Prevalence and molecular characterisation of carbapenemase-producing Enterobacterales in an outbreak-free setting in a single hospital in Uruguay

Papa-Ezdra, Romina; Caiata, Leticia; Palacio, Rosario; Outeda, Matilde; Cabezas, Laura; Bálsamo, Andrés; Vignoli, Rafael; Bado, Inés; Seija, Verónica

doi:10.1016/j.jgar.2020.11.006

Cited by 11 publications

(8 citation statements)

References 19 publications

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“…The presence of the MDR phenotype was associated with the main ESBL gene characterized, bla CTX-M-15 . CTX-M-15 is an enzyme frequently reported in K. pneumoniae worldwide [30] and in our region in particular [11,12,31,32]. MIC 50 , MIC 90, and resistance values were high for all antibiotics (except for amikacin) when EUCAST-2012 breakpoints were used.…”

Section: Discussionmentioning

confidence: 79%

“…The high resistance values for the analyzed antibiotics are related to the co-existence of different antibiotic resistance mechanisms within the same K. pneumoniae isolate. We characterized different combinations of genes arrays in the same isolate: bla CTX-M-15 ; aac(6 ′ )Ib, aadA, and B alleles; aac(6 ′ )Ib-cr, qnrA, and B variants; and dfr types and class 1 integrons, conferring resistance to third-generation cephalosporins, aminoglycosides, fluoroquinolones, and trimethoprim-sulfamethoxazole, respectively [9,12]. It is important to remark that trimethoprim-sulfamethoxazole could be an appropriate treatment option in the cases of urine isolates with MIC values of 40 mg/L.…”

Section: Discussionmentioning

confidence: 99%

“…Currently, AMR in this pathogen is mostly related to carbapenem and third-generation cephalosporin resistance [4]. Different extended-spectrum β-lactamases (ESBL) conferring resistance to third-generation cephalosporins have been reported in our country, including those from the main CTX-M groups (CTX-M-15, CTX-M-2, CTX-M-9 and CTX-M-14, and CTX-M-8 [9][10][11]), SHVderived enzymes (SHV-2 and SHV-5 [9][10][11]), and carbapenemases conferring resistance to carbapenems (KPC-2 and NDM-1 [12]). Additionally, resistance to fluoroquinolones due to plasmid-mediated quinolone resistance (PMQR) mechanisms QnrA and QnrB, principally, and aminoglycosides Aac(6 ′ )Ib due to modifying enzymes have also been detected [9][10][11][12].…”

Section: Introductionmentioning

confidence: 94%

“…Different extended-spectrum β-lactamases (ESBL) conferring resistance to third-generation cephalosporins have been reported in our country, including those from the main CTX-M groups (CTX-M-15, CTX-M-2, CTX-M-9 and CTX-M-14, and CTX-M-8 [9][10][11]), SHVderived enzymes (SHV-2 and SHV-5 [9][10][11]), and carbapenemases conferring resistance to carbapenems (KPC-2 and NDM-1 [12]). Additionally, resistance to fluoroquinolones due to plasmid-mediated quinolone resistance (PMQR) mechanisms QnrA and QnrB, principally, and aminoglycosides Aac(6 ′ )Ib due to modifying enzymes have also been detected [9][10][11][12]. Due to the high plasticity of this pathogen, in some cases, ESBL, carbapenemases, PMQR, and aminoglycosides modifying enzymes may coexist in the same clinical strain, leading to limited treatment options for patients involved [12].…”

Section: Introductionmentioning

confidence: 94%

“…Additionally, resistance to fluoroquinolones due to plasmid-mediated quinolone resistance (PMQR) mechanisms QnrA and QnrB, principally, and aminoglycosides Aac(6 ′ )Ib due to modifying enzymes have also been detected [9][10][11][12]. Due to the high plasticity of this pathogen, in some cases, ESBL, carbapenemases, PMQR, and aminoglycosides modifying enzymes may coexist in the same clinical strain, leading to limited treatment options for patients involved [12].…”

Section: Introductionmentioning

confidence: 99%

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Great Plasticity in a Great Pathogen: Capsular Types, Virulence Factors and Biofilm Formation in ESBL-Producing Klebsiella pneumoniae from Pediatric Infections in Uruguay

Araújo,

Papa-Ezdra,

Ávila

et al. 2024

Antibiotics

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Klebsiella pneumoniae is widely recognized as an opportunistic hospital and community pathogen. It is one of the priority microorganisms included in the ESKAPE group, and its antibiotic resistance related to extended-spectrum β-lactamases (ESBL) is a global public health concern. The multi-drug resistance (MDR) phenotype, in combination with pathogenicity factors, could enhance the ability of this pathogen to cause clinical infections. The aim of this study was to characterize pathogenicity factors and biofilm formation in ESBL-producing K. pneumoniae from pediatric clinical infections. Capsular types, virulence factors, and sequence types were characterized by PCR. Biofilm formation was determined by a semiquantitative microtiter technique. MDR phenotype and statistical analysis were performed. The K24 capsular type (27%), virulence factors related to iron uptake fyuA (35%) and kfuBC (27%), and sequence types ST14 (18%) and ST45 (18%) were the most frequently detected. Most of the strains were biofilm producers: weak (22%), moderate (22%), or strong (12%). In 62% of the strains, an MDR phenotype was detected. Strains with K24 capsular type showed an association with ST45 and the presence of fyuA; strains with kfuBC showed an association with moderate or strong biofilm production and belonging to ST14. Weak or no biofilm producers were associated with the absence of kfuBC. The MDR phenotype was associated with the main ESBL gene, blaCTX-M-15. The high plasticity of K. pneumoniae to acquire an MDR phenotype, in combination with the factors exposed in this report, could make it even more difficult to achieve a good clinical outcome with the available therapeutics.

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