medigraphic.com
ISSN 1561-3054 (Electronic)

2014, Number 3

<< Back Next >>

Rev Cubana Med Trop 2014; 66 (3)

Antimicrobial resistance observed in clinical Klebsiella spp isolates and extended spectrum B lactamases in Cuban hospitals

Quiñones PD, Carmona CY, Zayas IA, Abreu CM, Salazar RD, García GS, Torres TD, Kobayashi N, Valverde FA, del Campo MR

Language: Spanish
References: 32
Page: 386-399
PDF size: 246.22 Kb.


ABSTRACT

Introduction: the Klebsiella genus gives rise to many hospital outbreaks due to multi-drug-resistant strains on different continents and leads to increased morbidity and mortality.
Objectives: to identify the Klebsiella species causing infections in Cuban hospitals, to determine the origin of isolates per service, their antimicrobial susceptibility and, to determine the production and type of extended-spectrum β-lactamases (ESBLs) and the susceptibility of these isolations to several antimicrobials of therapeutic interest.
Methods: a descriptive study was conducted on 448 Klebsiella spp. Isolates that were received in the national reference microbiology laboratory of "Pedro Kouri" Institute of Tropical Medicine from 40 hospitals located in 12 Cuban provinces during the 2010-2012 period. Species identification was based on conventional biochemical tests and mass spectrometry technique called MS MALDI-TOF. The susceptibility to 15 antimicrobials and the extended spectrum β-lactamase production were determined by the E-test method and by the combined disks method, respectively, according to recommendations of the Institute of Clinical and Laboratory Standards. The polymerase chain reaction made it possible the detection of BlaESBL genes as indicated in the previously described protocol.
Results: Klebsiella pneumoniae (95.4 %) was the prevalent species, followed by K. oxytoca (4.1%), and K. ozaenae (0.5 %). The isolates were mainly from the intensive care units (26.3 %), surgery (22 %), and neonatology (13%) services. The highest resistance rate was observed for cephalosporins (48-52 %), trimethoprim-sulfamethoxazole (49 %), gentamicin (43 %), nalidixic acid (38 %), and tetracycline (34 %). Fifty-two percent of the isolates were extended spectrum β-lactamase producers, with CTX-M (82 %) and TEM (70 %) enzymes prevailing.
Conclusions: This study shows the clinical impact of Klebsiella spp in Cuban hospitals, which is highly resistant to different antimicrobials. The production of extended spectrum β-lactamases provides a significant resistance mechanism in Klebsiella in which carbapenems, piperacillin-tazobactam, cholistin and tigecycline play an important therapeutic role.


REFERENCES

  1. Martínez-Martínez L, Calvo J. El problema creciente de la resistencia antibiótica en bacilos gramnegativos. Rev Enferm Infecc y Microbiol Clin. 2010;28(2):25-31.

  2. Cars O, Hober LD, Murria M, Norberg O, Sivaraman S. Meeting the challenge of antibiotic resistance. Br Med J. 2008;337:726-28.

  3. Paterson DL, Bonomo RB. Extended-spectrum beta-lactamases: a clinical update. Clin Microbiol Rev. 2005;18:657-86.

  4. Kliebe C, Nies B, Meyer J, Tolxdorff–Neutzling RM, Wiedemann B. Evolution of plasmid–coded resistance to broad–spectrum cephalosporins. Antimicrob Agents Chemother. 1985;28:302-7.

  5. Senda K, Arakawa Y, Cichiyama S, Nakashima K, Ito H, Ohsuka S. PCR detection of metallo–ß–lactamase gene (blaIMP) in gram–negative rods resistant to broad– spectrum ß–lactams. J Clin Microbiol. 1996;34:2909-13.

  6. Elemam A, Rahimian J, Mandell W. Infection with panresistant Klebsiella pneumoniae: a report of 2 cases and a brief review of the literature. Clin Infect Dis. 2009;9:271-4.

  7. Programa Nacional de Prevención y Control de las Infecciones Intrahospitalarias. La Habana: MINSAP;2009.

  8. Hernández W, Ramos A, Nodarse R, Padrón A, De Armas E. Resistencia bacteriana en las bacterias productoras de betalactamasas extendidas (BLEE). Rev Cub Med Int Emerg. 2006;5(1):256-64.

  9. Pérez F, Camejo l, Rojas E. Comportamiento de la resistencia antimicrobiana de gérmenes aislados en heridas por quemaduras. Rev Cubana Cir. 2009;48(3):35-40.

  10. Abbott S. Klebsiella, Enterobacter, Citrobacter and Serratia. En: Murray PR, editor. Manual of clinical Microbiology. 9na ed. Washington, DC: ASM Press; 2007. p. 475-82.

  11. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI document M100-S21. Table 2A. Enterobacteraceae. M02-M07. Wayne (PA): Clinical and Laboratory Standards Institute; January, 2011.

  12. Valverde A, Coque T, Sánchez-Moreno M, Rollán A, Baquero F, Cantón R. Dramatic increase in prevalence of fecal carriage of extended-spectrum betalactamase- producing Enterobacteriaceae during non outbreak situations in Spain J. Clin. Microbiol. 2004;42:4769-75.

  13. López JM, Echeverri LM. K. pneumoniae: ¿la nueva ''superbacteria''? Patogenicidad, epidemiología y mecanismos de resistencia. IATREIA. 2009 [citado el 23 de enero 2011];23(2):157-165. Disponible en: http://www.redalyc.org/src/inicio/ArtPdfRed.jsp?iCve=180519015007.

