1887

Abstract

This study describes the molecular characteristics and risk factors associated with carbapenem-resistant strains. Risk factors associated with KPC-producing strains were investigated in this case-control study from May 2011 to May 2013. Bacterial identification was performed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined by broth microdilution. Carbapenemase production was assessed by both modified Hodge test (MHT) and ertapenem hydrolysis using MALDI-TOF MS. The presence of -lactamase-encoding genes was evaluated by PCR and DNA sequencing. Alterations in genes encoding outer membrane proteins were analysed by PCR and DNA sequencing as well as SDS-PAGE. Genetic relatedness among strains was determined by pulsed-field gel electrophoresis. This study included 94 patients. Longer hospitalisation, mechanical ventilation, catheters, and previous surgery were associated with KPC-producing . Sixty-eight strains showed resistance to carbapenems. Carbapenemase production was detected by MHT in 67 strains and by MALDI-TOF MS in 57. The presence of the gene was identified in 57 strains. The gene was not found in 11 carbapenem-resistant ; instead, the , , , and genes associated with OmpK35 and OmpK36 alterations were observed. Thirty-three KPC-producing strains were clonally related, and patients infected with these strains had a higher mortality rate (78.78 %). Our results show that KPC-producing was associated with several healthcare‐related risk factors, including recent surgery.

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2016-06-01
2020-03-29
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References

