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Campos ÁSÁ, Akineden Ö, Fernández-Silva JA, Ramírez-Vásquez NF. Extended-spectrum beta-lactamase-producing Klebsiella pneumoniae and risk factors associated with high total bacterial count in bulk tank milk from dairy farms in Colombia. Braz J Microbiol 2024:10.1007/s42770-024-01396-w. [PMID: 38874745 DOI: 10.1007/s42770-024-01396-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 05/16/2024] [Indexed: 06/15/2024] Open
Abstract
The objective of the study was to evaluate the frequency and genetic characteristics of ESBL-producing Escherichia coli and Klebsiella spp. and the risk factors associated with a high total bacterial count in bulk tank milk samples of dairy farms in three municipalities of the Antioquia Department, Colombia. Fifteen samples were positive for E. coli and Klebsiella spp. Subsequent analysis of the 16 S rRNA gene sequences confirmed these isolates included E. coli (n = 3), K. oxytoca (n = 11), and K. pneumoniae (n = 1). None of the isolates was positive for ESBL identification by phenotypic methods, but the only the isolate of K. pneumoniae was positive for the blaSHV61 gene by sequence analysis. The antibiotic susceptibility evaluation for all Klebsiella spp. isolates identified resistance to fosfomycin (50%; 6/12) and ampicillin (100%; 12/12). While most of the herds maintain adequate hygienic quality, specific risk factors such as having more than 60 milking cows, frequent changes in milkers, milking in paddocks, and using a chlorinated product for pre-dipping have been identified as associated with a high total bacterial count > 100,000 CFU/mL in bulk tank milk. However, certain variables including the milker being the owner of the animals and the proper washing and disinfection of the milking machine contribute to maintain a high level of hygiene and quality in the raw milk stored in the tanks. In conclusion, the frequency of ESBL producers was relatively low, with only K. pneumoniae testing positive for the blaSHV ESBL type. The presence of these bacteria in milk tanks represents a potential risk to public health for consumers of raw milk and its derivatives.
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Affiliation(s)
- Ángela-Sofía Ágredo Campos
- Grupo Centauro, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Ömer Akineden
- Dairy Sciences, Institute of Veterinary Food Science, Justus-Liebig-University Giessen, Ludwigstrasse 21, 35390, Giessen, Germany
| | - Jorge A Fernández-Silva
- Grupo Centauro, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia
| | - Nicolás F Ramírez-Vásquez
- Grupo Centauro, Escuela de Medicina Veterinaria, Facultad de Ciencias Agrarias, Universidad de Antioquia UdeA, Calle 70 No. 52-21, Medellín, Colombia.
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Souza PMS, Ribeiro ACOA, Pena EPN, Silva FAC, Calsa Júnior T, Morais MMC, Almeida ACS. Distinct carbapenems susceptibility profiles in isogenic isolates of Klebsiella pneumoniae presenting Ompk36 disruption and expression of down-regulated blaKPC-2. BRAZ J BIOL 2023; 83:e269946. [PMID: 37283335 DOI: 10.1590/1519-6984.269946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 04/27/2023] [Indexed: 06/08/2023] Open
Abstract
The isolation of multidrug-resistant Klebsiella pneumoniae in hospitals is a major public health threat, increasing patient hospitalization costs, morbidity and mortality. Therefore, this work investigated the resistance mechanisms that produced different carbapenems susceptibility profiles in two isogenic strains of K. pneumoniae isolated from the same patient in a public hospital in Recife, Pernambuco. The genes that encode the main porins in K. pneumoniae, ompK35 and ompK36, and several beta-lactamase genes were analyzed. The expression of these genes was evaluated by quantitative real time PCR (polymerase chain reaction) with reverse transcriptase (RT-qPCR). SDS-PAGE (sodium dodecyl sulphate-polyacrylamide gel electrophoresis) was performed to analyze the outer membrane proteins. The analysis of the ompK36 genetic environment disclosed an IS903 insertion sequence disrupting this gene in the ertapenem resistant isolate (KPN133). The blaKPC-2 gene showed down-regulated expression in both isolates. Our findings show that changes in porins, especially OmpK36, are more determinant to carbapenems susceptibility profile of bacterial isolates than variations in blaKPC gene expression.
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Affiliation(s)
- P M S Souza
- Universidade de Pernambuco - UPE, Instituto de Ciências Biológicas, Laboratório de Resistência Microbiana, Recife, PE, Brasil
| | - A C O A Ribeiro
- Universidade de Pernambuco - UPE, Instituto de Ciências Biológicas, Laboratório de Resistência Microbiana, Recife, PE, Brasil
| | - E P N Pena
- Universidade Federal de Pernambuco - UFPE, Departamento de Genética, Laboratório de Genômica e Proteômica de Plantas, Recife, PE, Brasil
| | - F A C Silva
- Universidade Federal de Pernambuco - UFPE, Departamento de Genética, Laboratório de Genômica e Proteômica de Plantas, Recife, PE, Brasil
| | - T Calsa Júnior
- Universidade Federal de Pernambuco - UFPE, Departamento de Genética, Laboratório de Genômica e Proteômica de Plantas, Recife, PE, Brasil
| | - M M C Morais
- Universidade de Pernambuco - UPE, Instituto de Ciências Biológicas, Laboratório de Resistência Microbiana, Recife, PE, Brasil
| | - A C S Almeida
- Universidade Federal Rural de Pernambuco - UFRPE, Departamento de Biologia, Laboratório de Genética, Bioquímica e Sequenciamento de DNA, Recife, PE, Brasil
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Wang Q, Wei S, Silva AF, Madsen JS. Cooperative antibiotic resistance facilitates horizontal gene transfer. THE ISME JOURNAL 2023; 17:846-854. [PMID: 36949153 PMCID: PMC10203111 DOI: 10.1038/s41396-023-01393-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 02/28/2023] [Accepted: 03/02/2023] [Indexed: 03/24/2023]
Abstract
The rise of β-lactam resistance among pathogenic bacteria, due to the horizontal transfer of plasmid-encoded β-lactamases, is a current global health crisis. Importantly, β-lactam hydrolyzation by β-lactamases, not only protects the producing cells but also sensitive neighboring cells cooperatively. Yet, how such cooperative traits affect plasmid transmission and maintenance is currently poorly understood. Here we experimentally show that KPC-2 β-lactamase expression and extracellular activity were higher when encoded on plasmids compared with the chromosome, resulting in the elevated rescue of sensitive non-producers. This facilitated efficient plasmid transfer to the rescued non-producers and expanded the potential plasmid recipient pool and the probability of plasmid transfer to new genotypes. Social conversion of non-producers by conjugation was efficient yet not absolute. Non-cooperative plasmids, not encoding KPC-2, were moderately more competitive than cooperative plasmids when β-lactam antibiotics were absent. However, in the presence of a β-lactam antibiotic, strains with non-cooperative plasmids were efficiently outcompeted. Moreover, plasmid-free non-producers were more competitive than non-producers imposed with the metabolic burden of a plasmid. Our results suggest that cooperative antibiotic resistance especially promotes the fitness of replicons that transfer horizontally such as conjugative plasmids.
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Affiliation(s)
- Qinqin Wang
- Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
| | - Shaodong Wei
- National Food Institute, Technical University of Denmark, 2800, Lyngby, Denmark
| | - Ana Filipa Silva
- Department of Biology, University of Copenhagen, 2100, Copenhagen, Denmark
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Josa DF, Bustos IG, Yusef SA, Crevoisier S, Silva E, López N, Leal R, Molina IT, Osorio JP, Arias G, Cortés-Muñoz F, Sánchez C, Reyes LF. Rapid Detection of Carbapenemase and Extended-Spectrum β-Lactamase Producing Gram-Negative Bacteria Directly from Positive Blood Cultures Using a Novel Protocol. Antibiotics (Basel) 2022; 12:antibiotics12010034. [PMID: 36671235 PMCID: PMC9854742 DOI: 10.3390/antibiotics12010034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Early and adequate antibiotic treatment is the cornerstone of improving clinical outcomes in patients with bloodstream infections (BSI). Delays in appropriate antimicrobial therapy have catastrophic consequences for patients with BSI. Microbiological characterization of multi-drug resistant pathogens (MDRP) allows clinicians to provide appropriate treatments. Current microbiologic techniques may take up to 96 h to identify causative pathogens and their resistant patterns. Therefore, there is an important need to develop rapid diagnostic strategies for MDRP. We tested a modified protocol to detect carbapenemase and extended-spectrum β-lactamase (ESBL) producing Gram-negative bacteria (GNB) from positive blood cultures. METHODS This is a prospective cohort study of consecutive patients with bacteremia. We developed a modified protocol using the HB&L® system to detect MDRP. The operational characteristics were analyzed for each test (HB&L-ESBL/AmpC® and HB&L-Carbapenemase® kits). The kappa coefficient, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios (LR) with 95% confidence intervals (CI), and reduction in identification time of this novel method were calculated. RESULTS Ninety-six patients with BSI were included in the study. A total of 161 positive blood cultures were analyzed. Escherichia coli (50%, 81/161) was the most frequently identified pathogen, followed by Klebsiella pneumoniae (15%, 24/161) and Pseudomonas aeruginosa (8%, 13/161). Thirty-three percent of isolations had usual resistance patterns. However, 34/161 (21%) of identified pathogens were producers of carbapenemases and 21/161 (13%) of extended-spectrum β-lactamases. Concordance between our HB&L® modified protocol and the traditional method was 99% (159/161). Finally, identification times were significantly shorter using our HB&L®-modified protocol than traditional methods: median (IQR) 19 h (18, 22) vs. 61 h (60, 64), p < 0.001. CONCLUSIONS Here, we provide novel evidence that using our HB&L®-modified protocol is an effective strategy to reduce the time to detect MDRP producers of carbapenemases or extended-spectrum β-lactamases, with an excellent concordance rate when compared to the gold standard. Further studies are needed to confirm these findings and to determine whether this method may improve clinical outcomes.
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Affiliation(s)
- Diego Fernando Josa
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
- Correspondence: (D.F.J.); (L.F.R.); Tel.: +57-1-861-5555 (ext. 23342) (L.F.R.)
| | - Ingrid Gisell Bustos
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
| | - Soad Amira Yusef
- Department of Critical Medicine, Fundación Clínica Shaio, Bogotá 110111, Colombia; (S.A.Y.); (S.C.)
- Unisabana Center of Translational Science, Universidad de la Sabana, Chía 53753, Colombia
| | - Stephanie Crevoisier
- Department of Critical Medicine, Fundación Clínica Shaio, Bogotá 110111, Colombia; (S.A.Y.); (S.C.)
- Unisabana Center of Translational Science, Universidad de la Sabana, Chía 53753, Colombia
| | - Edwin Silva
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
- Infectious Diseases Department, Fundación Clínica Shaio, Bogotá 110111, Colombia
| | - Natalia López
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
| | - Rafael Leal
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
| | - Isabel Torres Molina
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
| | - Juan Pablo Osorio
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
- Infectious Diseases Department, Fundación Clínica Shaio, Bogotá 110111, Colombia
| | - Gerson Arias
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
- Infectious Diseases Department, Fundación Clínica Shaio, Bogotá 110111, Colombia
| | - Fabián Cortés-Muñoz
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
| | - Carolina Sánchez
- Research Group Cardiovascular Medicine and Specialties of High Complexity, Fundación Clínica Shaio, Bogotá 110121, Colombia; (I.G.B.); (E.S.); (N.L.); (R.L.); (I.T.M.); (J.P.O.); (G.A.); (F.C.-M.); (C.S.)
| | - Luis Felipe Reyes
- Unisabana Center of Translational Science, Universidad de la Sabana, Chía 53753, Colombia
- Department of Critical Care, Clínica Universidad de La Sabana, Chía 250001, Colombia
- Correspondence: (D.F.J.); (L.F.R.); Tel.: +57-1-861-5555 (ext. 23342) (L.F.R.)
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Lee YL, Ko WC, Hsueh PR. Geographic patterns of global isolates of carbapenem-resistant Klebsiella pneumoniae and the activity of ceftazidime/avibactam, meropenem/vaborbactam, and comparators against these isolates: Results from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program, 2020. Int J Antimicrob Agents 2022; 60:106679. [PMID: 36241011 DOI: 10.1016/j.ijantimicag.2022.106679] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
Carbapenem-resistant Enterobacterales (CRE) are a growing threat to public health. This study was conducted to determine the prevalence of carbapenem-resistant Klebsiella pneumoniae (CR-KP) and the associated carbapenemase genes using data from the Antimicrobial Testing Leadership and Surveillance (ATLAS) program, 2020. Minimum inhibitory concentrations (MICs) were determined using the broth microdilution method, and carbapenemase genes were detected using multiplex polymerase chain reaction (PCR). Clinical and Laboratory Standards Institute breakpoints were used for interpretation of susceptibility. A total of 6753 K. pneumoniae isolates were collected from 57 countries in six regions worldwide. Of these, 1118 (16.6%) were CR-KP isolates. Among 1079 of the tested CR-KP isolates, 1017 (94.3%) had at least one of the class A (41.0%, 417/1017), B (39.3%, 400/1017), and D (38.8%, 395/1017) carbapenemase genes. The resistance patterns and associated genes differed significantly between the participating countries. India, Greece, and Argentina had the highest rates of carbapenem resistance. Susceptibility to the β-lactamase inhibitor combination, ceftazidime/avibactam was greater than that to meropenem/vaborbactam in all K. pneumoniae (93.7% vs. 90.3%, P < 0.05), CR-KP (63.3% vs. 41.5%, P < 0.05), CR-KP with genes for Klebsiella pneumoniae carbapenemase-like carbapenemase (99.5% vs. 96.0%, P < 0.05), oxacillinase-like carbapenemase (98.7% vs. 4.6%, P < 0.05), and CR-KP without carbapenemase genes (93.5% vs. 79.0%, P < 0.05). CR-KP was the only exception with class B carbapenemase, with susceptibility rates of 1.4% and 9.4% to ceftazidime/avibactam and meropenem/vaborbactam, respectively (P < 0.05). Overall, surveillance results are important for guiding empirical antimicrobial therapy in different regions and for monitoring the global transmission of CR-KP with varying resistance mechanisms.
