Nosocomial meningitis caused by Klebsiella pneumoniae producing carbapenemase, with initial cerebrospinal fluid minimal inflammatory response

Almeida, Sérgio Monteiro de; Nogueira, Keite da Silva; Palmeiro, Jussara Kasuko; Scheffer, Mara Cristina; Stier, Christiane Johnscher Niebel; França, João César Beenke; Costa, Libera Maria Dalla

doi:10.1590/0004-282x20140030

Cited by 8 publications

(12 citation statements)

References 8 publications

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“…In this retrospective study, Enterobacteriaceae, and especially CRE, played a significant role in neurosurgical bacterial meningitis/encephalitis with strong invasiveness, high toxicity, high morbidity and mortality rates. Overall, the microbiological findings in this study are consistent with the majority of previous reports [14]. Of these, Klebsiella pneumoniae (75, 40.5%), Escherichia coli (32, 17.3%), Enterobacter cloacae (19, 10.3%) and Enterobacter aerogenes (19, 10.3%) were the four most prevalent species.…”

Section: Discussionsupporting

confidence: 91%

Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae

Zheng

Liu

Zhang

et al. 2020

Journal of Infection and Chemotherapy

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a b s t r a c tObjectives: This is a retrospective observational study conducted in one of the largest clinical center of neurosurgery in China. Our aim was to determine the epidemiological characteristics of carbapenemresistant Enterobacteriaceae (CRE) related meningitis/encephalitis and to elucidate the risk factors for CRE neurosurgical infections. Patients and methods: We performed a retrospective study between January 2012 and December 2017 of patients who underwent neurosurgery. The medical records of each patient were reviewed, and 20 clinical variables on risk factors were extracted and evaluated by Multivariate logistic analysis for CREmeningitis/encephalitis. Results: In 2012e2017, the positive rate of neurosurgical meningitis/encephalitis was 7.9% (2947/29605), Enterobacteriaceae accounted for 6.3% (185/2947) of all bacterial infections. Totally, 133 Enterobacteriaceae include 26 CRE isolates were available in this study. Of them, Univariate analysis showed that the risk factors of CRE meningitis were ventilator, bacteremia, Intensive Care Unit (ICU) admission, hospital acquired pneumonia and mortality attribute to infection. Multivariate logistic analysis showed that hospital acquired pneumonia and mortality attribute to infection were independent risk factors for CRE meningitis.Conclusion: CRE is one of the most serious drug-resistant bacteria published by World Health Organization (WHO) in 2016, and meningitis/encephalitis caused by CRE is an important sign of the failure of the neurosurgery, which demands the physician's immediate attention.

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Section: Discussionsupporting

confidence: 91%

Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae

Zheng

Liu

Zhang

et al. 2020

Journal of Infection and Chemotherapy

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“…Klebsiella pneumoniae carbapenemase-producing Kp were first described in Brazil in 2006 (Monteiro et al, 2009) and their incidence has significantly increased since that time. In 2010, a great dispersion of bla KPC was observed in Brazil (Seki et al, 2011; Pereira et al, 2013), including an outbreak in our hospital (Almeida et al, 2014). During 2011 and 2012, few KPC-producing Enterobacteriaceae were found in this same hospital (42 cases in 2 years).…”

Section: Discussionmentioning

confidence: 95%

“…The first period (2000–2009) was characterized by ESBL prevalence, resistance to fluoroquinolones and aminoglycosides, and low resistance to imipenem and meropenem (Nogueira Kda et al, 2014, Nogueira et al, 2015). The second period was defined by a KPC-Kp outbreak that occurred in June 2010 (Almeida et al, 2014), and the third period was characterized by a gradual increase in the prevalence of KPC-Kp and other Enterobacteriaceae .…”