  1. Carvalhaes C. G., Cayô R., Assis D. M., Martins E. R., Juliano, Juliano M. A., Gales A. C.. 2013; Detection of spm-1-producing Pseudomonas aeruginosa and class D β-lactamase-producing Acinetobacter baumannii isolates by use of liquid chromatography-mass spectrometry and matrix-assisted laser desorption ionization-time of flight mass spectrometry. J Clin Microbiol51:287–290 [CrossRef][PubMed]
    [Google Scholar]
  2. Carvalhaes C. G., Picão R. C. G., Nicoletti A. G., Xavier D. E., Gales A. C.. 2010; Cloverleaf test (modified hodge test) for detecting carbapenemases production in Klebsiella pneumoniae: be aware of false positive results. J Antimicrob Chemother65:249–251[CrossRef]
    [Google Scholar]
  3. Casadevall A., Pirofski L. A.. 2000; Host–pathogen interactions: basic concepts of microbial commensalism, colonization, infection, and disease. Infect Immun68:6511–6518 [CrossRef][PubMed]
    [Google Scholar]
  4. CLSI. 2013; Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Third Informational Supplement. CLSI Document M100-S23 Wayne, PA: Clinical and Laboratory Standards Institute;
    [Google Scholar]
  5. CLSI. 2014; Performance Standards for Antimicrobial Susceptibility Testing; Twenty-Four Informational Supplement. CLSI Document M100-S24 Wayne, PA: Clinical and Laboratory Standards Institute;
    [Google Scholar]
  6. Correa L., Martino M. D., Siqueira I., Pasternak J., Gales A. C., Silva C. V., Camargo T. Z., Scherer P. F., Marra A. R.. 2013; A hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection. BMC Infect Dis13:80 [CrossRef][PubMed]
    [Google Scholar]
  7. Dice L. R.. 1945; Measures of the amount of ecological association between species. Ecology26:297–302 [CrossRef]
    [Google Scholar]
  8. Fehlberg L. C., da Silva Nogueira K., Cayô da Silva R., Nicoletti A. G., Palmeiro J. K., Gales A. C., Dalla-Costa L. M.. 2014; Detection of PER-2-producing Enterobacter cloacae in a Brazilian liver transplantation unit. Antimicrob Agents Chemother58:1831–1832 [CrossRef][PubMed]
    [Google Scholar]
  9. Gupta N., Limbago B. M., Patel J. B., Kallen A. J.. 2011; Carbapenem-resistant E nterobacteriaceae: epidemiology and prevention. Clin Infect Dis53:60–67 [CrossRef][PubMed]
    [Google Scholar]
  10. Hernández-Allés S., Albertí S., Alvarez D., Doménech-Sánchez A., Martínez-Martínez L., Gil J., Benedí V. J.. 1999; Porin expression in clinical isolates of Klebsiella pneumoniae . Microbiology145:673–679 [CrossRef][PubMed]
    [Google Scholar]
  11. Hoenigl M., Valentin T., Zarfel G., Wuerstl B., Leitner E., Salzer H. J. F., Posch J., Grisold A. J.. 2012; Nosocomial outbreak of klebsiella pneumoniae carbapenemase-producing klebsiella oxytoca in Austria. Antimicrob Agents Chemother (Bethesda)56:2158–2161 [CrossRef]
    [Google Scholar]
  12. Kofiteridis D. P., Valachis A., Dimoupoulou D., Maraki S., Mantadakis E., Mantadakis E., Samonis G.. 2014; Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization: a case control study. J Infect Chemother20:293–297[CrossRef]
    [Google Scholar]
  13. Leung V., Loo V. G., Frenette C., Domingo M. C., Bourgault A. M., Robson H. G.. 2012; First Canadian outbreak of Enterobacteriaceae-expressing Klebsiella pneumoniae carbapenemase type 3. Can J Infect dis Med Microbiol23:117–120 [CrossRef][PubMed]
    [Google Scholar]
  14. Monteiro J., Santos A. F., Asensi M. D., Peirano G., Gales A. C.. 2009; First report of kpc-2-producing Klebsiella pneumoniae strains in Brazil. Antimicrob Agents Chemother (Bethesda)53:333–334 [CrossRef]
    [Google Scholar]
  15. Papadimitriou-Olivgeris M., Marangos M., Fligou F., Christofidou M., Bartzavali C., Anastassiou E. D., Filos K. S.. 2012; Risk factors for kpc-producing Klebsiella pneumoniae enteric colonization upon ICU admission. J Antimicrob Chemother67:2976–2981 [CrossRef][PubMed]
    [Google Scholar]
  16. Patel G., Huprikar G, Factor S. H., Jenkins S. G., Calfee D. P.. 2008; Outcomes of carbapenem-resistant Klebsiella pneumoniae infection and the impact of antimicrobial and adjunctive therapies. Infect Control Hosp Epidemiol29:1099–1106[CrossRef]
    [Google Scholar]
  17. Qureshi Z. A., Paterson D. L., Potoski B. A., Kilayko M. C., Sandovsky G., Sordillo E.. 2012; Treatment outcome of bacteremia due to kpc-producing Klebsiella pneumoniae: superiority of combination antimicrobial regimens. Antimicrobial Agents and Chemotherapy56:2108–2113[CrossRef]
    [Google Scholar]
  18. Queenan A. M., Bush K.. 2007; Carbapenemases: the versatile β-lactamases. Clin. Microbiol. Rev20:440–458[CrossRef]
    [Google Scholar]
  19. Silva F. M., Carmo M. S., Silbert S., Gales A. C.. 2011; SPM-1-producing Pseudomonas aeruginosa: analysis of the ancestor relationship using multilocus sequence typing, pulsed-field gel electrophoresis, and automatedph ribotyping. Microb Drug Resist 17412:215–20220
    [Google Scholar]
  20. Silva F. M., Cayô R., Carvalhaes C. G., Rodrigues-Costa F., Cayô R., Correia-Sacchi F. P., Silva A. C. R.. 2015; Coproduction of KPC-2 and IMP-10 in carbapenem-resistant isolates from an outbreak in a Brazilian teaching hospital. J Clin Microbiol53:2324–2328 [CrossRef][PubMed]
    [Google Scholar]
  21. Souli M., Galani I., Antoniadou A., Papadomichelakis E., Poulakou G., Panagea T., Vourli S., Zerva L., Armaganidis A., Kanellakopoulou K.. 2012; An outbreak of infection due to β‐lactamase Klebsiella pneumoniacarbapenemase 2-producing K. pneumoniae in a Greek university hospital: molecular characterization, epidemiology, and outcomes. Clin Infect Dis50:364–373 [CrossRef]
    [Google Scholar]
  22. Tofteland S., Naseer U., Lislevand J. H., Sundsfjord A., Samuelsen O.. 2013; A long-term low-frequency hospital outbreak of kpc-producing Klebsiella pneumoniae involving intergenus plasmid diffusion and a persisting environmental reservoir. PLoS One8:e5901559018 [CrossRef][PubMed]
    [Google Scholar]
  23. Tumbarello M., Trecarichi E. M., Tumietto F., Del Bono V., De Rosa F. G., Bassetti M., Losito A. R., Tedeschi S., Saffioti C., Corsione S.. 2014; Predictive models for identification of hospitalized patients harboring kpc-producing pneumoniae Klebsiella pneumoniae . Antimicrob Agents Chemother (Bethesda)58:3514–3520 [CrossRef]
    [Google Scholar]
  24. Vatopoulos A.. 2008; High rates of metallo-beta-lactamase producing Klebsiella pneumoniae in Greece – a review of the current evidence. Euro Surveillance13:1–6
    [Google Scholar]
  25. Wang P., Hu F., Xiong Z., Ye X., Zhu D., Wang Y. F., Wang M.. 2011; Susceptibility of extended-spectrum-beta-lactamase-producing Enterobacteriaceae according to the new CLSI breakpoints. J Clin Microbiol49:3127–3131 [CrossRef][PubMed]
    [Google Scholar]
  26. Yang J., Ye L., Guo L., Zhao Q., Chen R., Luo Y., Chen Y., Tian S., Zhao J., other authors. 2013; A nosocomial outbreak of kpc-2-producing Klebsiella pneumoniae in a Chinese hospital: dissemination of ST11 and emergence of ST37, ST392 and ST395. Clin Microbiol Infect19:E509E515 [CrossRef][PubMed]
    [Google Scholar]
  27. Zarkotou O., Pournaras S., Tselioti P., Dragoumanos V., Pitiriga V., Ranellou K., Prekates A., Themeli-Digalaki K., Tsakris A.. 2011; Predictors of mortality in patients with bloodstream infections caused by kpc-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clin Microbiol Infect17:1798–1803 [CrossRef][PubMed]
    [Google Scholar]
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