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Affiliation(s)
- Yu-Lin Lee
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan; Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan; Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chien Ko
- Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Ren Hsueh
- Departments of Laboratory Medicine and Internal Medicine, China Medical University Hospital, Taichung, Taiwan; School of Medicine, China Medical University, Taichung, Taiwan; PhD Program for Aging, School of Medicine, China Medical University, Taichung, Taiwan; Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.
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Aristizabal-Hoyos A, Rodríguez EA, Torres-Palma RA, Jiménez JN. Concern levels of beta-lactamase-producing Gram-negative bacilli in hospital wastewater: hotspot of antimicrobial resistance in Latin-America. Diagn Microbiol Infect Dis 2022; 105:115819. [DOI: 10.1016/j.diagmicrobio.2022.115819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 07/03/2022] [Accepted: 09/16/2022] [Indexed: 11/24/2022]
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de Oliveira Santos JV, da Costa Júnior SD, de Fátima Ramos Dos Santos Medeiros SM, Cavalcanti IDL, de Souza JB, Coriolano DL, da Silva WRC, Alves MHME, Cavalcanti IMF. Panorama of Bacterial Infections Caused by Epidemic Resistant Strains. Curr Microbiol 2022; 79:175. [PMID: 35488983 PMCID: PMC9055366 DOI: 10.1007/s00284-022-02875-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 04/11/2022] [Indexed: 12/24/2022]
Abstract
Antimicrobial resistance (AMR) represents a critical obstacle to public health worldwide, due to the high incidence of strains resistant to available antibiotic therapies. In recent years, there has been a significant increase in the prevalence of resistant epidemic strains, associated with this, public health authorities have been alarmed about a possible scenario of uncontrolled dissemination of these microorganisms and the difficulty in interrupting their transmission, as nosocomial pathogens with resistance profiles previously considered sporadic. They become frequent bacteria in the community. In addition, therapy for infections caused by these pathogens is based on broad-spectrum antibiotic therapy, which favors an increase in the tolerance of remaining bacterial cells and is commonly associated with a poor prognosis. In this review, we present the current status of epidemic strains of methicillin-resistant Staphylococcus aureus (MRSA), Vancomycin-resistant Enterococcus (VRE), MDR Mycobacterium tuberculosis, extended-spectrum β-lactamase-producing Enterobacterales (ESBL), Klebsiella pneumoniae carbapenemase (KPC), and—New Delhi Metallo-beta-lactamase-producing Pseudomonas aeruginosa (NDM).
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Affiliation(s)
- João Victor de Oliveira Santos
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Sérgio Dias da Costa Júnior
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | | | - Iago Dillion Lima Cavalcanti
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Jaqueline Barbosa de Souza
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Davi Lacerda Coriolano
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Wagner Roberto Cirilo da Silva
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Maria Helena Menezes Estevam Alves
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil
| | - Isabella Macário Ferro Cavalcanti
- Laboratory of Immunopathology Keizo Asami (LIKA), Federal University of Pernambuco (UFPE), Av. Prof. Moraes Rego, 1235, Cidade Universitária, Recife, PE, CEP: 50670-901, Brazil.
- Laboratory of Microbiology and Immunology, Academic Center of Vitória (CAV), Federal University of Pernambuco (UFPE), Vitória de Santo Antão, Rua Do Alto Do Reservatório S/N, Bela Vista, Vitória de Santo Antão, Pernambuco, CEP: 55608-680, Brazil.
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Surveillance of Antimicrobial Resistance in Hospital Wastewater: Identification of Carbapenemase-Producing Klebsiella spp. Antibiotics (Basel) 2022; 11:antibiotics11030288. [PMID: 35326752 PMCID: PMC8944648 DOI: 10.3390/antibiotics11030288] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 02/17/2022] [Accepted: 02/19/2022] [Indexed: 02/01/2023] Open
Abstract
The objective of this study was to investigate the presence and persistence of carbapenemase-producing Klebsiella spp. isolated from wastewater and treated wastewater from two tertiary hospitals in Mexico. We conducted a descriptive cross-sectional study in two hospital wastewater treatment plants, which were sampled in February 2020. We obtained 30 Klebsiella spp. isolates. Bacterial identification was carried out by the Matrix-Assisted Laser Desorption/Ionization-Time of Flight mass spectrometry (MALDI-TOF MS®) and antimicrobial susceptibility profiles were performed using the VITEK2® automated system. The presence of carbapenem resistance genes (CRGs) in Klebsiella spp. isolates was confirmed by PCR. Molecular typing was determined by pulsed-field gel electrophoresis (PFGE). High rates of Klebsiella spp. resistance to cephalosporins and carbapenems (80%) were observed in isolates from treated wastewater from both hospitals. The molecular screening by PCR showed the presence of blaKPC and blaOXA-48-like genes. The PFGE pattern separated the Klebsiella isolates into 19 patterns (A–R) with three subtypes (C1, D1, and I1). Microbiological surveillance and identification of resistance genes of clinically important pathogens in hospital wastewater can be a general screening method for early determination of under-detected antimicrobial resistance profiles in hospitals and early warning of outbreaks and difficult-to-treat infections.
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Jing N, Yan W, Zhang Q, Yuan Y, Wei X, Zhao W, Guo S, Guo L, Gao Y, Zhao L, Shi C, Li Y. Epidemiology and genotypic characteristics of carbapenem resistant Enterobacterales in Henan, China: A multicentre study. J Glob Antimicrob Resist 2022; 29:68-73. [DOI: 10.1016/j.jgar.2022.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 11/28/2022] Open
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Saavedra SY, Bernal JF, Montilla-Escudero E, Arévalo SA, Prada DA, Valencia MF, Moreno J, Hidalgo AM, García-Vega ÁS, Abrudan M, Argimón S, Kekre M, Underwood A, Aanensen DM, Duarte C, Donado-Godoy P. Complexity of Genomic Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Isolates in Colombia Urges the Reinforcement of Whole Genome Sequencing-Based Surveillance Programs. Clin Infect Dis 2021; 73:S290-S299. [PMID: 34850835 PMCID: PMC8634422 DOI: 10.1093/cid/ciab777] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Klebsiella pneumoniae (CRKP) is an emerging public health problem. This study explores the specifics of CRKP epidemiology in Colombia based on whole genome sequencing (WGS) of the National Reference Laboratory at Instituto Nacional de Salud (INS)'s 2013-2017 sample collection. METHODS A total of 425 CRKP isolates from 21 departments were analyzed by HiSeq-X10®Illumina high-throughput sequencing. Bioinformatic analysis was performed, primarily using the pipelines developed collaboratively by the National Institute for Health Research Global Health Research Unit (GHRU) on Genomic Surveillance of Antimicrobial Resistance (AMR), and AGROSAVIA. RESULTS Of the 425 CRKP isolates, 91.5% were carbapenemase-producing strains. The data support a recent expansion and the endemicity of CRKP in Colombia with the circulation of 7 high-risk clones, the most frequent being CG258 (48.39% of isolates). We identified genes encoding carbapenemases blaKPC-3, blaKPC-2, blaNDM-1, blaNDM-9, blaVIM-2, blaVIM-4, and blaVIM-24, and various mobile genetic elements (MGE). The virulence of CRKP isolates was low, but colibactin (clb3) was present in 25.2% of isolates, and a hypervirulent CRKP clone (CG380) was reported for the first time in Colombia. ST258, ST512, and ST4851 were characterized by low levels of diversity in the core genome (ANI > 99.9%). CONCLUSIONS The study outlines complex CRKP epidemiology in Colombia. CG258 expanded clonally and carries specific carbapenemases in specific MGEs, while the other high-risk clones (CG147, CG307, and CG152) present a more diverse complement of carbapenemases. The specifics of the Colombian situation stress the importance of WGS-based surveillance to monitor evolutionary trends of sequence types (STs), MGE, and resistance and virulence genes.
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Affiliation(s)
| | - Johan Fabian Bernal
- Colombian Integrated Program for Antimicrobial Resistance Surveillance (COIPARS), CI Tibaitatá, Corporación Colombiana de Investigación Agropecuaria (AGROSAVIA), Tibaitatá - Mosquera, Cundinamarca, Colombia
| | | | - Stefany Alejandra Arévalo
- Colombian Integrated Program for Antimicrobial Resistance Surveillance (COIPARS), CI Tibaitatá, Corporación Colombiana de Investigación Agropecuaria (AGROSAVIA), Tibaitatá - Mosquera, Cundinamarca, Colombia
| | - Diego Andrés Prada
- Grupo de Microbiología, Dirección de Investigación en Salud Pública, Instituto Nacional de Salud, Bogotá, Colombia
| | - María Fernanda Valencia
- Colombian Integrated Program for Antimicrobial Resistance Surveillance (COIPARS), CI Tibaitatá, Corporación Colombiana de Investigación Agropecuaria (AGROSAVIA), Tibaitatá - Mosquera, Cundinamarca, Colombia
| | - Jaime Moreno
- Grupo de Microbiología, Instituto Nacional de Salud (INS), Bogotá, Colombia
| | | | - Ángela Sofía García-Vega
- Colombian Integrated Program for Antimicrobial Resistance Surveillance (COIPARS), CI Tibaitatá, Corporación Colombiana de Investigación Agropecuaria (AGROSAVIA), Tibaitatá - Mosquera, Cundinamarca, Colombia
| | - Monica Abrudan
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, UK.,Wellcome Genome Campus, Hinxton, UK
| | - Silvia Argimón
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, UK.,Wellcome Genome Campus, Hinxton, UK
| | - Mihir Kekre
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, UK.,Wellcome Genome Campus, Hinxton, UK
| | - Anthony Underwood
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, UK.,Wellcome Genome Campus, Hinxton, UK
| | - David M Aanensen
- Centre for Genomic Pathogen Surveillance, Big Data Institute, University of Oxford, Oxford, UK.,Wellcome Genome Campus, Hinxton, UK
| | - Carolina Duarte
- Grupo de Microbiología, Instituto Nacional de Salud (INS), Bogotá, Colombia
| | - Pilar Donado-Godoy
- Colombian Integrated Program for Antimicrobial Resistance Surveillance (COIPARS), CI Tibaitatá, Corporación Colombiana de Investigación Agropecuaria (AGROSAVIA), Tibaitatá - Mosquera, Cundinamarca, Colombia
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11
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Within patient genetic diversity of bla KPC harboring Klebsiella pneumoniae in a Colombian hospital and identification of a new NTE KPC platform. Sci Rep 2021; 11:21409. [PMID: 34725422 PMCID: PMC8560879 DOI: 10.1038/s41598-021-00887-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 10/19/2021] [Indexed: 11/30/2022] Open
Abstract
Resistance to carbapenems in Klebsiellapneumoniae has been mostly related with the worldwide dissemination of KPC, largely due to the pandemic clones belonging to the complex clonal (CC) 258. To unravel blaKPC post-endemic clinical impact, here we describe clinical characteristics of 68 patients from a high complexity hospital, and the molecular and genetic characteristics of their 139 blaKPC—K.pneumoniae (KPC-Kp) isolates. Of the 26 patients that presented relapses or reinfections, 16 had changes in the resistance profiles of the isolates recovered from the recurrent episodes. In respect to the genetic diversity of KPC-Kp isolates, PFGE revealed 45 different clonal complexes (CC). MLST for 12 representative clones showed ST258 was present in the most frequent CC (23.0%), however, remaining 11 representative clones belonged to non-CC258 STs (77.0%). Interestingly, 16 patients presented within-patient genetic diversity of KPC-Kp clones. In one of these, three unrelated KPC-Kp clones (ST258, ST504, and ST846) and a blaKPC—K.variicola isolate (ST182) were identified. For this patient, complete genome sequence of one representative isolate of each clone was determined. In K.pneumoniae isolates blaKPC was mobilized by two Tn3-like unrelated platforms: Tn4401b (ST258) and Tn6454 (ST504 and ST846), a new NTEKPC-IIe transposon for first time characterized also determined in the K.variicola isolate of this study. Genome analysis showed these transposons were harbored in different unrelated but previously reported plasmids and in the chromosome of a K.pneumoniae (for Tn4401b). In conclusion, in the blaKPC post-endemic dissemination in Colombia, different KPC-Kp clones (mostly non-CC258) have emerged due to integration of the single blaKPC gene in new genetic platforms. This work also shows the intra-patient resistant and genetic diversity of KPC-Kp isolates. This circulation dynamic could impact the effectiveness of long-term treatments.
