Risk factors for the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospitalized children

Robino, Luciana; Telechea, Héctor; Speranza, Noelia; García-Fulgueiras, Virginia; Cordeiro, Nicolás F.; Bado, Inés; Mota, María Inés; Giachetto, Gustavo; Algorta, Gabriela; Vignoli, Rafael

doi:10.3855/jidc.3014

Cited by 6 publications

(4 citation statements)

References 14 publications

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“…We analyzed associations between the different variables studied: capsular types, virulence factors, biofilm production, sequence types, ESBL, MDR phenotype, and type of infection. Nominal variables were compared using the Chi-square test for variables divided into categories [38]. A two-tailed p-value less than 0.05 was considered statistically significant.…”

Section: Discussionmentioning

confidence: 99%

Great Plasticity in a Great Pathogen: Capsular Types, Virulence Factors and Biofilm Formation in ESBL-Producing Klebsiella pneumoniae from Pediatric Infections in Uruguay

Araújo,

Papa-Ezdra,

Ávila

et al. 2024

Antibiotics

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Klebsiella pneumoniae is widely recognized as an opportunistic hospital and community pathogen. It is one of the priority microorganisms included in the ESKAPE group, and its antibiotic resistance related to extended-spectrum β-lactamases (ESBL) is a global public health concern. The multi-drug resistance (MDR) phenotype, in combination with pathogenicity factors, could enhance the ability of this pathogen to cause clinical infections. The aim of this study was to characterize pathogenicity factors and biofilm formation in ESBL-producing K. pneumoniae from pediatric clinical infections. Capsular types, virulence factors, and sequence types were characterized by PCR. Biofilm formation was determined by a semiquantitative microtiter technique. MDR phenotype and statistical analysis were performed. The K24 capsular type (27%), virulence factors related to iron uptake fyuA (35%) and kfuBC (27%), and sequence types ST14 (18%) and ST45 (18%) were the most frequently detected. Most of the strains were biofilm producers: weak (22%), moderate (22%), or strong (12%). In 62% of the strains, an MDR phenotype was detected. Strains with K24 capsular type showed an association with ST45 and the presence of fyuA; strains with kfuBC showed an association with moderate or strong biofilm production and belonging to ST14. Weak or no biofilm producers were associated with the absence of kfuBC. The MDR phenotype was associated with the main ESBL gene, blaCTX-M-15. The high plasticity of K. pneumoniae to acquire an MDR phenotype, in combination with the factors exposed in this report, could make it even more difficult to achieve a good clinical outcome with the available therapeutics.

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Section: Discussionmentioning

confidence: 99%

Great Plasticity in a Great Pathogen: Capsular Types, Virulence Factors and Biofilm Formation in ESBL-Producing Klebsiella pneumoniae from Pediatric Infections in Uruguay

Araújo,

Papa-Ezdra,

Ávila

et al. 2024

Antibiotics

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“…Until recently, and particularly in Uruguay, the most frequently detected ESBL (in varying proportions) was CTX-M-2 [12,33] . CTX-M-15 was first detected in 2006 in a general hospital [13], and in 2009, this ESBL was detected in the pediatric hospital [11].…”

Section: Discussionmentioning

confidence: 99%

Extended-spectrum β-lactamases, transferable quinolone resistance, and virulotyping in extra-intestinal E. coli in Uruguay

Vignoli

García-Fulgueiras

Cordeiro

et al. 2016

J Infect Dev Ctries

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Introduction: To characterize extended-spectrum β-lactamases (ESBLs) and plasmid-mediated quinolone resistance (PMQR) genes in Escherichia coli isolates obtained from extra-intestinal samples in three Uruguayan hospitals. Methodology: Fifty-five ESBL-producing E. coli isolates were studied. Virulence genes, ESBLs, and PMQR genes were detected by polymerase chain reaction. ESBL-producing isolates were compared by pulsed-field gel electrophoresis. Multi-locus sequence typing was also performed on 13 selected isolates. Results: Thirty-seven isolates harbored bla CTX-M-15 (67.3%), eight bla CTX-M-2 (14.6%), five bla CTX-M-14 (9.1%), three carried both bla CTX-M-2 and bla CTX-M-14 , one bla CTX-M-9 , and one bla CTX-M-8 . Among the CTX-M-15 producers, 92% belonged to sequence types ST131 and ST405, and carried aac(6')Ib-cr as well. Isolates harboring bla CTX-M-2 , bla CTX-M-14 , bla CTX-M-9 , or bla CTX-M-8 were found to be genetically unrelated. Conclusions: The successful dissemination of CTX-M-15-producing E.coli isolates seems to be linked to the spreading of high-risk clones and horizontal gene transfer. A trade-off between carrying more antibiotic resistance and less virulence-related genes could partially account for the evolutionary advantages featured by successful clones.

