Large Nosocomial Outbreak of Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae Traced to Clonal Expansion of an
            <i>mgrB</i>
            Deletion Mutant

Giani, Tommaso; Arena, Fabio; Vaggelli, Guendalina; Conte, Viola; Chiarelli, Adriana; Angelis, Lucia Henrici De; Fornaini, Rossella; Grazzini, Maddalena; Niccolini, Fabrizio; Pecile, Patrizia; Rossolini, Gian María

doi:10.1128/jcm.01017-15

Cited by 118 publications

(106 citation statements)

References 24 publications

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“…In addition to the two outbreaks attributed to the ST258 clone (196,197), a large nosocomial outbreak of colistin-resistant and KPC-producing ST512 K. pneumoniae isolates was reported in Italy (198) (Table 6; Fig. 5).…”

Section: Epidemiology Of Resistance To Polymyxins General Epidemiologmentioning

confidence: 99%

Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes

2017

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SUMMARY Polymyxins are well-established antibiotics that have recently regained significant interest as a consequence of the increasing incidence of infections due to multidrug-resistant Gram-negative bacteria. Colistin and polymyxin B are being seriously reconsidered as last-resort antibiotics in many areas where multidrug resistance is observed in clinical medicine. In parallel, the heavy use of polymyxins in veterinary medicine is currently being reconsidered due to increased reports of polymyxin-resistant bacteria. Susceptibility testing is challenging with polymyxins, and currently available techniques are presented here. Genotypic and phenotypic methods that provide relevant information for diagnostic laboratories are presented. This review also presents recent works in relation to recently identified mechanisms of polymyxin resistance, including chromosomally encoded resistance traits as well as the recently identified plasmid-encoded polymyxin resistance determinant MCR-1. Epidemiological features summarizing the current knowledge in that field are presented.

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Section: Epidemiology Of Resistance To Polymyxins General Epidemiologmentioning

confidence: 99%

Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes

2017

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“…This is largely due to the fact that its takes several days to obtain the susceptibility pattern of the bacteria responsible for the septicemia. In Italy, a large hospital outbreak of colistin-resistant and carbapenemase (KPC)-producing Klebsiella pneumoniae isolates, correlating with the local increased colistin consumption, has been recently described (12). Therefore, there is a need for a rapid detection of polymyxinresistant isolates from blood cultures.…”

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Rapid Detection of Polymyxin-Resistant Enterobacteriaceae from Blood Cultures

et al. 2016

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Enterobacterial strains resistant to polymyxins are being increasingly reported worldwide. The conventional methods for detection of colistin-resistant isolates such as broth microdilution remain time-consuming (24 to 48 h), and methods such as disc diffusion and Etest are not reliable. Recently, the rapid polymyxin NP test was developed for rapid identification of polymyxin-resistant Enterobacteriaceae. This test is based on the detection of glucose metabolism related to bacterial growth in the presence of a defined concentration of colistin (or polymyxin B). The formation of acid metabolites is evidenced by a color change of a pH indicator (red phenol) in less than 2 h. In this study, the polymyxin NP test was evaluated for detection of colistin-resistant Enterobacteriaceae directly from blood cultures. The test was performed with 73 blood culture sets (either spiked or clinical blood cultures) with various enterobacterial species. The test exhibited excellent discrimination between polymyxin-resistant and polymyxin-susceptible enterobacterial isolates, and results are obtained from blood cultures within 4 h. It is easy to perform and requires neither subculture nor a centrifugation step. This test is rapid, specific, and sensitive and allows early identification of polymyxin-resistant Enterobacteriaceae directly from blood cultures.

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“…En coherencia con lo anterior, en algunos estudios el aná-lisis genotípico de los aislados reveló diversidad clonal que se asoció al incremento en la prescripción de colistina, sin embargo, en otros estudios se encontró una naturaleza clonal en los aislados del brote y ausencia de exposición previa a colistina, lo que evidencia que una vez seleccionados los aislados resistentes, estos tienen la habilidad para persistir y diseminarse rápidamente en el ambiente hospitalario 34,35 .…”

Section: Discussionunclassified

Brotes hospitalarios de bacterias resistentes a colistina: revisión sistemática de la literatura

Higuita-Gutiérrez

Jiménez

2017

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Cómo citar este artículo: L.F. Higuita-Gutiérrez, et al. Brotes hospitalarios de bacterias resistentes a colistina: revisión sistemática de la literatura. Infectio 2017; 21(4): [214][215][216][217][218][219][220][221][222] Resumen Objetivo: la colistina se ha constituido en un medicamento de uso común en países endémicos en resistencia a carbapenémicos; sin embargo, con su uso ha emergido el reporte de resistencia. El objetivo de este estudio es describir los brotes hospitalarios por bacterias resistentes a colistina Material y método: revisión sistemática de la literatura en cinco bases de datos siguiendo los criterios de la guía PRISMA de identificación, tamización, elección e inclusión. Resultados: Se identificaron 13 brotes en 7 países diferentes, 77% (n = 10) en Italia y Grecia, y 61,5% (n=8) en cepas de K. pneumoniae. Los pacientes presentaron condiciones de base, con múltiples comorbilidades y exposición afrecuente a los servicios de salud. Las pruebas y los criterios de susceptibilidad fueron variables, los mecanismos de resistencia que se encuentran simultáneamente con resistencia a colistina incluyen carbapenemasas y betalactamasas de espectro extendido. El genotipo predominante de acuerdo a MLST fue el ST-258. Conclusión: la emergencia de resistencia a colistina no se circunscribe a un grupo etario ni a una comorbilidad específica; sin embargo, se concentra en países donde la resistencia a carbapenémicos es endémica. Esto permite alertar a las autoridades sanitarias y a los centros hospitalarios para establecer programas de vigilancia, prevención y control que permiten la detección y contención oportuna de esta problemática Palabras clave: Brotes de enfermedades, colistina, resistencia a medicamentos Outbreaks of colistin resistant bacteria: systematic review AbstractObjetive: colistin has become a drug commonly used in endemic countries in resistance to carbapenems; however, with their use has emerged the resistance. The objective of this study is to describe outbreaks by bacteria resistant to colistin Design: systematic review of the literature in five databases with the criteria guide PRISMA of identification, tamization, election and inclusion. Results: 13 outbreaks were identified in 7 different countries, 77% (n = 10) in Italy and Greece, and 61.5% (n = 8) in K. pneumoniae strains. Patients had baseline conditions, multiple comorbidities and frequent exposure to health services. Tests and susceptibility criteria were variable, the resistance mechanisms that are simultaneously with the resistant to colistin include carbapenemases and extended spectrum beta-lactamases. The predominant genotype according to MLST was the ST-258. Conclusion: the emergence of resistance to colistin is not limited to an age group or a specific comorbidity; however, it concentrated in countries where resistance to carbapenems is endemic. This allows alert health authorities and hospitals to establish programs of surveillance, prevention and control that enable timely detection and containment of this problem Keywords: D...

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Large Nosocomial Outbreak of Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae Traced to Clonal Expansion of an mgrB Deletion Mutant

Cited by 118 publications

References 24 publications

Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes

Polymyxins: Antibacterial Activity, Susceptibility Testing, and Resistance Mechanisms Encoded by Plasmids or Chromosomes

Rapid Detection of Polymyxin-Resistant Enterobacteriaceae from Blood Cultures

Brotes hospitalarios de bacterias resistentes a colistina: revisión sistemática de la literatura

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