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12
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Rodríguez EA, Pino NJ, Jiménez JN. Climatological and Epidemiological Conditions Are Important Factors Related to the Abundance of bla KPC and Other Antibiotic Resistance Genes (ARGs) in Wastewater Treatment Plants and Their Effluents, in an Endemic Country. Front Cell Infect Microbiol 2021; 11:686472. [PMID: 34485173 PMCID: PMC8414572 DOI: 10.3389/fcimb.2021.686472] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 07/21/2021] [Indexed: 11/24/2022] Open
Abstract
Several physicochemical and season factors have been related to the abundance of antibiotic resistance genes (ARGs) in wastewater treatment plants (WWTPs), considered hotspots of bacterial resistance. However, few studies on the subject have been carried out in tropical countries endemic for resistance mechanisms such as blaKPC. In this study, the occurrence of ARGs, particularly blaKPC, was determined throughout a WWTP, and the factors related to their abundance were explored. In 2017, wastewater samples were taken from a WWTP in Colombia every 15 days for 6 months, and a total of 44 samples were analyzed by quantitative real-time PCR. sul1, sul2, blaKPC, and ermB were found to be the most prevalent ARGs. A low average reduction of the absolute abundance ARGs in effluent with respect to influent was observed, as well as a greater absolute abundance of ARGs in the WWTP effluent in the rainy season. Factors such as temperature, pH, oxygen, total organic carbon (TOC), chemical oxygen demand (COD), and precipitation were significantly correlated with the absolute abundance of several of the ARGs evaluated. A generalized linear mixed-effects model analysis showed that dissolved oxygen and precipitation in the sampling day were important factors related to the absolute concentration of blaKPC over time. In conclusion, the abundance of ARGs in the WWTP could be influenced by endemic conditions and physicochemical and climatological parameters. Therefore, it is necessary to continuously monitor clinical relevant genes in WWTPs from different global regions, even more so in low-income countries where sewage treatment is limited.
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Affiliation(s)
- Erika A Rodríguez
- Línea de Epidemiología Molecular Bacteriana, Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - Nancy J Pino
- Grupo Diagnóstico y Control de la Contaminación (GDCON), Sede de Investigación Universitaria, Universidad de Antioquia, Medellín, Colombia
| | - J Natalia Jiménez
- Línea de Epidemiología Molecular Bacteriana, Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
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13
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Tompkins K, van Duin D. Treatment for carbapenem-resistant Enterobacterales infections: recent advances and future directions. Eur J Clin Microbiol Infect Dis 2021; 40:2053-2068. [PMID: 34169446 DOI: 10.1007/s10096-021-04296-1] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/15/2021] [Indexed: 12/16/2022]
Abstract
Carbapenem-resistant Enterobacterales (CRE) are a growing threat to human health worldwide. CRE often carry multiple resistance genes that limit treatment options and require longer durations of therapy, are more costly to treat, and necessitate therapies with increased toxicities when compared with carbapenem-susceptible strains. Here, we provide an overview of the mechanisms of resistance in CRE, the epidemiology of CRE infections worldwide, and available treatment options for CRE. We review recentlyapproved agents for the treatment of CRE, including ceftazidime-avibactam, meropenem-vaborbactam, imipenem-relebactam, cefiderocol, and novel aminoglycosides and tetracyclines. We also discuss recent advances in phage therapy and antibiotics that are currently in development targeted to CRE. The potential for the development of resistance to these therapies remains high, and enhanced antimicrobial stewardship is imperative both to reduce the spread of CRE worldwide and to ensure continued access to efficacious treatment options.
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Affiliation(s)
- Kathleen Tompkins
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA.
| | - David van Duin
- Division of Global Health and Infectious Diseases, University of North Carolina, Chapel Hill, NC, USA
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14
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Nakamura-Silva R, Oliveira-Silva M, Furlan JPR, Stehling EG, Miranda CES, Pitondo-Silva A. Characterization of multidrug-resistant and virulent Klebsiella pneumoniae strains belonging to the high-risk clonal group 258 (CG258) isolated from inpatients in northeastern Brazil. Arch Microbiol 2021; 203:4351-4359. [PMID: 34110479 DOI: 10.1007/s00203-021-02425-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/31/2021] [Accepted: 06/02/2021] [Indexed: 12/24/2022]
Abstract
Multidrug-resistant (MDR) and hypervirulent Klebsiella pneumoniae (hvKp) clones have become a major threat to global public health. The clonal group 258 (CG258) is considered a high-risk CG and the K. pneumoniae strains belonging to it are often multi-resistant and to spread mainly in the hospital environment. This study aimed to characterize the antimicrobial resistance profile, virulence factors, and the clonal relationships among 13 K. pneumoniae strains belonging to CG258 from patients admitted to a tertiary hospital in Teresina, in the state of Piauí, northeastern Brazil. Ten strains were classified as MDR and three as extensively drug-resistant (XDR). Three different β-lactamase-encoding genes (blaKPC, blaOXA-1-like, and blaCTX-M-Gp1) and six virulence genes (fimH, ycfM, mrkD, entB, ybtS, and kfu) were detected. Moreover, two hypermucoviscous K. pneumoniae strains and one capsular K-type 2 were found. Multilocus sequence typing analysis revealed ten different sequence types (STs) (ST14, ST17, ST20, ST29, ST45, ST101, ST268, ST1800, ST3995, and ST3996) belonging to CG258, being two (ST3995 and ST3996) described for the first time in this study.
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Affiliation(s)
- Rafael Nakamura-Silva
- Postgraduate Program in Environmental Technology, Universidade de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - Mariana Oliveira-Silva
- Postgraduate Program in Environmental Technology, Universidade de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil
| | - João Pedro Rueda Furlan
- School of Pharmaceutical Sciences of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Eliana Guedes Stehling
- School of Pharmaceutical Sciences of Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - Carlos Eduardo Saraiva Miranda
- Postgraduate Program in Dentistry, Universidade de Ribeirão Preto, UNAERP. Bloco J, Laboratório 1. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, São Paulo, CEP: 14096-900, Brazil
| | - André Pitondo-Silva
- Postgraduate Program in Environmental Technology, Universidade de Ribeirão Preto, Ribeirão Preto, São Paulo, Brazil. .,Postgraduate Program in Dentistry, Universidade de Ribeirão Preto, UNAERP. Bloco J, Laboratório 1. Av. Costábile Romano, 2201 - Ribeirânia, Ribeirão Preto, São Paulo, CEP: 14096-900, Brazil.
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15
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Cortés JA, Leal AL, Muñetón López G, Bravo-Ojeda JS, Nócua-Báez LC, Avila V, Silva E, Álvarez-Moreno CA, Espitia P, Gualtero SM, Valderrama SL, Guevara FO, Esparza G, Saavedra CH, Díaz JA, Valderrama-Ríos MC. Guía de práctica clínica para la tamización de pacientes con riesgo de colonización por Enterobacterales productores de carbapenemasas y el manejo de infecciones causadas por estas bacterias. REVISTA DE LA FACULTAD DE MEDICINA 2021. [DOI: 10.15446/revfacmed.v69n3.90140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Las infecciones por Enterobacterales productores de carbapenemasas (EPC) han aumentado en los últimos años. Colombia se ha convertido en un país endémico para este grupo de microorganismos y las infecciones que causan tienen un impacto importante en términos de morbilidad y mortalidad. La identificación temprana de los portadores de EPC que ingresan como pacientes a las instituciones de salud es necesaria para implementar medidas de aislamiento y control de infecciones adecuadas que limiten la diseminación de este tipo de microorganismos en los hospitales. Además, el tratamiento de estas infecciones es difícil debido a las limitadas alternativas terapéuticas disponibles y la escasez de estudios que demuestren su efectividad en este escenario.
Por lo anterior, el objetivo del presente trabajo es desarrollar una guía de práctica clínica (GPC) para la tamización de pacientes con riesgo de colonización por EPC y para el manejo de pacientes con infecciones, ya sea sospechadas o confirmadas, causadas por este tipo de bacterias, mediante un proceso de adaptación de GPC basado en la metodología ADAPTE. Con este propósito en mente, se hacen recomendaciones informadas en evidencia para realizar la tamización y oportuna identificación de portadores de EPC admitidos en instituciones hospitalarias, así como para el adecuado manejo farmacológico de las infecciones por EPC en este escenario.
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16
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Dynamics of bla KPC-2 Dissemination from Non-CG258 Klebsiella pneumoniae to Other Enterobacterales via IncN Plasmids in an Area of High Endemicity. Antimicrob Agents Chemother 2020; 64:AAC.01743-20. [PMID: 32958711 DOI: 10.1128/aac.01743-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 02/06/2023] Open
Abstract
Carbapenem-resistant Enterobacterales (CRE) pose a significant threat to global public health. The most important mechanism for carbapenem resistance is the production of carbapenemases. Klebsiella pneumoniae carbapenemase (KPC) represents one of the main carbapenemases worldwide. Complex mechanisms of bla KPC dissemination have been reported in Colombia, a country with a high endemicity of carbapenem resistance. Here, we characterized the dynamics of dissemination of bla KPC gene among CRE infecting and colonizing patients in three hospitals localized in a highly endemic area of Colombia (2013 and 2015). We identified the genomic characteristics of KPC-producing Enterobacterales recovered from patients infected/colonized and reconstructed the dynamics of dissemination of bla KPC-2 using both short and long read sequencing. We found that spread of bla KPC-2 among Enterobacterales in the participating hospitals was due to intra- and interspecies horizontal gene transfer (HGT) mediated by promiscuous plasmids associated with transposable elements that was originated from a multispecies outbreak of KPC-producing Enterobacterales in a neonatal intensive care unit. The plasmids were detected in isolates recovered in other units within the same hospital and nearby hospitals. The gene "epidemic" was driven by IncN-pST15-type plasmids carrying a novel Tn4401b structure and non-Tn4401 elements (NTEKPC) in Klebsiella spp., Escherichia coli, Enterobacter spp., and Citrobacter spp. Of note, mcr-9 was found to coexist with bla KPC-2 in species of the Enterobacter cloacae complex. Our findings suggest that the main mechanism for dissemination of bla KPC-2 is HGT mediated by highly transferable plasmids among species of Enterobacterales in infected/colonized patients, presenting a major challenge for public health interventions in developing countries such as Colombia.
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17
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Salazar-Ospina L, Vanegas JM, Jiménez JN. High intermittent colonization by diverse clones of β-lactam-resistant Gram-negative bacilli suggests an excessive antibiotic use and different sources of transmission in haemodialysis patients. J Hosp Infect 2020; 107:76-86. [PMID: 33171186 DOI: 10.1016/j.jhin.2020.10.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Revised: 10/29/2020] [Accepted: 10/31/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND The spread of β-lactam-resistant Gram-negative bacilli (GNB) is a topic of worldwide concern; however, knowledge about colonization by these bacteria in haemodialysis patients is limited. AIM To analyse the dynamics and factors associated with colonization by β-lactam-resistant GNB in a dialysis centre. METHODS A longitudinal study was conducted. Stool samples were collected for each patient to evaluate extended-spectrum β-lactamase (ESBL)- and carbapenemase-producing Gram-negative bacilli. Colonization screens were performed at three time-points and then classified as absent, intermittent, or persistent. Molecular typing included enterobacterial repetitive intergenic consensus (ERIC)-polymerase chain reaction, pulsed-field gel electrophoresis (PFGE), and multi-locus sequence typing (MLST). Clinical information was obtained from medical records and personal interview. A generalized estimating equations model was performed to determinate factors associated with the colonization. FINDINGS A total of 210 patients were included. ESBL-producing and carbapenem-resistant GNB colonization reached 41.2% and 11.5%, respectively. Most patients were intermittent carriers with frequencies of 73.9% and 92.95% for each bacteria group. The most frequent ESBL was CTX-M-G1, while the most common carbapenemase was KPC. ERIC-PCR and PFGE revealed high genetic diversity among strains and the Escherichia coli clone ST131 was the most important by MLST. Fluoroquinolone use (odds ratio: 3.13; 95% confidence interval: 1.03-9.44; P [cap] = 0.043) and chronic obstructive lung disease (odds ratio: 3.53; 1.42-8.74; P = 0.006) were associated with ESBL-producing GNB colonization. CONCLUSION Our findings indicate a high intermittent colonization by diverse clones of β-lactam-resistant GNB in haemodialysis patients. It suggests excessive antibiotic pressure that favours the acquisition of bacteria with diverse genetic profiles and different transmission sources.
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Affiliation(s)
- L Salazar-Ospina
- Línea de Epidemiología Molecular Bacteriana, Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - J M Vanegas
- Línea de Epidemiología Molecular Bacteriana, Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia
| | - J N Jiménez
- Línea de Epidemiología Molecular Bacteriana, Grupo de Investigación en Microbiología Básica y Aplicada (MICROBA), Escuela de Microbiología, Universidad de Antioquia, Medellín, Colombia.
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18
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Dos Santos WM, Aromataris E, Secoli SR, Matuoka JY. Cost-effectiveness of antimicrobial treatment for inpatients with carbapenem-resistant Klebsiella pneumoniae infection: a systematic review of economic evidence. ACTA ACUST UNITED AC 2020; 17:2417-2451. [PMID: 31821188 DOI: 10.11124/jbisrir-d-18-00019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The objective of this review was to evaluate the cost-effectiveness of antimicrobial therapy for patients with carbapenem-resistant Klebsiella pneumoniae infection. INTRODUCTION Among the main multi-resistant microorganisms, carbapenem-resistant K. pneumoniae is responsible for the mortality of 40% of patients following 30 days of infection. Treatment for carbapenem-resistant K. pneumoniae infection entails the use of high-cost antimicrobials. Inappropriate use of antimicrobials can increase the cost of treatment fourfold. This review aimed to evaluate the cost-effectiveness of antimicrobial therapy treatment for patients with carbapenem-resistant K. pneumoniae infection to better inform decision making in hospital services. INCLUSION CRITERIA The review included studies on participants 18 years or over with carbapenem-resistant K. pneumoniae infection who had undergone antimicrobial therapy in hospital and acute care services. Studies that compared the cost-effectiveness of different antimicrobial therapy for carbapenem-resistant K. pneumoniae infection were included. Outcome measures were cost per unit of effect expressed in clinical outcome units; this included cost per avoided death, cost per prevention of sepsis and cost per duration of stay. Economic studies with a cost-effectiveness design were considered, as well as modeling studies. METHODS A three-step search strategy was utilized to locate studies published in English, Spanish or Portuguese, with no date restrictions. Two independent reviewers screened titles and abstracts and the full texts of potentially relevant studies for eligibility. Methodological quality was assessed by two independent reviewers using the JBI critical appraisal checklist for economic evaluations. Data were extracted from included studies using the standardized JBI data extraction tool. Data were synthesized using narrative, tables and the JBI Dominance Ranking Matrix. RESULTS This review identified eight studies that evaluated the cost-effectiveness of different treatments for carbapenem-resistant K. pneumoniae infection. The results of this study demonstrated that there was no gold standard treatment for carbapenem-resistant K. pneumoniae infection, hence treatment was generally directed by colonization pressure and resistance profiles. Furthermore, due to the moderate quality and limited number of studies, there was high uncertainty of the values of the cost-effectiveness ratio. CONCLUSIONS Ofloxacin appears to be the most cost-effective treatment; however, conclusions are limited due to the small number and low quality of studies.
