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

Barberino, Maria Goreth; Cruvinel, Silvia de Araujo; Salvino, Marco Aurélio; Silva, Márcio de Oliveira

doi:10.1016/j.bjid.2017.10.002

Cited by 11 publications

(6 citation statements)

References 14 publications

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“…The first clinical report of bla NDM in northeast Brazil was in a public hospital in Salvador, recently described by Barberino et al [48]. In our investigation, the presence of the bla NDM gene was verified in an E. coli isolate; however this strain did not express phenotypic resistance to carbapenems.…”

Section: Discussioncontrasting

confidence: 41%

Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features

Leal¹,

Azevedó²,

Silva

et al. 2019

BMC Infect Dis

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Background Bloodstream infections (BSI) are associated with high morbidity and mortality. This scenario worsens with the emergence of drug-resistant pathogens, resulting in infections which are difficult to treat or even untreatable with conventional antimicrobials. The aim of this study is to describe the epidemiological aspects of BSI caused by multiresistant gram-negative bacilli (MDR-GNB). Methods We conducted a laboratory-based surveillance for gram-negative bacteremia over a 1-year period. The bacterial isolates were identified by MALDI-TOF/MS and the antimicrobial susceptibility testing was performed by VITEK®2. Resistance genes were identified through PCR assays. Results Of the 143 patients, 28.7% had infections caused by MDR-GNB. The risk factors for MDR bacteremia were male sex, age ≥ 60, previous antimicrobial use, liver disease and bacteremia caused by K. pneumoniae . K. pneumoniae was the most frequently observed causative agent and had the highest resistance level. Regarding the resistance determinants, SHV, TEM, OXA-1-like and CTX-M-gp1 were predominant enzymatic variants, whereas CTX-M-gp9, CTX-M-gp2, KPC, VIM, GES, OXA-48-like, NDM and OXA-23-like were considered emerging enzymes. Conclusions Here we demonstrate that clinically relevant antibiotic resistance genes are prevalent in this setting. We hope our findings support the development of intervention measures by policy makers and healthcare professionals to face antibiotic resistance. Electronic supplementary material The online version of this article (10.1186/s12879-019-4265-z) contains supplementary material, which is available to authorized users.

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Section: Discussioncontrasting

confidence: 41%

Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features

Leal¹,

Azevedó²,

Silva

et al. 2019

BMC Infect Dis

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“…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%

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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“…The occurrence of the bla NDM gene in 59.2 % of the isolates analyzed in this study is worrying and highlights the emergence of another carbapenemase that, in addition to KPC, can also hydrolyze carbapenems. Barberino et al (2018) 33 were the first to report the presence of the bla NDM gene in clinical isolates of K. pneumoniae and Citrobacter in two patients admitted to a public hospital in Salvador, Bahia, in northeastern Brazil. Da Silva et al (2019) 34 detected the bla NDM-1 gene in different species of Gram-negative bacteria isolated from nine Brazilian states but did not include the state of Pernambuco.…”

Section: Discussionmentioning

confidence: 99%

High plasmid variability, and the presence of IncFIB, IncQ, IncA/C, IncHI1B, and IncL/M in clinical isolates of Klebsiella pneumoniae with bla KPC and bla NDM from patients at a public hospital in Brazil.

Oliveira

Beltrão

Scavuzzi

et al. 2020

Rev. Soc. Bras. Med. Trop.

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Introduction: Antibiotic resistance in carbapenemase-producing Klebsiella pneumoniae is acquired and disseminated mainly by plasmids. Therefore, we aimed to investigate the occurrence of carbapenemase genes, analyze the genetic diversity by ERIC-PCR, and examine the most common plasmid incompatibility groups (Incs) in clinical isolates of K. pneumoniae from colonization and infection in patients from a hospital in Brazil. Methods: Twenty-seven isolates of carbapenem-resistant K. pneumoniae were selected and screened for the presence of carbapenemase genes and Incs by PCR, followed by amplicon sequencing. Results: The bla KPC and bla NDM genes were detected in 24 (88.8 %) and 16 (59.2 %) of the isolates, respectively. Thirteen isolates (48.1 %) were positive for both genes. The IncFIB (92.6 %) and IncQ (88.8 %) were the most frequent plasmids, followed by IncA/C, IncHI1B, and IncL/M, indicating that plasmid variability existed in these isolates. To our knowledge, this is the first report of IncHI1B in Brazil. We found eight isolates with clonal relationship distributed in different sectors of the hospital. Conclusions: The accumulation of resistance determinants, the variability of plasmid Incs, and the clonal dissemination detected in K. pneumoniae isolates demonstrate their potential for infection, colonization, and the dissemination of different resistance genes and plasmids.

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

Cited by 11 publications

References 14 publications

Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features

Bloodstream infections caused by multidrug-resistant gram-negative bacteria: epidemiological, clinical and microbiological features

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

High plasmid variability, and the presence of IncFIB, IncQ, IncA/C, IncHI1B, and IncL/M in clinical isolates of Klebsiella pneumoniae with bla KPC and bla NDM from patients at a public hospital in Brazil.

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