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“…Los microorganismos resistentes reducen significativamente los antibacterianos disponibles para su tratamiento, ya que los genes codificantes para BLEE generalmente se asocian con otros genes de resistencia antibacteriana (aminoglucósidos, quinolonas, cotrimoxazol) 22 . En el primer caso, el paciente presentó fallo al tratamiento con oxiiminocefalosporinas, dirigido a una cepa de E.coli susceptible in vitro.…”

Section: Discussionunclassified

“…Recientemente comunicamos la detección de infecciones por enterobacterias productoras de BLEE en nuestra unidad 20 . Entre los factores favorecedores de BLEE están: el consumo previo de oxiiminocefalosporinas, presencia de enfermedades crónicas de base, internación en UCI en los últimos 6 meses e infección nosocomial causada por enterobacterias 22 . Estos factores predisponen tanto para las infecciones como para la colonización digestiva con cepas portadoras de BLEE 2,23 .…”

Section: Discussionunclassified

Fallo terapéutico por resistencia antibacteriana intra-tratamiento, a propósito de dos casos clínicos

Robino¹,

Cordeiro²,

García-Fulgueiras³

et al. 2013

Rev. chil. infectol.

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Objective: We describe two cases of treatment failure due to intratreatment acquisition of antibiotic resistant microorganisms with the aim of highlighting the possible molecular mechanisms by which treatment failure occurred. Patients and Methods: We analyzed the clinical histories and the isolates obtained from 2 patients, one with a urinary tract infection (UTI) by E. coli, initially treated with cefuroxim (to which the isolate was susceptible), and another with osteoarthritis (OA) treated initially with meropenem plus vancomycin, developing K. pneumoniae susceptible to meropenem. During treatment, in both patients, resistant microorganisms were isolated, and empirical therapy was modified, initially with ceftriaxone and afterwards meropenem in case 1, and adding amikacin in case 2. Both strains (per patient) were compared by PFGE and resistance genes were sought by PCR. Results: Regarding the UTI, the initial strain acquired an IncFIB SHV-5-producing plasmid. In the OA case, the initial susceptible strain was substituted by a CTX-M-9 and AadB-AadA2-Aac(6')Ib-producing K. pneumoniae. Por otra parte, la resistencia a aminoglucósidos está mediada principalmente por la producción de enzimas que modifican su estructura.Dependiendo de la modificación de la molécula, estas enzimas se denominan adenilantes, acetilantes o fosforilantes de aminoglucósidos 9 . Los genes que codifican para dichos mecanismos frecuentemente se encuentran en elementos genéticos como integrones o trasposones, los cuales pueden encontrarse a su vez en plásmidos con la capacidad de ser transferidos entre bacterias mediante el fenómeno de conjugación 10 . La elección de un agente antimicrobiano requiere considerar factores como: patrones locales de resistencia; la identificación del agente etiológico y su perfil de susceptibilidad; las características del antimicrobiano (propiedades farmacocinéticas y farmacodinámicas, capacidad bactericida, espectro de acción, concentración en diferentes parénquimas o líquidos biológicos, forma de administración e intervalos); factores dependientes del huésped (sitio de infección, prótesis, estado de inmunidad) y el entorno en donde se adquiere la infección 11,12

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Risk factors for the acquisition of extended-spectrum beta-lactamase-producing Enterobacteriaceae in hospitalized children

Abstract: This item has no abstract. Follow the links below to access the full text.

Cited by 6 publications

References 14 publications

Great Plasticity in a Great Pathogen: Capsular Types, Virulence Factors and Biofilm Formation in ESBL-Producing Klebsiella pneumoniae from Pediatric Infections in Uruguay

Great Plasticity in a Great Pathogen: Capsular Types, Virulence Factors and Biofilm Formation in ESBL-Producing Klebsiella pneumoniae from Pediatric Infections in Uruguay

Extended-spectrum β-lactamases, transferable quinolone resistance, and virulotyping in extra-intestinal E. coli in Uruguay

Fallo terapéutico por resistencia antibacteriana intra-tratamiento, a propósito de dos casos clínicos

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