  14. Alves MS. Identification of clinical isolates of indole-positive and indole-negative Klebsiella spp. J Clin Microbiol. 2006;44(10):3640-6.

  15. Mantilla JR, Barreto E, Reguero MT, Veranda DA. Identificación por PCR-SSCP de genes de cefotaximasas en aislamientos hospitalarios de Enterobacteriaceae. Rev Colombiana Biotecnol. 2009;11(2):55-7.

  16. Wener KM, Schechner V, Gold HS, Wright SB, Carmel Y. Treatment with fluoroquinolones or with β-Lactam–β-Lactamase inhibitor combinations is a risk factor for isolation of extended-spectrum-β-Lactamase-producing Klebsiella species in hospitalized patients. Antimicrobial Agents Chemother. 2010;54(5):2010-6.

  17. Gupta A, Della-Latta P, Todd B, San Gabriel P, Haas J, Fann Wu, et al. Outbreak of extended-spectrum beta-lactamase–producing Klebsiella pneumoniae in a neonatal intensive care unit linked to artificial nails. Infect Control Hosp Epidemiol. 2004; 25(3):210-5.

  18. Sahly H, Navon-Venezia S, Roesler L, Hay A, Carmeli Y, Podschun R, et al. Extended-spectrum B-Lactamase production is associated with an increase in cell invasion and expression of fimbrial adhesins in Klebsiella pneumoniae. Antimicrob Agents Chemother. 2008;52(9):3029-34.

  19. Riser E, Noone P, Howard FM. Epidemiological study of Klebsiella infection in the special care baby unit of a London hospital. J Clin Pathol. 1980;33(4):400-7.

  20. Pérez-Morenoa PM, Centelles-Serranoa MJ, Cortell-Ortolá M. Molecular epidemiology and resistance mechanisms involved in reduced susceptibility to amoxicillin/clavulanic acid in Klebsiella pneumoniae isolates from a chronic care centre. Int J of Antimicrob Agents. 2011;37:462-6.

  21. Valverde A. Complex molecular epidemiology of extended-spectrum blactamases in Klebsiella pneumoniae: a long-term perspective from a single institution in Madrid. J Antimicrob Chemother. 2008;61:64-72.

  22. Grupo para el Estudio de la Resistencia a Antibióticos en Medellin (GERMEN). Perfiles de sensibilidad de Klebsiella pneumoniae. Datos obtenidos en los años 2007 y 2008 de 13 instituciones hospitalarias del Área Metropolitana del valle de Aburrá. Medellín; 2009 [citado 15 de septiembre de 2009]. Disponible en: http://www.scielo.unal.edu.co/www.grupogermen.org/pdf/klebsiella.pdf.

  23. Laurent C, Rodriguez-Villalobos H, Rost F, Strale H, Vincent JL. Intensive care unit outbreak of extended-spectrum beta-lactamase producing Klebsiella pneumoniae controlled by cohorting patients and reinforcing infection control measures. Infect Control Hosp Epidemiol. 2008;29:517-24.

  24. Feizabadi P. Genetic characterization of ESBL producing Klebsiella pneumoniae. J Infect Dev Ctries. 2010;4(10):609-15.

  25. Rodríguez-Baño J, Pascual A. Microorganismos multirresistentes, ¿adquisición nosocomial o comunitaria? Enferm Infecc Microbiol Clin. 2004;22:505-6.

  26. Suarez B. Detección de fenotipos de resistencia en aislamientos clínicos de Klebsiella pneumoniae y Escherichia coli. [Tesis de Especialista de Primer Grado en Microbiología]. La Habana: IPK;2011.

  27. Gaitán SL, Espinal PA. Caracterización molecular de Escherichia coli y Klebsiella pneumoniae productores de ß-lactamasas de espectro extendido en hospitales de la Región Caribe, Colombia .Rev Chil Infect. 2009;26(3):239-46.

  28. Guillén R, Velazquez G, Lird G, Espinola C, Laconich M, Meyer M, et al. Estudio multicéntrico de Enterobacterias productoras de betalactamasas de espectro extendido: detección de genes blactm-2 y blaPER-2. Paraguay 2009 [citado 23 de septiembre de 2010]. Disponible en: www.labciencia.com.

  29. Nematzadeh S, Shahcheraghi F, Feizabadi MM, Nikbin VS, Nasehi L. Molecular characterization of CTX-Mβ-lactamases among Klebsiella pneumoniae isolated from patients at Tehran hospitals. In dian J Med Microbiol. 2011;29(3):254-7.

  30. Boyd DA, Tyler S, Christianson S, McGeer A, Muller MP, Willey BM, et al. Complete nucleotide sequence of a 92-kilobase plasmid harboring the CTX-M-15 extended-spectrum beta-lactamase involved in an outbreak in long-term-care facilities in Toronto, Canada. Antimicrob Agents Chemother. 2004;48:3758-64.

  31. Livermore DM, Warner M, Mushtaq S, Doumith M, Jiancheng Z, Woodford N. What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline. Int J Antimicrob Chenother. 2011;37:415-9.

  32. Meletis G. Colistin heteroresistance in carbapenemase-producing Klebsiella pneumoniae. J Antimicrob Chemother. 2011;66:946-7.




2020     |     www.medigraphic.com