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Affiliation(s)
- Wendel Mombaque Dos Santos
- School of Nursing, University of São Paulo, São Paulo, Brazil.,The Brazilian Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Edoardo Aromataris
- Joanna Briggs Institute, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, Australia
| | - Silvia Regina Secoli
- School of Nursing, University of São Paulo, São Paulo, Brazil.,The Brazilian Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence
| | - Jessica Yumi Matuoka
- School of Nursing, University of São Paulo, São Paulo, Brazil.,The Brazilian Centre for Evidence-based Healthcare: a Joanna Briggs Institute Centre of Excellence
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19
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Angles-Yanqui E, Huaringa-Marcelo J, Sacsaquispe-Contreras R, Pampa-Espinoza L. [Panorama of carbapenemases in PeruUm panorama das carbapenemases presentes no Peru]. Rev Panam Salud Publica 2020; 44:e61. [PMID: 32973907 PMCID: PMC7498286 DOI: 10.26633/rpsp.2020.61] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 04/07/2020] [Indexed: 02/06/2023] Open
Abstract
Objetivo. Describir los genotipos de las carbapenemasas reportadas de aislamientos microbiológicos de pacientes en Perú. Métodos. Se realizó una búsqueda sistemática de la literatura biomédica publicada desde el 1 enero de 2000 hasta el 15 de setiembre de 2019 en las bases de datos PubMed, SCOPUS, Biblioteca Virtual de Salud, Biblioteca Virtual de CONCYTEC, Google Scholar y otras fuentes de publicaciones de resúmenes o póster en congresos nacionales o internacionales sobre carbapenemasas con confirmación genotípica; la selección y extracción de datos fue por pares. Resultados. Se incluyeron 14 estudios en los que se realizó la caracterización genotípica de 313 carbapenemasas. Ciento tres de estos reportes pertenecían a estudios efectuados en enterobacterias; de estos, 74 fueron en Klebsiella pneumoniae, 11 en Proteus mirabilis, 7 en Enterobacter cloacae y 11 en otras. Sesenta y una de estas 103 corresponden a blaNDM, 39 a blaKPC y 3 a blaIMP. Según su estructura molecular, 64 son metalobetalactamasas y 39 son serinbetalactamasas. En Pseudomonas aeruginosa se incluyeron 84 reportes, 79 corresponden a blaIMP, 4 a blaVIM, y 1 a blaGES. En Acinetobacter baumannii 126 reportes, 55 corresponden a blaOXA-23, 66 a blaOXA24, 3 a blaNDM y 2 a blaOXA-143. Conclusiones. Existe un número escaso de publicaciones respecto a carbapenemasas de pacientes en Perú; los reportes genotípicos provienen en su mayoría de hospitales de la capital del país. Esta es la primera revisión que intenta conocer los tipos de carbapenemasas reportadas en enterobacterias, P. aeruginosa y A. baumannii.
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Affiliation(s)
- Eddie Angles-Yanqui
- Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia Lima Perú Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú
| | - Jorge Huaringa-Marcelo
- Facultad de Ciencias de la Salud, Universidad Científica del Sur Lima Perú Facultad de Ciencias de la Salud, Universidad Científica del Sur, Lima, Perú
| | | | - Luis Pampa-Espinoza
- Instituto Nacional de Salud Lima Perú Instituto Nacional de Salud, Lima, Perú
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20
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Fang L, Xu H, Ren X, Li X, Ma X, Zhou H, Hong G, Liang X. Epidemiology and Risk Factors for Carbapenem-Resistant Klebsiella Pneumoniae and Subsequent MALDI-TOF MS as a Tool to Cluster KPC-2-Producing Klebsiella Pneumoniae, a Retrospective Study. Front Cell Infect Microbiol 2020; 10:462. [PMID: 33042858 PMCID: PMC7521130 DOI: 10.3389/fcimb.2020.00462] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 07/28/2020] [Indexed: 12/21/2022] Open
Abstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) appeared recently and now presents a particularly critical problem to hospitalized patients worldwide. We aim to investigate the epidemiology and the risk factors for CRKP colonization and infections, and to evaluate the application performance of MALDI-TOF MS in clustering CRKP. Results: CRKP colonization and infections incidence was 2.7 (35/1,319,427) per 100,000 patient-days. Inpatients in CRKP group had higher medical expense than CSKP group. Inpatients with underlying conditions, particularly with pulmonary diseases, and with antimicrobial use prior to culture within 30 days, especially with carbapenem use, were risk factors for CRKP acquisition. All CRKP isolates were detected producing KPC-2. The MALDI-TOF MS system and PFGE system provided similar results, with a good concordance between the two methods (adjusted Rand's coefficient, 0.846) and a high probability of MALDI-TOF MS to predict PFGE results (Wallace coefficient, 0.908). Conclusions: Underlying conditions, particularly pulmonary diseases, and antimicrobial use prior to culture within 30 days, especially carbapenem use, are risk factors for CRKP acquisition. BlaKPC−2 is the mainstream gene of CRKP in our geographic area of analysis. As only simple sample preparation is needed and the results can be obtained in a short time, MALDI-TOF MS may be considered a probable alternative to PFGE in clustering KPC-2-producing CRKP.
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Affiliation(s)
- Lili Fang
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China.,School of Public Health, Xiamen University, Xiamen, China
| | - Heping Xu
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China.,School of Public Health, Xiamen University, Xiamen, China
| | - Xiaoying Ren
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China.,School of Public Health, Xiamen University, Xiamen, China
| | - Xun Li
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China.,School of Public Health, Xiamen University, Xiamen, China
| | - Xiaobo Ma
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China.,School of Public Health, Xiamen University, Xiamen, China
| | - Haijian Zhou
- State Key Laboratory for Infectious Disease Prevention and Control, Chinese Center for Disease Control and Prevention, National Institute for Communicable Disease Control and Prevention, Beijing, China.,Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, China
| | - Guolin Hong
- Department of Clinical Laboratory, The First Affiliated Hospital, School of Medicine, Xiamen University, Xiamen, China.,Xiamen Key Laboratory of Genetic Testing, Xiamen, China.,School of Public Health, Xiamen University, Xiamen, China
| | - Xianming Liang
- Center of Clinical Laboratory, School of Medicine, Zhongshan Hospital, Xiamen University, Xiamen, China.,Institute of Infectious Disease, School of Medicine, Xiamen University, Xiamen, China
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Reyes JA, Melano R, Cárdenas PA, Trueba G. Mobile genetic elements associated with carbapenemase genes in South American Enterobacterales. Braz J Infect Dis 2020; 24:231-238. [PMID: 32325019 PMCID: PMC9392046 DOI: 10.1016/j.bjid.2020.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/11/2020] [Accepted: 03/21/2020] [Indexed: 01/04/2023] Open
Abstract
Introduction Carbapenem resistance in members of order Enterobacterales is a growing public health problem causing high mortality in developing and industrialized countries. Its emergence and rapid propagation worldwide was due to both intercontinental spread of pandemic strains and horizontal dissemination via mobile genetic elements (MGE) such as plasmids and transposons. Objective To describe MGE carrying carbapenem resistance genes in Enterobacterales which have been reported in South America. Search strategy and selection criteria A search of the literature in English or Spanish published until 2019 in PubMed, Google Scholar, LILACS and SciELO databases was performed for studies of MGE in Enterobacterales reported in South American countries. Results Seven South American countries reported MGE related to carbapenemases. Carbapenemase-producing Klebsiella pneumoniae belonging to clonal complex 258 were the most prevalent pathogens reported; others carbapenemase-producing Enterobacterales such as Escherichia coli, Serratia marcescens, and Providencia rettgeri also have been reported. The MGE implicated in the spread of the most prevalent carbapenemase genes are Tn4401 and non-Tn4401 elements for blaKPC and ISAba125 for blaNDM, located in different plasmid incompatibility groups, i.e. L/M, A/C, FII and bacterial clones. Conclusion This review indicates that, like in other parts of the world, the most commonly reported carbapenemases in Enterobacterales from South America are being disseminated through clones, plasmids, and transposons which have been previously reported in other parts of the world.
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Esparza G. Bacterias Gram negativas resistentes a carbapenemicos en Colombia: un desafío continuo al sistema de salud. INFECTIO 2020. [DOI: 10.22354/in.v24i2.831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Bacterias Gram negativas resistentes a carbapenemicos en Colombia: un desafío continuo al sistema de salud
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Garcia-Fulgueiras V, Zapata Y, Papa-Ezdra R, Ávila P, Caiata L, Seija V, Rojas Rodriguez AE, Magallanes C, Márquez Villalba C, Vignoli R. First characterization of K. pneumoniae ST11 clinical isolates harboring bla KPC-3 in Latin America. Rev Argent Microbiol 2019; 52:211-216. [PMID: 31874719 DOI: 10.1016/j.ram.2019.10.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 09/02/2019] [Accepted: 10/25/2019] [Indexed: 12/01/2022] Open
Abstract
Antimicrobial resistance due to carbapenemase production in Enterobacteriaceae clinical isolates is a global threat. Klebsiellapneumoniae harboring the blaKPC gene is one of the major concerns in hospital settings in Latin America. The aim of this study was to characterize the antibiotic resistance mechanisms and to typify four carbapenem-resistant K. pneumoniae clinical isolates from the city of Manizales, Colombia. We identified blaKPC-3 in all four isolates by polymerase chain reaction and subsequent sequencing. The plasmid-mediated quinolone resistance genes qnrB19-like and aac(6')Ib-cr; fosfomycin resistance gene fosA and an insertion sequence IS5-like in mgrB (colistin resistance) were also detected. Sequence types ST11 with capsular type wzi75, and ST258 with wzi154, were characterized. The blaKPC-3 gene was mobilized in a 100-kb IncFIB conjugative plasmid with vagCD toxin-antitoxin system. This work reports multiple resistance genes in blaKPC-producing K. pneumoniae and the first occurrence of ST11 clinical isolates harboring blaKPC-3 in Latin America.
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Affiliation(s)
- Virginia Garcia-Fulgueiras
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Yuliana Zapata
- Grupo de Investigación en Enfermedades Infecciosas, Universidad Católica de Manizales, Caldas, Colombia
| | - Romina Papa-Ezdra
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Pablo Ávila
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Leticia Caiata
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Verónica Seija
- Departamento de Laboratorio Clínico, Área Microbiología, Hospital de Clínicas, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay
| | - Ana E Rojas Rodriguez
- Grupo de Investigación en Enfermedades Infecciosas, Universidad Católica de Manizales, Caldas, Colombia
| | - Carmen Magallanes
- Cátedra de Microbiología, Instituto de Química Biológica, Facultad de Ciencias y de Química, Universidad de la República, Montevideo, Uruguay
| | - Carolina Márquez Villalba
- Cátedra de Microbiología, Instituto de Química Biológica, Facultad de Ciencias y de Química, Universidad de la República, Montevideo, Uruguay
| | - Rafael Vignoli
- Departamento de Bacteriología y Virología, Instituto de Higiene, Facultad de Medicina, Universidad de la República, Montevideo, Uruguay.
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Novel patterns in the molecular epidemiology of KPC-producing Klebsiella pneumoniae in Tucumán, Argentina. J Glob Antimicrob Resist 2019; 19:183-187. [DOI: 10.1016/j.jgar.2019.02.015] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 02/05/2019] [Accepted: 02/17/2019] [Indexed: 11/30/2022] Open
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Valenzuela-Valderrama M, González IA, Palavecino CE. Photodynamic treatment for multidrug-resistant Gram-negative bacteria: Perspectives for the treatment of Klebsiella pneumoniae infections. Photodiagnosis Photodyn Ther 2019; 28:256-264. [PMID: 31505296 DOI: 10.1016/j.pdpdt.2019.08.012] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Accepted: 08/09/2019] [Indexed: 12/25/2022]
Abstract
The emergence of multi-drug resistance for pathogenic bacteria is one of the most pressing global threats to human health in the 21st century. Hence, the availability of new treatment becomes indispensable to prevent morbidity and mortality caused by infectious agents. This article reviews the antimicrobial properties of photodynamic therapy (PDT), which is based on the use of photosensitizers compounds (PSs). The PSs are non-toxic small molecules, which induce oxidative stress only under excitation with light. Then, the PDT has the advantage to be locally activated using phototherapy devices. We focus on PDT for the Klebsiella pneumoniae, as an example of Gram-negative bacteria, due to its relevance as an agent of health-associated infections (HAI) and a multi-drug resistant bacteria. K. pneumoniae is a fermentative bacillus, member of the Enterobacteriaceae family, which is most commonly associated with producing infection of the urinary tract (UTI) and pneumonia. K. pneumoniae infections may occur in deep organs such as bladder or lungs tissues; therefore, activating light must get access or penetrate tissues with sufficient power to produce effective PDT. Consequently, the rationale for selecting the most appropriate PSs, as well as photodynamic devices and photon fluence doses, were reviewed. Also, the mechanisms by which PDT activates the immune system and its importance to eradicate the infection successfully, are discussed.
