Multidrug resistance genes, including blaKPC and blaCTX-M-2, among Klebsiella pneumoniae isolated in Recife, Brazil

Abstract

Introduction:The prevalence of cephalosporins and carbapenem-resistant Klebsiella pneumoniae strains is rising in Brazil, with potential serious consequences in terms of patients' outcomes and general care. Methods: This study characterized 24 clinical isolates of K. pneumoniae from two hospitals in Recife, Brazil, through the antimicrobial susceptibility profile, analyses of β-lactamase genes (bla TEM, bla SHV, bla CTX-M , bla KPC , bla VIM , bla IMP, and bla SPM ), plasmidial profile and ERIC-PCR (Enterobacterial repetitive intergenic consensus-polymerase chain reaction). Results: ERIC-PCR and plasmidial analysis grouped the isolates in 17 and 19 patterns, respectively. Six isolates from one hospital presented the same pattern by ERIC-PCR, indicating clonal dissemination. All isolates presented bla SHV , 62.5% presented bla CTX-M-2 , 29% bla TEM , and 41.7% bla KPC . Metallo-β-lactamase genes bla VIM , bla IMP, and bla SPM were not detected. Eleven isolates were identified carrying at least 3 β-lactamase studied genes, and 2 isolates carried bla SHV, bla TEM , bla CTX-M-2 , and bla KPC simultaneously. Conclusions: The accumulation of resistance genes in some strains, observed in this study, imposes limitations in the therapeutic options available for the treatment of infections caused by K. pneumoniae in Recife, Brazil. These results should alert the Brazilian medical authorities to establish rigorous methods for more efficiently control the dissemination of antimicrobial resistance genes in the hospital environment.

Investigation of class 1 integrons in Klebsiella pneumoniae clinical and microbiota isolates belonging to different phylogenetic groups in Recife, State of Pernambuco

“…We also observed that the frequency and diversity of class 1 integrons in the K. pneumoniae clinical isolates in Recife increased between 1998 and 1999 and between 2007 and 2008. This result is consistent with the observed rapid dissemination of beta-lactamase genes along with resistance to extended-spectrum cephalosporins and carbapenems among K. pneumoniae clinical isolates in Recife in recent years 35 . In this study, the diversity of class 1 integrons in K. pneumoniae isolates from Recife, Brazil favors the dissemination of resistance among K. pneumoniae and other species in the hospital environment.…”

Detection of bla KPC-2 in Proteus mirabilis in Brazil

“…Until 2005, the geographical distribution of these enzymes in members of the family Enterobacteriaceae -K. pneumoniae, in particular -was limited to the eastern part of the United States. In Brazil, KPC has been described since 2006, and it was fi rst reported in K. pneumoniae isolates from Recife (2) , followed by reports (3) in other species from the Enterobacteriaceae and non-fermenting bacilli (4) (5) (6) . Carbapenem resistance in Proteus mirabilis caused by KPC-2 was also fi rst reported in the United States (7) in 2008, and currently, there are a few reports of P. mirabilis KPC producers worldwide (8) (9) .…”

“…Plasmid DNA was extracted by the UltraClean Endotoxin-Free Mini Plasmid Prep Kit (Mo Bio Lab, Carlsbad, CA, USA) and was visualized and analyzed by electrophoresis on a 0.7% agarose gel. The molecular weight of each plasmid was determined by comparison with plasmids of known molecular weight, e.g., with that of K. pneumoniae K16-P strain (3) . Five plasmids with estimated molecular sizes of >150kb, 150kb, 120kb, 90kb, and 70kb were identifi ed in the isolate.…”

“…Five plasmids with estimated molecular sizes of >150kb, 150kb, 120kb, 90kb, and 70kb were identifi ed in the isolate. Genes bla KPC, bla VIM, bla IMP, bla SPM , bla GES , bla SHV , bla TEM , and bla CTX-M were analyzed by PCR using genomic DNA and specific primers (3) . bla VIM , bla IMP , bla SPM , bla GES , bla CTM-M , and bla SHV were not present, while bla KPC and bla TEM were detected, amplifying fragments of approximately 1,000bp .…”

Ecological competition and the incidence of Acinetobacter baumannii bloodstream infections in a teaching hospital in Southeastern Brazil

“…Such an understanding of these relationships may also further our understanding of the behavior of endemic pathogens (e.g., A. baumannii) when challenged with the introduction of emerging agents (e.g., carbapenem-resistant enterobacteria) 25,26 . Our study found a negative association between the incidence of A. baumannii and the incidences of both S. aureus and Enterobacter spp.…”