenting susceptibility to polymyxin. This study showed that NDM‐producing Enterobacterales other than Klebsiella are already spread in Brazil, in diversified species, and cocarrying important resistance genes. Prompt detection and effective implementation of measures to prevent further spread are mandatory for mitigating the dissemination of NDM carbapenemase in hospital settings and preserving the already limited antimicrobial therapy options.

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First report of a clinical isolate of New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae in Brazil

Cited by 6 publications

References 9 publications

Prevalence of Klebsiella pneumoniae carbapenemase - and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option

Prevalence of Klebsiella pneumoniae carbapenemase - and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option

Isolation of bla NDM -producing Enterobacteriaceae in a public hospital in Salvador, Bahia, Brazil

Genomic characterization of New Delhi metallo‐beta‐lactamase–producing species of Morganellaceae, Yersiniaceae, and Enterobacteriaceae (other than Klebsiella) from Brazil over 2013–2022

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