Section: Methodsmentioning

confidence: 99%

Molecular Epidemiology of Multidrug-Resistant Klebsiella pneumoniae Isolates in a Brazilian Tertiary Hospital

et al. 2019

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Multidrug-resistant (MDR) Klebsiella pneumoniae (Kp) is a major bacterial pathogen responsible for hospital outbreaks worldwide, mainly via the spread of high-risk clones and epidemic resistance plasmids. In this study, we evaluated the molecular epidemiology and β-lactam resistance mechanisms of MDR-Kp strains isolated in a Brazilian academic care hospital. We used whole-genome sequencing to study drug resistance mechanisms and their relationships with a K. pneumoniae carbapenemase-producing (KPC) Kp outbreak. Forty-three Kp strains were collected between 2003 and 2012. Antimicrobial susceptibility testing was performed for 15 antimicrobial agents, and polymerase chain reaction (PCR) was used to detect 32 resistance genes. Mutations in ompk35 , ompk36 , and ompk37 were evaluated by PCR and DNA sequencing. Pulsed field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were carried out to differentiate the strains. Based on distinct epidemiological periods, six Kp strains were subjected to whole-genome sequencing. β-lactamase coding genes were widely distributed among isolates. Almost all isolates had mutations in porin genes, particularly ompk35 . The presence of bla KPC promoted a very high increase in carbapenem minimum inhibitory concentration only when ompk35 and ompk36 were interrupted by insertion sequences. A major cluster was identified by PFGE analysis and all isolates from this cluster belonged to clonal group (CG) 258. We have also identified a large repertoire of resistance genes in the sequenced isolates. A bla KPC–2 -bearing plasmid (pUFPRA2) was also identified, which was very similar to a plasmid previously described in the first Brazilian KPC-Kp (2005). We found high-risk clones (CG258) and an epidemic resistance plasmid throughout the duration of the study (2003 to 2012), emphasizing a persistent presence of MDR-Kp strains in the hospital setting. Finally, we found that horizontal transfer of resistance genes between clones may have played a key role in the evolution of the outbreak.

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“…Even in these diseases, the failure of brain infection treatment is mostly attributed not to the potency of the drugs, but to the BBB that impairs the efficient delivery of the drugs to the brain. Another major therapeutic challenge is represented by agents usually causing nosocomial CNS infections (i.e., post neurosurgical meningitis with or without brain involvement; infections of external ventricular drainage system; infections of ventriculoperitoneal shunt), which often show a multi-drug resistant phenotype [ 2 , 3 ].…”

Section: Introductionmentioning

confidence: 99%

Antimicrobial Essential Oil Formulation: Chitosan Coated Nanoemulsions for Nose to Brain Delivery

et al. 2020

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Brain infections as meningitis and encephalitis are attracting a great interest. Challenges in the treatment of these diseases are mainly represented by the blood brain barrier (BBB) that impairs the efficient delivery of even very potent drugs to reach the brain. The nose to the brain administration route, is a non-invasive alternative for a quick onset of action, and enables the transport of numerous medicinal agents straight to the brain thus workarounding the BBB through the highly vascularized olfactory region. In this report, Thymus vulgaris and Syzygium aromaticum essential oils (EOs) were selected to be included in chitosan coated nanoemulsions (NEs). The EOs were firstly analyzed to determine their chemical composition, then used to prepare NEs, that were deeply characterized in order to evaluate their use in intranasal administration. An in vitro evaluation against a collection of clinical isolated bacterial strains was carried out for both free and nanoemulsioned EOs. Chitosan coated NEs showed to be a potential and effective intranasal formulation against multi-drug resistant Gram-negative bacteria such as methicillin-susceptible Staphylococcus aureus and multi-drug resistant Gram-negative microorganisms including carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae.

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Nosocomial meningitis caused by Klebsiella pneumoniae producing carbapenemase, with initial cerebrospinal fluid minimal inflammatory response

Cited by 8 publications

References 8 publications

Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae

Epidemiology and risk factors of neurosurgical bacterial meningitis/encephalitis induced by carbapenem resistant Enterobacteriaceae

Molecular Epidemiology of Multidrug-Resistant Klebsiella pneumoniae Isolates in a Brazilian Tertiary Hospital

Antimicrobial Essential Oil Formulation: Chitosan Coated Nanoemulsions for Nose to Brain Delivery

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