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Affiliation(s)
- Manuel Valenzuela-Valderrama
- Laboratorio de Microbiología Celular, Instituto de Investigación e Innovación en Salud, Facultad de Ciencias de la Salud, Universidad Central de Chile, Chile; Centro de Estudios Avanzados en Enfermedades Crónicas (ACCDiS), Independencia, Santiago 8380000, Chile.
| | - Iván Alonzo González
- Instituto de Investigación e Innovación en Salud, Facultad de Ciencias de la Salud, Universidad Central de Chile, Chile.
| | - Christian Erick Palavecino
- Laboratorio de Microbiología Celular, Instituto de Investigación e Innovación en Salud, Facultad de Ciencias de la Salud, Universidad Central de Chile, Chile.
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Diversity profiling of xenic cultures of Dientamoeba fragilis following systematic antibiotic treatment and prospects for genome sequencing. Parasitology 2019; 147:29-38. [PMID: 31452478 DOI: 10.1017/s0031182019001173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The presence of bacterial DNA in Dientamoeba fragilis DNA extracts from culture poses a substantial challenge to sequencing the D. fragilis genome. However, elimination of bacteria from D. fragilis cultures has proven difficult in the past, presumably due to its dependence on some unknown prokaryote/s. This study explored options for removal of bacteria from D. fragilis cultures and for the generation of genome sequence data from D. fragilis. DNA was extracted from human faecal samples and xenic D. fragilis cultures. Extracts were subjected to 16S ribosomal DNA bacterial diversity profiling. Xenic D. fragilis cultures were then subject to antibiotic treatment regimens that systematically removed bacterial species depending on their membrane structure (Gram-positive or Gram-negative) and aerobic requirements. The impact of these treatments on cultures was assessed by 16S amplicon sequencing. Prior to antibiotic treatment, the cultures were dominated by Gram-negative bacteria. Addition of meropenem to cultures eliminated anaerobic Gram-negative bacteria, but it also led to protozoan death after 5 days incubation. The seeding of meropenem resistant Klebsiella pneumoniae strain KPC-2 into cultures before treatment by meropenem prevented death of D. fragilis cells beyond this 5 day period, suggesting that one or more species of Gram-negative bacteria may be an essential nutritional requirement for D. fragilis. Gram-positive cells were completely eliminated using vancomycin without affecting trophozoite growth. Finally, this study shows that genome sequencing of D. fragilis is feasible following bacterial elimination from cultures as the result of the major advances occurring in bioinformatics. We provide evidence on this fact by successfully sequencing the D. fragilis 28S large ribosomal DNA subunit gene using culture-derived DNA.
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Virulence factors and clinical patterns of multiple-clone hypermucoviscous KPC-2 producing K. pneumoniae. Heliyon 2019; 5:e01829. [PMID: 31286076 PMCID: PMC6587045 DOI: 10.1016/j.heliyon.2019.e01829] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 02/18/2019] [Accepted: 05/23/2019] [Indexed: 12/21/2022] Open
Abstract
Carbapenemase-producing Klebsiella pneumoniae (CRKP) are increasingly reported worldwide being necessary the local epidemiological monitoring. Our aim was to characterize the hypermucoviscous CRKP isolates collected in our hospital during a 6 months period. Carriage of the carbapenemase genes (blaKPC, blaNDM, blaVIM and blaOXA-48), extended spectrum β-lactamases (blaSHV-2, blaCTX-M) and the virulence genes (magA, k2A, rmpA, wabG, uge, allS, entB, ycfM, kpn, wcaG, fimH, mrkD, iutA, iroN, hly and cnf-1) were determined by multiplex-PCR. Genetic relationship among the isolates was performed by PFGE and MLST. A total of 35 isolates were recovered, being the urinary and respiratory tract the most common infection sites (34.2%). The blaKPC-2 gene was present in all the isolates, coexisting with blaCTX-M-2 (45.7%), blaSHV-2 (28.6%), and blaCTX-M-2/blaSHV-2 (14.3%). The capsular serotype K2 corresponded with 68.6% of the isolates. Virulence factors frequency were variable [adhesins (97.1%), siderophores (94.3%) and phagocytosis resistance (wabG 48.5%, uge 80% and ycfM 57.1%)]. A total of 10 STs were identified although 40% of them clustered on ST25-CC65, and 17% to ST17. The incidence of KPC-2-producing K. pneumoniae reported by the hospital was 0.290 per 1000 admissions. In summary we described an epidemic scenario of multidrug resistant hypermucoviscous KPC-2 producing ST25 K. pneumoniae in our institution.
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Prado-Vivar MB, Ortiz L, Reyes J, Villacis E, Fornasini M, Baldeon ME, Cardenas PA. Molecular typing of a large nosocomial outbreak of KPC-producing bacteria in the biggest tertiary-care hospital of Quito, Ecuador. J Glob Antimicrob Resist 2019; 19:328-332. [PMID: 31116967 DOI: 10.1016/j.jgar.2019.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 06/14/2013] [Accepted: 06/21/2013] [Indexed: 01/17/2023] Open
Abstract
OBJECTIVES Klebsiella pneumoniae is an opportunistic pathogen associated with nosocomial infections worldwide. Isolates with a K. pneumoniae carbapenemase (KPC)-producing phenotype show reduced susceptibility to first-choice antibiotics. Between 2012-2013, the largest public tertiary-care hospital in Quito (Ecuador) reported an outbreak of KPC-producing bacteria with more than 800 cases. We developed a molecular epidemiological approach to analyse the clonality of K. pneumoniae isolates recovered from selected hospital services and patient samples. METHODS A retrospective cohort study was performed based on microbial isolates and their corresponding records from the hospital and referred to Instituto Nacional de Investigación en Salud Pública (INSPI). From 800 isolates that were collected between 2012-2013, a total of 100 isolates were randomly selected for this study. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Genotypic detection and phylogenetic relationship analysis were performed by multilocus sequence typing (MLST). The blaKPC carbapenemase gene was also amplified by PCR and was sequenced using Sanger sequencing. RESULTS Molecular analysis showed that the outbreak had a polyclonal origin with two predominant genotypes, comprising sequence types ST25 and ST258, present in 38 and 36 cases, respectively. These genotypes were found in all studied hospital services including general surgery, intensive care unit and emergency. TheblaKPC-5 gene was the most prevalent blaKPC variant in this study. CONCLUSION These data indicate that KPC-producing polyclonal K. pneumoniae are frequent causes of nosocomial hospital outbreaks in South America. Similar genotypes have been reported in Colombia, Argentina, Brazil, North America and Asia.
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Affiliation(s)
- M Belen Prado-Vivar
- Instituto de Microbiología, COCIBA, Universidad San Francisco de Quito, Diego de Robles s/n y Vía Interoceánica, Quito, Pichincha, Ecuador; Centro de Investigación Traslacional (CIT), Universidad de las Américas, Quito, Pichincha, Ecuador
| | - Lizeth Ortiz
- Centro de Investigación Traslacional (CIT), Universidad de las Américas, Quito, Pichincha, Ecuador
| | - Jorge Reyes
- Instituto de Microbiología, COCIBA, Universidad San Francisco de Quito, Diego de Robles s/n y Vía Interoceánica, Quito, Pichincha, Ecuador; Instituto Nacional de Investigación en Salud Pública (INSPI), Quito, Pichincha, Ecuador
| | - Eduardo Villacis
- Instituto Nacional de Investigación en Salud Pública (INSPI), Quito, Pichincha, Ecuador
| | - Marco Fornasini
- Centro de Investigación Traslacional (CIT), Universidad de las Américas, Quito, Pichincha, Ecuador; Center for Biomedical Research (CENBIO), Eugenio Espejo College of Health Science, Universidad Tecnológica Equinoccial, Quito, Pichincha, Ecuador
| | - Manuel E Baldeon
- Centro de Investigación Traslacional (CIT), Universidad de las Américas, Quito, Pichincha, Ecuador; Center for Biomedical Research (CENBIO), Eugenio Espejo College of Health Science, Universidad Tecnológica Equinoccial, Quito, Pichincha, Ecuador
| | - Paul A Cardenas
- Instituto de Microbiología, COCIBA, Universidad San Francisco de Quito, Diego de Robles s/n y Vía Interoceánica, Quito, Pichincha, Ecuador; Centro de Investigación Traslacional (CIT), Universidad de las Américas, Quito, Pichincha, Ecuador.
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Santos WMD, Secoli SR. Economic burden of inpatients infected with Klebsiella pneumoniae carbapenemase. EINSTEIN-SAO PAULO 2019; 17:eGS4444. [PMID: 31116310 PMCID: PMC6533035 DOI: 10.31744/einstein_journal/2019gs4444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 11/23/2018] [Indexed: 12/28/2022] Open
Abstract
Objective: To estimate the direct medical costs of drug therapy of Klebsiella pneumoniae carbapenemase (KPC) infection patients in hospital-based context. Methods: A cost-of-illness study conducted with a prospective cohort design with hospitalized adults infected by KPC. Data collection was performed using an instrument composed of sociodemographic data, clinical and prescription medication. Estimates of the direct costs associated to each treatment were derived from the payer's perspective, in the case of federal public hospitals from Brazil, and included only drug costs. These costs were based on the average price available at the Brazilian Price Database Health. No discount rate was used for the cost of drugs. The costs are calculate in American Dollar (US$). Results: A total of 120 inpatients participated of this study. The total drug cost of these inpatients was US$ 367,680.85. The systemic antimicrobial group was responsible for 59.5% of total costs. The direct drug cost per patients infected by KPC was conservatively estimated at nearly US$ 4,100.00, and about of 60% of costs occurred during the period of infection. Conclusion: The findings of our study indicate a thoughtful economic hazard posed by KPC that all healthcare sectors have to face. The increasing worldwide incidence of these bacteria represents a growing burden that most health systems are unable to deal with. There is an imperative need to develop protocols and new antimicrobials to treatment of KPC, aiming to rearrange resources to increase the effectiveness of healthcare services.
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Distribution and molecular characterization of beta-lactamases in Gram-negative bacteria in Colombia, 2001-2016. ACTA ACUST UNITED AC 2019; 39:199-220. [PMID: 31529860 DOI: 10.7705/biomedica.v39i3.4351] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Indexed: 12/18/2022]
Abstract
Beta-lactamases are enzymes with hydrolytic activity over beta-lactam antibiotics and they are the main resistance mechanism in Gram-negative bacteria. Extended-spectrum beta-lactamases (ESBL), AmpC, and carbapenemases have the greatest clinical and epidemiological impact in hospital settings. The increasing frequency and worldwide spread of these enzymes have limited the therapeutic options in hospital-acquired infections and those originating in the community.
In Colombia, surveillance networks and research groups began studying them in the late 90s. Different variants of these enzymes have been molecularly characterized and their high prevalence and dissemination in medium and high complexity hospitals, along with a high clinical impact, have been reported. Furthermore, many studies in Colombia have evidenced high endemicity for some of these beta-lactamases, which requires an urgent implementation of antimicrobial stewardship programs in order to preserve the few therapeutic options and infection control strategies to prevent and limit their dissemination.
In this publication, we carried out a review of the different enzyme variants, geographic distribution, and molecular characterization of these beta-lactamases in Colombia. Additionally, we describe the available information in the literature regarding studies conducted between the late 1990s and 2016, which provide an overview of the beta-lactamases circulating in different regions of Colombia, their increase over time, and their clinical implications.
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Vanegas Múnera JM, Jiménez Quiceno JN. Colonization and risk of infection by multidrug-resistant bacteria in hemodialysis patients: a topic of concern. INFECTIO 2019. [DOI: 10.22354/in.v23i2.778] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Antimicrobial resistance worsens the prognosis in patients with chronic diseases. Patients on hemodialysis have infection rates that exceed those reported in other types of patients. Colonization has been suggested as a risk factor for the development of infections. However, the majority of the studies that have evaluated this association have methodological limitations that have called into question the validity of the results; such as the lack of use of molecular methods to confirm that the colonizing species are the same as that which causes infection, the measurement of exposure only at the beginning of the study, the absence of follow-up, the evaluation of bacteremia as the only important outcome and the focus only on Staphylococcus aureus, without including other resistant bacteria of clinical importance such as multidrug-resistant Gram-negative bacteria. This lead to the need to use molecular epidemiology methods for refine the association between colonization and infection in endemic countries like Colombia, where the high rates of antimicrobial resistance demand accurate prevention strategies in susceptible patients.
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Plazak ME, Tamma PD, Heil EL. The antibiotic arms race: current and emerging therapy for Klebsiella pneumoniae carbapenemase (KPC) - producing bacteria. Expert Opin Pharmacother 2018; 19:2019-2031. [PMID: 30346216 DOI: 10.1080/14656566.2018.1538354] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Introduction: The rapid spread of Klebsiella pneumoniae Carbapenemase (KPC)-producing bacteria comprises one of the greatest challenges to global health. Historically, clinicians were limited to therapies with suboptimal efficacy and intolerable toxicity until the FDA approved ceftazidime-avibactam and meropenem-vaborbactam, adding two essential pharmacotherapies to our antibiotic armamentarium. These agents display superior efficacy and safety compared to historical treatment options; however, resistance has already been reported. Several antimicrobials currently in the drug pipeline exhibit early promise and may fill needed gaps in therapy. Areas covered: This article encompasses both the past and present treatment options for the management of KPC-producing bacterial infections via an extensive review and critical appraisal of the current literature. Expert opinion: Traditional treatment options can no longer be recommended as first-line options for the management of KPC-producing bloodstream infections. Ceftazidime-avibactam or meropenem-vaborbactam plus or minus an aminoglycoside or polymyxin should be utilized as backbone therapies given their superior efficacy and safety profiles when compared to traditional treatment options. For susceptible KPC-producing urinary tract infections, it is reasonable to consider treatment with an aminoglycoside or with fosfomycin as a monotherapy. All of these decisions should be based on patient-specific characteristics, severity of infection and source control, susceptibility patterns, and input from infectious diseases experts.
