Evaluation of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Rio Grande do Sul, Brazil

Lorenzoni, Vinícius Victor; Silva, Danielly da Costa; Rampelotto, Roberta Filipini; Brites, Patrícia Chaves; Villa, Bárbara; Hörner, Rosmari

doi:10.1590/0037-8682-0209-2017

Cited by 14 publications

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“…Another study by Arnold et al,16 concluded that Klebsiella pneumonia Carbapenemase (KPC) producing bacteria have created challenges for clinicians due to highly drug resistance, resulting in delays in effective treatment so the effective antibiotics are limited to Polymyxin, Tigecyclines and occasionally aminoglycosides, which is similarto our study that shows predominance of KPC from Enterobacteriaceae showing 100% sensitivity towards Polymyxin B and Tigecycline.Similarly, Amikacin, Piperacillin/Tazobactam and Tobramycin could be used as good alternatives as almost half of Carbapenem resistant Enterobacteriaceae were found sensitive to them. This study is similar to the study done by Almugadam et al14 and Lorenzoni et al15 which shows 83.3% (10/12) and increased rate 98.6% respectively, rate of sensitivity of Amikacin in Carbapenem resistant enterobacteriaceae.…”

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confidence: 92%

“…towards Nitrofurantoin among Carbapenem resistant Enterobacteriaceae.When Carbapenem resistant samples were subjected to other antibiotic sensitivity test, all strains of Carbapenem resistant Enterobacteriaceae were found to be sensitive to Colistin, Polymyxin B and Tigecycline. Similar type of study was conducted by Lorenzoni et al,15 which show high level of sensitivity to Colistin (91.4%) among Klebsiella pneumoniae. Another study by Arnold et al,16 concluded that Klebsiella pneumonia Carbapenemase (KPC) producing bacteria have created challenges for clinicians due to highly drug resistance, resulting in delays in effective treatment so the effective antibiotics are limited to Polymyxin, Tigecyclines and occasionally aminoglycosides, which is similarto our study that shows predominance of KPC from Enterobacteriaceae showing 100% sensitivity towards Polymyxin B and Tigecycline.Similarly, Amikacin, Piperacillin/Tazobactam and Tobramycin could be used as good alternatives as almost half of Carbapenem resistant Enterobacteriaceae were found sensitive to them.…”

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confidence: 70%

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Resistance Pattern of Carbapenem on Enterobacteriaceae

et al. 2018

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Introduction: Gram negative bacilli are the important causes of common clinical infections. Carbapenem resistant Enterobacteriaceae are considered as important public health threat and is classified as urgent by the Centers of Disease Control and Prevention because of their progressive geographic dissemination and limited therapeutic alternatives. This study was done to find out the resistance pattern of Carbapenem among Enterobacteriaceae.Methods: The descriptive cross-sectional study was carried out in Clinical Microbiology laboratory from February 2018 to May 2018 after ethical approval. Organism was identified on the basis of its microscopic observation by performing Gram’s stain and by identification of morphology after its growth in culture media followed by its biochemical reactions. Antibiotic sensitivity test of isolated pathogens was done using Muller Hinton Agar by the standard disk diffusion technique of Kirby-Bauer method.Results: In our study, total 1055 sample belongs to the family Enterobacteriaceae. From the family Enterobactericeae, 348 (27%) of the bacilli were found to be Carbapenem resistant. Among which most common bacteria was Klebsiella pneumoniae followed by Escherichia coli. All strains of Carbapenem resistant Enterobacteriaceae were sensitive to Colistin, Polymyxin B and Tigecycline. Conclusions: Among Enterobacteriaceae, around one-third of the bacterial isolates were Carbapenem resistant. However, to reduce drug resistance antimicrobial stewardship programme and proper infection control measures is required.

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confidence: 92%

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confidence: 70%

Resistance Pattern of Carbapenem on Enterobacteriaceae

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“…Data regarding important CRE studies in Taiwan and other countries are shown in Table 1 . There were big variations in the rates of CPE among clinical CRE isolates in Taiwan as compared to those from other countries ( Lorenzoni et al, 2017 ; Woodford et al, 2017 ; Laolerd et al, 2018 ). It is notable that persistently high KPC-2 rates (73.9% in 2012, and 61.1% in 2015) and emergence of KPC-17 as well as KPC-34 since 2014 were observed ( Chiu et al, 2018 ).…”

