Spread of carbapenem-resistant Klebsiella pneumoniae in a tertiary hospital in Sao Paulo, Brazil

Pereira, Graziella Hanna; Garcia, Doroti Oliveira; Mostardeiro, Marcelo M.; Ogassavara, Cinthya Terumi; Levin, Anna S.

doi:10.1016/j.jhin.2011.05.023

Cited by 14 publications

(12 citation statements)

References 6 publications

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“…However, two of the rmtG-harboring K. pneumoniae strains were negative for any replicon, including IncN, based on this protocol. K. pneumoniae strains producing various ESBLs and, more recently, KPCs (Klebsiella pneumoniae Carbapenemases), are reported from Brazil (14)(15)(16)(17)(18)(19). We screened the eight 16S-RMTase-producing strains for KPC, CTX-M, SHV, and TEM group ␤-lactamases by PCR and sequencing as described previously (20).…”

mentioning

confidence: 99%

Coproduction of 16S rRNA Methyltransferase RmtD or RmtG with KPC-2 and CTX-M Group Extended-Spectrum β-Lactamases in Klebsiella pneumoniae

Bueno

Francisco

O’Hara

et al. 2013

Antimicrob Agents Chemother

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bEight Klebsiella pneumoniae clinical strains with high-level aminoglycoside resistance were collected from eight hospitals in São Paulo State, Brazil, in 2010 and 2011. Three of them produced an RmtD group 16S rRNA methyltransferase, RmtD1 or RmtD2. Five strains were found to produce a novel 16S rRNA methyltransferase, designated RmtG, which shared 57 to 58% amino acid identity with RmtD1 and RmtD2. Seven strains coproduced KPC-2 with or without various CTX-M group extended-spectrum ␤-lactamases, while the remaining strain coproduced CTX-M-2.

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mentioning

confidence: 99%

Coproduction of 16S rRNA Methyltransferase RmtD or RmtG with KPC-2 and CTX-M Group Extended-Spectrum β-Lactamases in Klebsiella pneumoniae

Bueno

Francisco

O’Hara

et al. 2013

Antimicrob Agents Chemother

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“…On the other hand, the 42 isolates of A. baumannii used in this study were previously evaluated and belonged to 10 different clusters and 21 profiles (15). Moreover, although K. pneumoniae isolates were not typed, isolates that circulate in Brazil belong to several different strains (25). These facts minimize the possibility that our results refer to only one or very few clones.…”

mentioning

confidence: 78%

Susceptibility of Multiresistant Gram-Negative Bacteria to Fosfomycin and Performance of Different Susceptibility Testing Methods

Neto

Oliveira

Rizek

et al. 2014

Antimicrob Agents Chemother

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Fosfomycin may be a treatment option for multiresistant Gram-negative bacteria. This study compared susceptibility methods using 94 multiresistant clinical isolates. With agar dilution (AD), susceptibilities were 81%, 7%, 96%, and 100% (CLSI) and 0%, 0%, 96%, and 30% (EUCAST), respectively, for Acinetobacter baumannii, Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterobacter spp. Categorical agreement between Etest and AD for Enterobacteriaceae and A. baumannii was >80%. Disk diffusion was adequate only for Enterobacter. CLSI criteria for urine may be adequate for systemic infections.

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“…Clinicians have the option to treat infections caused by multidrug-resistant strains with carbapenems, bearing in mind that this intervention may be a risk factor for emergence of carbapenemresistant strains [50]. Indeed, we identified an observational study conducted in Chile reporting infections by P. aeruginosa in PICUs that demonstrated resistance to carbapenems [20], and two outbreaks of carbapenem-resistant K. pneumoniae (in Colombia and Brazil) [26,27].…”

Section: Discussionmentioning

confidence: 99%

“…Figure 3 illustrates that PICUs and NICUs of Central America, Venezuela, and Brazil have been inundated by lethal outbreaks of multidrug-resistant strains of K. pneumoniae, which harbored genes for ESBL enzymes and carbapenemases [21][22][23][24][25][26][27]. These outbreaks were, in part, propagated by breaches in infection-control procedures, including inappropriate intravenous solution use, inadequate hand hygiene and contact precautions, and failure to screen the local environment and equipment as sources of contamination [21][22][23].…”

Section: Outbreaksmentioning

confidence: 99%

Gram-negative infections in pediatric and neonatal intensive care units of Latin America

Berezin

Solórzano

2014

J Infect Dev Ctries

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In order to review the epidemiology of Gram-negative infections in the pediatric and neonatal intensive care units (PICUs and NICUs) of Latin America a systematic search of PubMed and targeted search of SciELO was performed to identify relevant articles published since 2005. Independent cohort data indicated that overall infection rates were higher in Latin American PICUs and NICUs versus developed countries (range, 5%-37% vs 6%-15%, respectively). Approximately one third of Latin American patients with an acquired PICU or NICU infection died, and crude mortality was higher among extremely low-birth-weight infants and those with an infection caused by Gram-negative bacteria. In studies reporting > 100 isolates, the frequency of Gram-negative pathogens varied from 31% (Colombia) to 63% (Mexico), with Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli the predominant pathogens in almost all countries, and Acinetobacter spp. and Serratia spp. isolated sporadically. The activity of quinolones and third-generation cephalosporins against P. aeruginosa, Acinetobacter spp., and Enterobacteria was seriously compromised, coincident with a high prevalence of circulating extended-spectrum β-lactamases. Furthermore, we identified two observational studies conducted in Chile and Brazil reporting infections by P. aeruginosa and Acinetobacter baumannii in PICUs, demonstrating resistance to carbapenems, and two outbreaks of carbapenem-resistant K. pneumoniae in Colombia and Brazil. The endemicity of multidrug-resistant Gram-negative infections in Latin American PICUs and NICUs is punctuated by intermittent clonal outbreaks. The problem may be alleviated by ensuring ICUs are less crowded, increasing staffing levels of better-trained health care personnel, and implementing antimicrobial stewardship and surveillance programs.

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Spread of carbapenem-resistant Klebsiella pneumoniae in a tertiary hospital in Sao Paulo, Brazil

Cited by 14 publications

References 6 publications

Coproduction of 16S rRNA Methyltransferase RmtD or RmtG with KPC-2 and CTX-M Group Extended-Spectrum β-Lactamases in Klebsiella pneumoniae

Coproduction of 16S rRNA Methyltransferase RmtD or RmtG with KPC-2 and CTX-M Group Extended-Spectrum β-Lactamases in Klebsiella pneumoniae

Susceptibility of Multiresistant Gram-Negative Bacteria to Fosfomycin and Performance of Different Susceptibility Testing Methods

Gram-negative infections in pediatric and neonatal intensive care units of Latin America

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