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Affiliation(s)
- Michael E Plazak
- a Department of Pharmacy , University of Maryland Medical Center , Baltimore , MD , USA
| | - Pranita D Tamma
- b Department of Pediatrics , Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Emily L Heil
- c Department of Pharmacy Practice and Science , University of Maryland School of Pharmacy , Baltimore , MD , USA
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Mashni O, Nazer L, Le J. Critical Review of Double-Carbapenem Therapy for the Treatment of Carbapenemase-Producing Klebsiella pneumoniae. Ann Pharmacother 2018; 53:70-81. [PMID: 30019911 DOI: 10.1177/1060028018790573] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVE To review the clinical data on the effectiveness and safety of double carbapenem therapy (DCT) in patients infected with carbapenemase-producing Klebsiella pneumoniae (CP-Kp). DATA SOURCES A literature search was performed utilizing PubMed and EMBASE (from 1966 to May 2018); bibliographies of the retrieved articles were also searched. STUDY SELECTION AND DATA EXTRACTION Articles were included if they evaluated patients with infections caused by CP-Kp and were treated with DCT. Meeting abstracts, editorials, and animal and in vitro studies were excluded. DATA SYNTHESIS The search strategy revealed 8 case reports and 6 clinical studies (total of 171 patients) that evaluated the administration of ertapenem followed by prolonged infusions of meropenem or doripenem. Most patients were critically ill and commonly had infections in the blood, lungs, and urine. Clinical and microbiological success were reported in 70% of the patients and mortality in 24%. Adverse events, which included mostly seizures, sodium disorders, and gastrointestinal symptoms, were reported in 16 patients; none required interruption of treatment. Relevance to Patient Care and Clinical Practice: This review evaluated the clinical experience of DCT in the treatment of CP-Kp infections, based on case reports and clinical studies, for the potential role of DCT as a therapeutic option. CONCLUSION Despite the limited studies, current data suggest that DCT may be an effective and safe strategy to treat CP-Kp. However, large randomized controlled trials are necessary to clearly define the role of DCT.
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Affiliation(s)
- Ola Mashni
- 1 King Hussein Cancer Center, Amman, Jordan
| | - Lama Nazer
- 1 King Hussein Cancer Center, Amman, Jordan
| | - Jennifer Le
- 2 University of California San Diego, CA, USA
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dos Santos WM, Matuoka JY, Secoli SR. Cost-effectiveness of the antimicrobial treatment for inpatients infected with Klebsiella pneumoniae carbapenemase. ACTA ACUST UNITED AC 2018; 16:336-344. [DOI: 10.11124/jbisrir-2016-003332] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Rojas LJ, Weinstock GM, De La Cadena E, Diaz L, Rios R, Hanson BM, Brown JS, Vats P, Phillips DS, Nguyen H, Hujer KM, Correa A, Adams MD, Perez F, Sodergren E, Narechania A, Planet PJ, Villegas MV, Bonomo RA, Arias CA. An Analysis of the Epidemic of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae: Convergence of Two Evolutionary Mechanisms Creates the "Perfect Storm". J Infect Dis 2017; 217:82-92. [PMID: 29029188 PMCID: PMC5853647 DOI: 10.1093/infdis/jix524] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/22/2017] [Indexed: 01/11/2023] Open
Abstract
Background Carbapenem resistance is a critical healthcare challenge worldwide. Particularly concerning is the widespread dissemination of Klebsiella pneumoniae carbapenemase (KPC). Klebsiella pneumoniae harboring blaKPC (KPC-Kpn) is endemic in many areas including the United States, where the epidemic was primarily mediated by the clonal dissemination of Kpn ST258. We postulated that the spread of blaKPC in other regions occurs by different and more complex mechanisms. To test this, we investigated the evolution and dynamics of spread of KPC-Kpn in Colombia, where KPC became rapidly endemic after emerging in 2005. Methods We sequenced the genomes of 133 clinical isolates recovered from 24 tertiary care hospitals located in 10 cities throughout Colombia, between 2002 (before the emergence of KPC-Kpn) and 2014. Phylogenetic reconstructions and evolutionary mapping were performed to determine temporal and genetic associations between the isolates. Results Our results indicate that the start of the epidemic was driven by horizontal dissemination of mobile genetic elements carrying blaKPC-2, followed by the introduction and subsequent spread of clonal group 258 (CG258) isolates containing blaKPC-3. Conclusions The combination of 2 evolutionary mechanisms of KPC-Kpn within a challenged health system of a developing country created the "perfect storm" for sustained endemicity of these multidrug-resistant organisms in Colombia.
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Affiliation(s)
- Laura J Rojas
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio
| | | | - Elsa De La Cadena
- Bacterial Resistance and Hospital Epidemiology Unit, International Center for Medical Research and Training (CIDEIM), Cali, Colombia
- Molecular Genetics and Antimicrobial Resistance Unit - International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia
| | - Lorena Diaz
- Molecular Genetics and Antimicrobial Resistance Unit - International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia
- Center for Antimicrobial Resistance and Microbial Genomics, Division of Infectious Diseases, University of Texas McGovern Medical School at Houston Houston, Texas
| | - Rafael Rios
- Molecular Genetics and Antimicrobial Resistance Unit - International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia
| | - Blake M Hanson
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Joseph S Brown
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Purva Vats
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Daniel S Phillips
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Hoan Nguyen
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Kristine M Hujer
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio
| | - Adriana Correa
- Bacterial Resistance and Hospital Epidemiology Unit, International Center for Medical Research and Training (CIDEIM), Cali, Colombia
| | - Mark D Adams
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Federico Perez
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Research Service, Medical Service, and Geriatric Research
- Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio
| | - Erica Sodergren
- The Jackson Laboratory for Genomic Medicine, Farmington, Connecticut
| | - Apurva Narechania
- Center for Infectious Diseases, UTHealth School of Public Health, Houston, Texas
| | - Paul J Planet
- Sackler Institute for Comparative Genomics, American Museum of Natural History, New York, New York
- Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Pediatric Infectious Disease Division, Children’s Hospital of Philadelphia, Pennsylvania
| | - Maria V Villegas
- Bacterial Resistance and Hospital Epidemiology Unit, International Center for Medical Research and Training (CIDEIM), Cali, Colombia
- Molecular Genetics and Antimicrobial Resistance Unit - International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Biochemistry, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Proteomics and Bioinformatics, Case Western Reserve University School of Medicine, Cleveland, Ohio
- Research Service, Medical Service, and Geriatric Research
- Education and Clinical Center, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Ohio
- Case Western Reserve University -Cleveland VAMC Center for Antimicrobial Resistance and Epidemiology, Ohio
| | - Cesar A Arias
- Molecular Genetics and Antimicrobial Resistance Unit - International Center for Microbial Genomics Universidad El Bosque, Bogotá, Colombia
- Center for Antimicrobial Resistance and Microbial Genomics, Division of Infectious Diseases, University of Texas McGovern Medical School at Houston Houston, Texas
- Department of Microbiology and Molecular Genetics, University of Texas Medical School at Houston Houston, Texas
- Center for Infectious Diseases, UTHealth School of Public Health, Houston, Texas
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Codjoe FS, Donkor ES. Carbapenem Resistance: A Review. Med Sci (Basel) 2017; 6:medsci6010001. [PMID: 29267233 PMCID: PMC5872158 DOI: 10.3390/medsci6010001] [Citation(s) in RCA: 262] [Impact Index Per Article: 37.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 11/25/2017] [Accepted: 12/05/2017] [Indexed: 12/16/2022] Open
Abstract
Carbapenem resistance is a major and an on-going public health problem globally. It occurs mainly among Gram-negative pathogens such as Klebsiella pneumoniae, Pseudomonas aeruginosa and Acinetobacter baumannii, and may be intrinsic or mediated by transferable carbapenemase-encoding genes. This type of resistance genes are already widespread in certain parts of the world, particularly Europe, Asia and South America, while the situation in other places such as sub-Saharan Africa is not well documented. In this paper, we provide an in-depth review of carbapenem resistance providing up-to-date information on the subject.
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Affiliation(s)
- Francis S Codjoe
- Department of Medical Laboratory Sciences (Microbiology Division), School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu KB 143 Accra, Ghana.
- Biomolecular Science Research Centre, Sheffield Hallam University, Sheffield S1 1WB, UK.
| | - Eric S Donkor
- Department of Medical Microbiology, School of Biomedical & Allied Health Sciences, College of Health Sciences, University of Ghana, Korle Bu KB 143 Accra, Ghana.
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De Belder D, Lucero C, Rapoport M, Rosato A, Faccone D, Petroni A, Pasteran F, Albornoz E, Corso A, Gomez SA. Genetic Diversity of KPC-Producing Escherichia coli, Klebsiella oxytoca, Serratia marcescens, and Citrobacter freundii Isolates from Argentina. Microb Drug Resist 2017; 24:958-965. [PMID: 29236574 DOI: 10.1089/mdr.2017.0213] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The predominance of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae was caused by the spread of ST258 clone. In Latin America, KPC was reported in 2006, with the isolation of genetically unrelated K. pneumoniae in Colombia. Since then, the expansion of blaKPC in either K. pneumoniae ST258 or other Enterobacteriaceae (ETB) species was increasingly reported. In this study, we characterized 89 KPC-producing Escherichia coli, Klebsiella oxytoca, Serratia marcescens, and Citrobacter freundii that were received between 2010 and 2014. The results revealed that all isolates harbored blaKPC-2. Moreover, the dissemination of KPC by non-K. pneumoniae was mainly caused by the dispersion of ETB mostly genetically unrelated. E. coli is a community pathogen that may serve as the vehicle for the spread of KPC into community settings. Recently, KPC was detected in E. coli ST131, an international epidemic and multidrug-resistant clone. We found that 5/29 KPC-producing E. coli belonged to ST131 and four were blaCTXM-15 producers. The detection of blaKPC in ST131 should be closely monitored to prevent further dissemination. The blaKPC is generally located within Tn4401 transposon capable of mobilization through transposition found in plasmids in ST258. Less is known about the diversity of blaKPC genetic elements that disseminate horizontally among other species of ETB. We found that 16/29 E. coli and 2/18 S. marcescens harbored blaKPC-2 in Tn4401a. In 71 isolates, blaKPC-2 was located amidst diverse Tn3-derived genetic elements bearing non-Tn4401 structure. Further studies on the plasmids that encode blaKPC-2 in these clinical isolates may provide additional insight into its transmission mechanisms.
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Affiliation(s)
- Denise De Belder
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina .,2 Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.
| | - Celeste Lucero
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Melina Rapoport
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Adriana Rosato
- 3 Department of Pathology and Genomic Medicine, Center for Molecular and Translational Human Infectious Diseases Research, Houston Methodist Research Institute, Houston, Texas
| | - Diego Faccone
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina .,2 Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.
| | - Alejandro Petroni
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Fernando Pasteran
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Ezequiel Albornoz
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Alejandra Corso
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina
| | - Sonia A Gomez
- 1 Servicio Antimicrobianos, Dpto. Bacteriología, Instituto Nacional de Enfermedades Infecciosas , ANLIS "Dr. Carlos G. Malbrán," Buenos Aires, Argentina .,2 Consejo Nacional de Investigaciones Científicas y Tecnológicas (CONICET), Buenos Aires, Argentina.
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Tuon FF, Rocha JL, Formigoni-Pinto MR. Pharmacological aspects and spectrum of action of ceftazidime-avibactam: a systematic review. Infection 2017; 46:165-181. [PMID: 29110143 DOI: 10.1007/s15010-017-1096-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Accepted: 10/27/2017] [Indexed: 12/11/2022]
Abstract
PURPOSE Ceftazidime-avibactam is an antimicrobial association active against several Enterobacteriaceae species, including those resistant to carbapenem. Considering the importance of this drug in the current panorama of multidrug-resistant bacteria, we performed a systematic review about ceftazidime-avibactam with emphasis on clinical and pharmacological published data. METHODS A systematic search of the medical literature was performed. The databases searched included MEDLINE, EMBASE and Web of Science (until September 2017). The search terms used were 'avibactam', 'NXL104' and 'AVE1330A'. Bibliographies from those studies were also reviewed. Ceftazidime was not included as a search term, once relevant studies about avibactam in association with other drugs could be excluded. Only articles in English were selected. No statistical analysis or quality validation was included in this review. RESULTS A total of 151 manuscripts were included. Ceftazidime-avibactam has limited action against anaerobic bacteria. Avibactam is a potent inhibitor of class A, class C, and some class D enzymes, which includes KPC-2. The best pharmacodynamic profile of ceftazidime-avibactam is ƒT > MIC, validated in an animal model of soft tissue infection. Three clinical trials showed the efficacy of ceftazidime-avibactam in patients with intra-abdominal and urinary infections. Ceftazidime-avibactam has been evaluated versus meropenem/doripenem in hospitalized adults with nosocomial pneumonia, neutropenic patients and pediatric patients. CONCLUSION Ceftazidime-avibactam has a favorable pharmacokinetic profile for severe infections and highly active against carbapenemases of KPC-2 type.