Section: Prevalence and Mortality Rates Of Carbapenemase-producing Enmentioning

confidence: 88%

Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects

et al. 2018

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Carbapenem-resistant Enterobacteriaceae (CRE), a major resistance concern emerging during the last decade because of significantly compromising the efficacy of carbapenem agents, has currently become an important focus of infection control. Many investigations have shown a high association of CRE infections with high case-fatality rates. In Taiwan, a few surveys observed that a significant proportion (29–47%) of the CR-Klebsiella pneumoniae isolates harbored a plasmidic allele encoding K. pneumoniae carbapenemases (KPC, especially KPC-2). A significant increase in the number of oxacillinase (OXA)-48-like carbapenemases among CR-K. pneumoniae isolates was observed between 2012 and 2015. By striking contrast, isolates of CR-Escherichia coli and CR-Enterobacter species in Taiwan had a much lower percentage of carbapenemase production than CR-K. pneumoniae isolates. This differs from isolates found in China as well as in the India subcontinent. Apart from the hospital setting, CRE was also cultured from the inpatients from communities or long-term care facilities (LTCF). Therefore, implementation of regular CRE screening of LTCF residents, strict disinfectant use in nursing homes and hospital settings, and appropriate control of antibiotic prescriptions is suggested to alleviate the spread of clinical CRE isolates in Taiwan. Although there are some promising new antibiotics against CRE, such as ceftazidime-avibactam, meropenem-vaborbactam, aztreonam-avibactam and cefiderocol, these agents are not available in Taiwan currently. Therefore, in order to effectively decrease case-fatality rates among patients with the infections owing to carbapenemase-producing CRE isolates, combination antibiotic schemes, including colistin (or amikacin) and/or tigecycline in combination with an anti-pseudomonal carbapenem agent, remain the mainstay for treating clinical CRE infections.

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“…Among Enterobacteriaceae species carbapenem resistance is a big problem especially in K. pneumoniae. A study performed on 70 CRE isolates at a tertiary hospital in Brazil in 2015 showed that the most prevalent microorganism was K. pneumoniae (95.7%) with a high-level resistance to carbapenems (> 98%) [16]. In a study from Turkey evaluating 181 CRE isolates, about half of the isolates displayed multidrugresistance [17].…”

Section: Discussionmentioning

confidence: 99%

“…However, in isolates with ESBLs or cell wall permeability defects, it can cause increased level of cephalosporin and carbapenem resistance. Furthermore, co-expression of OXA-48 and ESBLs (CTX-M-15, SHV) and coexpression of OXA-48 and AmpC enzymes in CRE were reported [11,16,17]. In the presented study, out of the 57 CRKP isolates, the frequency of carbapenemases determined were blaOXA-48 (82.45%), blaOXA-55 (40.35%), blaOXA-51 (3.50%), blaOXA-23 (1.75%), blaOXA-24 (1.75%), blaIMP (1.75%).…”

Section: Discussionmentioning

confidence: 99%

Investigation of carbapenemase and mcr-1 genes in carbapenem-resistant Klebsiella pneumoniae isolates

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et al. 2019

J Infect Dev Ctries

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Introduction: Carbapenem-resistant Klebsiella pneumoniae are a major problem. We aimed to investigate carbapenemase-encoding genes and transferable mcr-1 genes among 57 carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from hospitalized patients. Methodology: Antibiotic susceptibility tests were performed by Phoenix (BD). Results for ertapenem and colistin were confirmed by gradient diffusion and microdilution methods. Carbapenemase and mcr-1 genes were investigated by Polymerase Chain Reaction (PCR). Results: Thirty-two (56.14%) isolates were from intensive care units (ICU). Antibiotic resistance rates by Phoenix: 52.63% for amikacin; 73.69% trimethoprim sulfamethoxazole; 91.23% cefepime; 82.46% tigecycline; 59.65% colistin. Carbapenemases positivity: 82.45% (47) for blaOXA-48, 40.35% (23) blaOXA-55, 3.50% (2) blaOXA-51, 1.75% (1) blaOXA-23, 1.75% (1) blaOXA-24, 1.75% (1) blaIMP. blaOXA-58, blaKPC, blaNDM-1, and blaVIM were not detected. Twenty (35.08%) isolates had both blaOXA-48 and blaOXA-55. Three isolates were mcr-1 (+) and blaOXA-48 (+). One mcr-1 (+) isolates was blaOXA-51 (+). One colistin sensitive isolate determined by Phoenix, was found colistin resistant by microdilution. Conclusion: OXA-48 and OXA-55 co-harboring isolates and mcr-1 gene (+) isolates were spreading. Automated colistin susceptibility results should be confirmed by microdilution method. Resistance mechanisms in Enterobacteriaceae should be determined and the isolates should be monitored by molecular epidemiological methods. Effective infection control measures will contribute to reduce risk of antibiotic resistant bacterial infections and dissemination of antibiotic resistance.

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Evaluation of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Rio Grande do Sul, Brazil

Cited by 14 publications

References 11 publications

Resistance Pattern of Carbapenem on Enterobacteriaceae

Resistance Pattern of Carbapenem on Enterobacteriaceae

Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects

Investigation of carbapenemase and mcr-1 genes in carbapenem-resistant Klebsiella pneumoniae isolates

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