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Affiliation(s)
- Felipe Francisco Tuon
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil. .,Hospital de Clínicas-Serviço de Infectologia, 3º. andar, Rua General Carneiro, 180-Alto da Glória, Curitiba, PR, 80060-900, Brazil.
| | - Jaime L Rocha
- Department of Medicine, School of Health and Biosciences, Pontifícia Universidade Católica do Paraná, Curitiba, PR, Brazil
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Logan LK, Weinstein RA. The Epidemiology of Carbapenem-Resistant Enterobacteriaceae: The Impact and Evolution of a Global Menace. J Infect Dis 2017; 215:S28-S36. [PMID: 28375512 DOI: 10.1093/infdis/jiw282] [Citation(s) in RCA: 915] [Impact Index Per Article: 130.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are a serious public health threat. Infections due to these organisms are associated with significant morbidity and mortality. Mechanisms of drug resistance in gram-negative bacteria (GNB) are numerous; β-lactamase genes carried on mobile genetic elements are a key mechanism for the rapid spread of antibiotic-resistant GNB worldwide. Transmissible carbapenem-resistance in Enterobacteriaceae has been recognized for the last 2 decades, but global dissemination of carbapenemase-producing Enterobacteriaceae (CPE) is a more recent problem that, once initiated, has been occurring at an alarming pace. In this article, we discuss the evolution of CRE, with a focus on the epidemiology of the CPE pandemic; review risk factors for colonization and infection with the most common transmissible CPE worldwide, Klebsiella pneumoniae carbapenemase-producing K. pneumoniae; and present strategies used to halt the striking spread of these deadly pathogens.
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Affiliation(s)
- Latania K Logan
- Section of Pediatric Infectious Diseases, Department of Pediatrics.,Cook County Health and Hospitals System, Chicago, Illinois
| | - Robert A Weinstein
- Division of Infectious Diseases, Department of Internal Medicine, Rush Medical College, Rush University Medical Center, and.,Cook County Health and Hospitals System, Chicago, Illinois
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Khorvash F, Yazdani MR, Soudi AA, Shabani S, Tavahen N. Prevalence of Acquired Carbapenemase Genes in Klebsiella Pneumoniae by Multiplex PCR in Isfahan. Adv Biomed Res 2017; 6:41. [PMID: 28503496 PMCID: PMC5414410 DOI: 10.4103/2277-9175.204594] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background: Multi-drug resistant Klebsiella pneumoniae has been considered as a serious global threat. This study was done to investigate carbapenemase producing genomes among K. pneumoniae isolates in Isfahan, Central Iran. Materials and Methods: In a cross-sectional study from 2011 to 2012, 29 carbapenem resistant (according to disc diffusion method) carbapenemase producing (according to modified Hodge test) K. pneumoniae strains were collected from Intensive Care Unit (ICUs) of Al-Zahra referral Hospital. In the strains with the lack of sensitivity to one or several carbapenems, beta-lactams, or beta-lactamases, there has been performed modified Hodge test to investigate carbapenmase and then only strains producing carbapenmases were selected for molecular methods. Results: In this study, there have been 29 cases of K. pneumoniae isolated from hospitalized patients in the (ICU). Three cases (10.3%) contained blaVIM, 1 case (3.4%) contained blaIMP, and 1 case (3.4%) contained blaOXA. The genes blaNDM and blaKPC were not detected. Then, 16 cases (55.2%) from positive cases of K. pneumoniae were related to the chip, 4 cases (13.8%) to catheter, 6 cases (20.7%) to urine, and 3 cases (10.3%) to wound. Conclusion: It is necessary to monitor the epidemiologic changes of these carbapenemase genes in K. pneumoniae in our Hospital. More attention should be paid to nosocomial infection control measures. Other carbapenemase producing genes should be investigated.
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Affiliation(s)
- Farzin Khorvash
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Mohammed Reza Yazdani
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ali Asghar Soudi
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shiva Shabani
- Department of Infectious Diseases, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Nirvana Tavahen
- Department of Pediatrics, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
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Yang F, Huang L, Li L, Yang Y, Mao D, Luo Y. Discharge of KPC-2 genes from the WWTPs contributed to their enriched abundance in the receiving river. THE SCIENCE OF THE TOTAL ENVIRONMENT 2017; 581-582:136-143. [PMID: 28065546 DOI: 10.1016/j.scitotenv.2016.12.063] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Revised: 12/09/2016] [Accepted: 12/09/2016] [Indexed: 05/07/2023]
Abstract
At present, very little is known about the persistence and spread pathway of KPC-2 genes in the environment. Our previous study reported the prevalence and persistence of KPC-2 genes in wastewater treatment plants (WWTPs). In the present work, we investigated the occurrence and fate of KPC-2 genes in a WWTP discharge-receiving river and studied the effect of WWTP discharges on the prevalence of KPC-2 genes and host bacteria in the receiving river. It is observed that a considerable level of KPC-2 genes occurred in the receiving river, and a significant increase of blaKPC-2 abundance in the downstream following WWTP discharge was observed compared to the upstream. Furthermore, opportunistic pathogens with 100% identical blaKPC-2 sequence, like Escherichia coli and Kluyvera georgiana, were isolated from both WWTP and its receiving water, whereas no blaKPC-2 carrying bacteria was detected in the upstream. These findings indicated that the treated wastewater discharges have a considerable influence on blaKPC-2 levels in the receiving river. Interestingly, there is no correlation between concentrations of antibiotics and blaKPC-2 concentrations, demonstrating that the increase of KPC-2 genes in the receiving river is mainly due to WWTP release. This finding is important because it illustrates a significant pathway for KPC-2 gene proliferation to the environment.
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Affiliation(s)
- Fengxia Yang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, China
| | - Liang Huang
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Linyun Li
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China
| | - Yang Yang
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, China
| | - Daqing Mao
- School of Environmental Science and Engineering, Tianjin University, Tianjin, China.
| | - Yi Luo
- College of Environmental Science and Engineering, Ministry of Education Key Laboratory of Pollution Processes and Environmental Criteria, Nankai University, Tianjin, China.
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Horna G, Velasquez J, Fernández N, Tamariz J, Ruiz J. Characterisation of the first KPC-2-producing Klebsiella pneumoniae ST340 from Peru. J Glob Antimicrob Resist 2017; 9:36-40. [PMID: 28219824 DOI: 10.1016/j.jgar.2016.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 12/13/2016] [Accepted: 12/14/2016] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to characterise a KPC-carrying Klebsiella pneumoniae isolate from a Peruvian hospital setting. METHODS The identity of the isolate was confirmed by amplification and sequencing of the 16S rRNA gene, and the antibiotic resistance profile was determined by disk diffusion and automated methods The sequence type (ST) and phylogenetic group were established by PCR. The presence of different β-lactamase genes was determined, including blaMBL, blaKPC, blaCTX-M, blaSHV, blaOXA-1-like, blaOXA-2-like, blaOXA-5-like, blaOXA-48-like and blaTEM and up to six different plasmid-encoded AmpC genes as well as class 1 integrons. The conjugability of β-lactam resistance was assessed by conjugation. RESULTS The isolate was confirmed to be K. pneumoniae classified as belonging to the KpI phylogenetic group within ST340, which belongs to the high-risk clonal complex 258 (CC258). The isolate was resistant to all β-lactam agents tested, with only the presence of a non-conjugative blaKPC-2 gene being detected and carried in a non-classical genetic structure. CONCLUSIONS This is the first description of a member of CC258 and of a blaKPC-2 gene in Peru. Intensive surveillance is needed to determine the relevance of both in this area.
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Affiliation(s)
- Gertrudis Horna
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain; Universidad Peruana Cayetano Heredia, Av. Honorio Delgado N.° 430, San Martín de Porras, Lima 31, Peru
| | | | | | - Jesus Tamariz
- Universidad Peruana Cayetano Heredia, Av. Honorio Delgado N.° 430, San Martín de Porras, Lima 31, Peru.
| | - Joaquim Ruiz
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic - Universitat de Barcelona, Barcelona, Spain
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Shameem M, Mir MA. Management of Pneumonia and Blood Stream Infections with New Antibiotic Adjuvant Entity (Ceftriaxone + Sulbactam + Disodium Edetate)- A Novel Way to Spare Carbapenems. J Clin Diagn Res 2017; 10:LC23-LC27. [PMID: 28208889 DOI: 10.7860/jcdr/2016/20904.9014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Accepted: 08/10/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Nosocomial infections have been considered as a major health problem causing incremental morbidity, mortality and costs of therapy. AIM This retrospective study was initiated with aim to analyse the comparative efficacy of a novel Antibiotic Adjuvant Entity (AAE), a combination of ceftriaxone + sulbactam + disodium edetate and meropenem in combination with colistin, for the management of Multi Drug Resistant (MDR) nosocomial Gram-negative bacterial infections. MATERIALS AND METHODS Case history sheets of patients with documented MDR nosocomial Gram-negative infections who received either AAE or meropenem in combination with colistin for management of infections over a period of 3 years (November 2012 - October 2015) were included in the study. Data related to clinical management, demographics, vital signs and laboratory parameters along with prior antibiotic therapy, dose and clinical outcomes were evaluated thoroughly to analyse the clinical benefits of this new AAE+ colistin therapy for management of MDR nosocomial infections. RESULTS Out of 115 patients short listed for the study, 52 patients had received AAE + colistin therapy and 63 patients have received meropenem + colistin. AAE + colistin therapy resulted in significantly higher efficacy (86.53%) as compared to meropenem + colistin (63.49%). A rising trend in clinical cure rates was observed in AAE based combination therapy in contrast to the decreasing trend in meropenem based combination therapy. A progressive decline in clinical cure rates was observed in meropenem treated group over a period of 3 years due to rising carbapenemases and multiple resistance by pathogens, where as AAE maintained the same efficacy. CONCLUSION The AAE + colistin therapy has shown better bacteriological and clinical efficacy as compared to meropenem + colistin in the management of various nosocomial MDR Gram-negative infections. A significant number of meropenem failure patients responded to the AAE therapy highlighting the new hope to spare carbapenems.
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Affiliation(s)
- Mohammad Shameem
- Professor, Department of Tuberculosis and Chest Disease, JN Medical College, Aligarh Muslim University , Aligarh, Uttar Pradesh, India
| | - Mohammad Amin Mir
- Senior Resident, Department of Surgery, Firoz Hospital and Research Centre , Aligarh, Uttar Pradesh, India
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Escandón-Vargas K, Reyes S, Gutiérrez S, Villegas MV. The epidemiology of carbapenemases in Latin America and the Caribbean. Expert Rev Anti Infect Ther 2016; 15:277-297. [PMID: 27915487 DOI: 10.1080/14787210.2017.1268918] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Enterobacteriaceae, Pseudomonas spp., and Acinetobacter spp. infections are major causes of morbidity and mortality, especially due to the emergence and spread of β-lactamases. Carbapenemases, which are β-lactamases with the capacity to hydrolyze or inactivate carbapenems, have become a serious concern as they have the largest hydrolytic spectrum and therefore limit the utility of most β-lactam antibiotics. Areas covered: Here, we present an update of the current status of carbapenemases in Latin America and the Caribbean. Expert commentary: The increased frequency of reports on carbapenemases in Latin America and the Caribbean shows that they have successfully spread and have even become endemic in some countries. Countries such as Brazil, Colombia, Argentina, and Mexico account for the majority of these reports. Early suspicion and detection along with implementation of antimicrobial stewardship programs in all healthcare settings are crucial for the control and prevention of carbapenemase-producing bacteria.
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Affiliation(s)
- Kevin Escandón-Vargas
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - Sergio Reyes
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - Sergio Gutiérrez
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia
| | - María Virginia Villegas
- a Bacterial Resistance and Hospital Epidemiology Unit , International Center for Medical Research and Training (CIDEIM) , Cali , Colombia.,b Molecular Genetics and Antimicrobial Resistance Unit, International Center for Microbial Genomics , Universidad El Bosque , Bogotá , Colombia
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Ribeiro PCS, Monteiro AS, Marques SG, Monteiro SG, Monteiro-Neto V, Coqueiro MMM, Marques ACG, de Jesus Gomes Turri R, Santos SG, Bomfim MRQ. Phenotypic and molecular detection of the bla KPC gene in clinical isolates from inpatients at hospitals in São Luis, MA, Brazil. BMC Infect Dis 2016; 16:737. [PMID: 27927163 PMCID: PMC5142414 DOI: 10.1186/s12879-016-2072-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 11/28/2016] [Indexed: 11/10/2022] Open
Abstract
Background Bacteria that produce Klebsiella pneumoniae carbapenemases (KPCs) are resistant to broad-spectrum β-lactam antibiotics. The objective of this study was to phenotypically and genotypically characterize the antibiotic susceptibility to carbapenems of 297 isolates recovered from clinical samples obtained from inpatients at 16 hospitals in São Luis (Maranhão, Brazil). Methods The study was conducted using phenotypic tests and molecular methods, including polymerase chain reaction (PCR), sequencing and enterobacterial repetitive intergenic consensus (ERIC)-PCR. The nonparametric chi-square test of independence was used to evaluate the associations between the bacterial blaKPC gene and the modified Hodge test, and the chi-square adherence test was used to assess the frequency of carbapenemases and their association with the blaKPC gene. Results The most frequently isolated species were Acinetobacter baumannii (n = 128; 43.0%), K. pneumoniae (n = 75; 25.2%), and Pseudomonas aeruginosa (n = 42; 14.1%). Susceptibility assays showed that polymixin B was active against 89.3% of the bacterial isolates. The Acinetobacter spp. and K. pneumoniae strains were susceptible to amikacin and tigecycline, and Pseudomonas spp. were sensitive to gentamicin and amikacin. Among the 297 isolates, 100 (33.7%) were positive for the blaKPC gene, including non-fermentative bacteria (A. baumannii) and Enterobacteriaceae species. Among the isolates positive for the blaKPC gene, K. pneumoniae isolates had the highest positivity rate of 60.0%. The blaKPC gene variants detected included KPC-2, which was found in all isolates belonging to species of the Enterobacteriaceae family. KPC-2 and KPC-3 were observed in A. baumannii isolates. Importantly, the blaKPC gene was also detected in three Raoultella isolates and one isolate of the Pantoea genus. ERIC-PCR patterns showed a high level of genetic diversity among the bacterial isolates; it was capable of distinguishing 34 clones among 100 strains that were positive for blaKPC and were circulating in 11 of the surveyed hospitals. Conclusions The high frequency of the blaKPC gene and the high degree of clonal diversity among microorganisms isolated from patients from different hospitals in São Luis suggest the need to improve the quality of health care to reduce the incidence of infections and the emergence of carbapenem resistance in these bacteria as well as other Gram-negative pathogens.
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Affiliation(s)
- Patricia Cristina Saldanha Ribeiro
- Programa de Pós-Graduação em Biologia Parasitária, Universidade CEUMA, Rua Josué Montello, No. 1, Renascença II, São Luís, Maranhão, CEP 65075-120, Brazil
| | - Andrea Souza Monteiro
- Programa de Pós-Graduação em Biologia Parasitária, Universidade CEUMA, Rua Josué Montello, No. 1, Renascença II, São Luís, Maranhão, CEP 65075-120, Brazil
| | - Sirlei Garcia Marques
- Hospital Universitário da Universidade Federal do Maranhão, Rua Barão de Itapari, 227, Centro, São Luís, Maranhão, Brazil
| | - Sílvio Gomes Monteiro
- Programa de Pós-Graduação em Biologia Parasitária, Universidade CEUMA, Rua Josué Montello, No. 1, Renascença II, São Luís, Maranhão, CEP 65075-120, Brazil
| | - Valério Monteiro-Neto
- Programa de Pós-Graduação em Biologia Parasitária, Universidade CEUMA, Rua Josué Montello, No. 1, Renascença II, São Luís, Maranhão, CEP 65075-120, Brazil
| | - Martina Márcia Melo Coqueiro
- Programa de Pós-Graduação em Biologia Parasitária, Universidade CEUMA, Rua Josué Montello, No. 1, Renascença II, São Luís, Maranhão, CEP 65075-120, Brazil
| | - Ana Cláudia Garcia Marques
- Programa de Pós-Graduação em Saúde do Adulto e da Criança-UFMA, Universidade Federal do Maranhão, Av. dos Portugueses, 1966 - Bacanga, São Luis, Maranhão, Brazil
| | - Rosimary de Jesus Gomes Turri
- Departamento de Farmácia, Universidade Federal do Maranhão, Av. dos Portugueses, 1966 - Bacanga, São Luis, Maranhão, Brazil
| | - Simone Gonçalves Santos
- Instituto de Ciências Biológicas, Universidade Federal de Minas Gerais, Av. Antonio Carlos, 6627, Pampulha, Belo Horizonte, MG, Brazil
| | - Maria Rosa Quaresma Bomfim
- Programa de Pós-Graduação em Biologia Parasitária, Universidade CEUMA, Rua Josué Montello, No. 1, Renascença II, São Luís, Maranhão, CEP 65075-120, Brazil.
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Falco A, Ramos Y, Franco E, Guzmán A, Takiff H. A cluster of KPC-2 and VIM-2-producing Klebsiella pneumoniae ST833 isolates from the pediatric service of a Venezuelan Hospital. BMC Infect Dis 2016; 16:595. [PMID: 27770796 PMCID: PMC5075218 DOI: 10.1186/s12879-016-1927-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2015] [Accepted: 10/12/2016] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae is a bacterial pathogen that has developed resistance to multiple antibiotics and is a major cause of nosocomial infections worldwide. Carbapenemase-producing Klebsiella pneumoniae have been isolated in many hospitals in Venezuela, but they have not been well-studied. The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae isolates from the pediatric service of a hospital located in Anzoategui State, in the eastern part of Venezuela. METHODS Nineteen Klebsiella pneumoniae strains isolated in the hospital from April to July 2014 were evaluated phenotypically and molecularly for the presence of carbapenemases blaKPC, blaIMP and blaVIM. Molecular epidemiology was performed with Repetitive Extragenic Palindromic-PCR (REP-PCR) and Multilocus Sequence Typing (MLST). They were also studied for phenotypic and molecular resistance to a quaternary ammonium compound (QAC) disinfectant. RESULTS All 19 isolates contained both bla VIM-2 and bla KPC-2 genes, and the bla KPC-2 gene was associated with Tn4401b. All isolates were phenotypically sensitive to QACs and contained qacΔE and addA2 genes typical of class 1 integrons. Analysis by REP-PCR and MLST showed that all isolates had identical profiles characteristic of sequence type ST833. CONCLUSION All 19 strains are bla VIM-2 and bla KPC-2-producing ST833 K. pneumoniae sensitive to QACs. This analysis may help to understand the routes of dissemination and confirms that QAC disinfectants can be used to help control their spread.
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Affiliation(s)
- Aura Falco
- Laboratorio de Genética Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela
| | - Yusibeska Ramos
- Laboratorio B, Dirección de Energía y Ambiente, Instituto de Estudios Avanzados, Caracas, Venezuela
| | - Esther Franco
- Servicio de Laboratorio Clínico del anexo pediátrico "Dr. Rafael Tobías Guevara" del Complejo Hospitalario Universitario "Dr. Luis Razetti", Barcelona, Venezuela
| | - Alegría Guzmán
- Servicio de Laboratorio Clínico del anexo pediátrico "Dr. Rafael Tobías Guevara" del Complejo Hospitalario Universitario "Dr. Luis Razetti", Barcelona, Venezuela
| | - Howard Takiff
- Laboratorio de Genética Molecular, Centro de Microbiología y Biología Celular, Instituto Venezolano de Investigaciones Científicas, Caracas, Venezuela.
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Rojas LJ, Wright MS, De La Cadena E, Motoa G, Hujer KM, Villegas MV, Adams MD, Bonomo RA. Initial Assessment of the Molecular Epidemiology of blaNDM-1 in Colombia. Antimicrob Agents Chemother 2016; 60:4346-50. [PMID: 27067339 PMCID: PMC4914651 DOI: 10.1128/aac.03072-15] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Accepted: 04/07/2016] [Indexed: 01/11/2023] Open
Abstract
We report complete genome sequences of four blaNDM-1-harboring Gram-negative multidrug-resistant (MDR) isolates from Colombia. The blaNDM-1 genes were located on 193-kb Inc FIA, 178-kb Inc A/C2, and 47-kb (unknown Inc type) plasmids. Multilocus sequence typing (MLST) revealed that these isolates belong to sequence type 10 (ST10) (Escherichia coli), ST392 (Klebsiella pneumoniae), and ST322 and ST464 (Acinetobacter baumannii and Acinetobacter nosocomialis, respectively). Our analysis identified that the Inc A/C2 plasmid in E. coli contained a novel complex transposon (Tn125 and Tn5393 with three copies of blaNDM-1) and a recombination "hot spot" for the acquisition of new resistance determinants.
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Affiliation(s)
- Laura J Rojas
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | | | - Elsa De La Cadena
- International Center for Medical Research and Training, CIDEIM, Cali, Colombia
| | - Gabriel Motoa
- International Center for Medical Research and Training, CIDEIM, Cali, Colombia
| | - Kristine M Hujer
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Maria V Villegas
- International Center for Medical Research and Training, CIDEIM, Cali, Colombia
| | - Mark D Adams
- J. Craig Venter Institute, La Jolla, California, USA
| | - Robert A Bonomo
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA Department of Pharmacology, Case Western Reserve University, Cleveland, Ohio, USA Department of Molecular Biology and Microbiology, Case Western Reserve University, Cleveland, Ohio, USA Research Service, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, Ohio, USA
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Lee CR, Lee JH, Park KS, Kim YB, Jeong BC, Lee SH. Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods. Front Microbiol 2016; 7:895. [PMID: 27379038 PMCID: PMC4904035 DOI: 10.3389/fmicb.2016.00895] [Citation(s) in RCA: 446] [Impact Index Per Article: 55.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/26/2016] [Indexed: 01/08/2023] Open
Abstract
The emergence of carbapenem-resistant Gram-negative pathogens poses a serious threat to public health worldwide. In particular, the increasing prevalence of carbapenem-resistant Klebsiella pneumoniae is a major source of concern. K. pneumoniae carbapenemases (KPCs) and carbapenemases of the oxacillinase-48 (OXA-48) type have been reported worldwide. New Delhi metallo-β-lactamase (NDM) carbapenemases were originally identified in Sweden in 2008 and have spread worldwide rapidly. In this review, we summarize the epidemiology of K. pneumoniae producing three carbapenemases (KPCs, NDMs, and OXA-48-like). Although the prevalence of each resistant strain varies geographically, K. pneumoniae producing KPCs, NDMs, and OXA-48-like carbapenemases have become rapidly disseminated. In addition, we used recently published molecular and genetic studies to analyze the mechanisms by which these three carbapenemases, and major K. pneumoniae clones, such as ST258 and ST11, have become globally prevalent. Because carbapenemase-producing K. pneumoniae are often resistant to most β-lactam antibiotics and many other non-β-lactam molecules, the therapeutic options available to treat infection with these strains are limited to colistin, polymyxin B, fosfomycin, tigecycline, and selected aminoglycosides. Although, combination therapy has been recommended for the treatment of severe carbapenemase-producing K. pneumoniae infections, the clinical evidence for this strategy is currently limited, and more accurate randomized controlled trials will be required to establish the most effective treatment regimen. Moreover, because rapid and accurate identification of the carbapenemase type found in K. pneumoniae may be difficult to achieve through phenotypic antibiotic susceptibility tests, novel molecular detection techniques are currently being developed.
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Affiliation(s)
- Chang-Ro Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Jung Hun Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Kwang Seung Park
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Young Bae Kim
- Division of STEM, North Shore Community College, Danvers MA, USA
| | - Byeong Chul Jeong
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
| | - Sang Hee Lee
- National Leading Research Laboratory of Drug Resistance Proteomics, Department of Biological Sciences, Myongji University Yongin, South Korea
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Wong D, Spellberg B. Leveraging antimicrobial stewardship into improving rates of carbapenem-resistant Enterobacteriaceae. Virulence 2016; 8:383-390. [PMID: 27187821 DOI: 10.1080/21505594.2016.1188234] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are among the most critical threats facing our healthcare system and account for significant patient mortality. There is considerable interest in the development of new treatment strategies. However, less attention has been paid to reducing CRE infection rates. Antibiotic stewardship programs can be uniquely empowered to reduce widespread pathogen resistance and by extension, optimize patient care and lower healthcare costs.
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Affiliation(s)
- Darren Wong
- a Division of Infectious Diseases , USC Keck School of Medicine , Los Angeles , CA , USA
| | - Brad Spellberg
- a Division of Infectious Diseases , USC Keck School of Medicine , Los Angeles , CA , USA.,b Los Angeles County-USC (LAC + USC) Medical Center , Los Angeles , CA , USA
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Perez F, El Chakhtoura NG, Papp-Wallace K, Wilson BM, Bonomo RA. Treatment options for infections caused by carbapenem-resistant Enterobacteriaceae: can we apply "precision medicine" to antimicrobial chemotherapy? Expert Opin Pharmacother 2016; 17:761-81. [PMID: 26799840 PMCID: PMC4970584 DOI: 10.1517/14656566.2016.1145658] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
INTRODUCTION For the past three decades, carbapenems played a central role in our antibiotic armamentarium, trusted to effectively treat infections caused by drug-resistant bacteria. The utility of this class of antibiotics has been compromised by the emergence of resistance especially among Enterobacteriaceae. AREAS COVERED We review the current mainstays of pharmacotherapy against infections caused by carbapenem-resistant Enterobacteriaceae (CRE) including tigecycline, aminoglycosides, and rediscovered 'old' antibiotics such as fosfomycin and polymyxins, and discuss their efficacy and potential toxicity. We also summarize the contemporary clinical experience treating CRE infections with antibiotic combination therapy. Finally, we discuss ceftazidime/avibactam and imipenem/relebactam, containing a new generation of beta-lactamase inhibitors, which may offer alternatives to treat CRE infections. We critically evaluate the published literature, identify relevant clinical trials and review documents submitted to the United States Food and Drug Administration. EXPERT OPINION Defining the molecular mechanisms of resistance and applying insights about pharmacodynamic and pharmacokinetic properties of antibiotics, in order to maximize the impact of old and new therapeutic approaches should be the new paradigm in treating infections caused by CRE. A concerted effort is needed to carry out high-quality clinical trials that: i) establish the superiority of combination therapy vs. monotherapy; ii) confirm the role of novel beta-lactam/beta-lactamase inhibitor combinations as therapy against KPC- and OXA-48 producing Enterobacteriaceae; and, iii) evaluate new antibiotics active against CRE as they are introduced into the clinic.
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Affiliation(s)
- Federico Perez
- Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
- Research Services, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
- Department of Medicine, University Hospitals Case Medical Center
| | | | - Krisztina Papp-Wallace
- Research Services, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
- Department of Medicine, University Hospitals Case Medical Center
- Departments of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | | | - Robert A. Bonomo
- Medicine, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
- Research Services, Louis Stokes Cleveland Department of Veterans Affairs Medical Center
- Department of Medicine, University Hospitals Case Medical Center
- Departments of Pharmacology, Case Western Reserve University School of Medicine, Cleveland, Ohio
- VISN-10 Geriatrics Research, Cleveland, Ohio
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