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Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil.

Abstract

Increased resistance to polymyxin in Klebsiella pneumoniae (ColRKP) has been observed. Molecular epidemiology, as well as the clinical impact of these difficult to treat pathogens need to be better characterized. We present the clinical outcomes of 28 patients infected by ColRKP in a tertiary hospital. Isolates with MIC >2 by Vitek 2 were confirmed by the microdilution broth test. Polymerase chain reaction (PCR) was performed for blaKPC, blaNDM, blaOXA-48 and blamcr-1 genes in the isolates, and Whole Genome Sequencing (WGS) was performed in six isolates. Seventeen (61%) patients were female and the mean age was 50 years old. In-hospital and 30-day mortality were 64% (18/28) and 53% (15/28), respectively. Central line-associated bloodstream infection in addition to bacteremia episodes due to other sources were the most frequent (61%). Mean APACHE and Charlson comorbidity index were 16 and 5, respectively. Twenty patients (71%) received at least one active drug and ten (35%) received two drugs: tigecycline 46% (13/28); amikacin 21% (6/28) and fosfomycin 3% (1 case). Twenty-six out of 28 tested cases were positive for blaKPC. Eight different clusters were identified. Four STs were detected (ST11, ST23, ST340, and ST437). Mutations on pmrA, arnB, udg, and yciM genes were present in all six isolates submitted to WGS; lpxMand mgrB mutations were also detected in all but one isolate. In conclusion, we observed resistance to polymyxin in severely ill patients mostly from intensive care units and/or immunosuppressed patients with high mortality rates in whom a diversity of ColRKP clusters was identified and might indicate selective pressure.

Authors+Show Affiliations

Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Subcomissão de Controle de Infecção Hospitalar, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Subcomissão de Controle de Infecção Hospitalar, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Subcomissão de Controle de Infecção Hospitalar, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Subcomissão de Controle de Infecção Hospitalar, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Subcomissão de Controle de Infecção Hospitalar, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Laboratório Clínico, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Divisão de Laboratório Clínico, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM) 54, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM) 54, São Paulo, São Paulo, Brazil.Universidade de São Paulo, Instituto de Medicina Tropical de São Paulo, Laboratório de Investigação Médica (LIM) 54, São Paulo, São Paulo, Brazil. Universidade de São Paulo, Faculdade de Medicina, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31241658

Citation

Boszczowski, Icaro, et al. "Multidrug-resistant Klebsiella Pneumoniae: Genetic Diversity, Mechanisms of Resistance to Polymyxins and Clinical Outcomes in a Tertiary Teaching Hospital in Brazil." Revista Do Instituto De Medicina Tropical De Sao Paulo, vol. 61, 2019, pp. e29.
Boszczowski I, Salomão MC, Moura ML, et al. Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil. Rev Inst Med Trop Sao Paulo. 2019;61:e29.
Boszczowski, I., Salomão, M. C., Moura, M. L., Freire, M. P., Guimarães, T., Cury, A. P., ... Costa, S. F. (2019). Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil. Revista Do Instituto De Medicina Tropical De Sao Paulo, 61, pp. e29. doi:10.1590/S1678-9946201961029.
Boszczowski I, et al. Multidrug-resistant Klebsiella Pneumoniae: Genetic Diversity, Mechanisms of Resistance to Polymyxins and Clinical Outcomes in a Tertiary Teaching Hospital in Brazil. Rev Inst Med Trop Sao Paulo. 2019 Jun 19;61:e29. PubMed PMID: 31241658.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil. AU - Boszczowski,Icaro, AU - Salomão,Matias Chiarastelli, AU - Moura,Maria Luísa, AU - Freire,Maristela Pinheiro, AU - Guimarães,Thais, AU - Cury,Ana Paula, AU - Rossi,Flávia, AU - Rizek,Camila Fonseca, AU - Martins,Roberta Cristina Ruedas, AU - Costa,Silvia Figueiredo, Y1 - 2019/06/19/ PY - 2018/09/24/received PY - 2019/01/10/accepted PY - 2019/6/27/entrez PY - 2019/6/27/pubmed PY - 2019/7/16/medline SP - e29 EP - e29 JF - Revista do Instituto de Medicina Tropical de Sao Paulo JO - Rev. Inst. Med. Trop. Sao Paulo VL - 61 N2 - Increased resistance to polymyxin in Klebsiella pneumoniae (ColRKP) has been observed. Molecular epidemiology, as well as the clinical impact of these difficult to treat pathogens need to be better characterized. We present the clinical outcomes of 28 patients infected by ColRKP in a tertiary hospital. Isolates with MIC >2 by Vitek 2 were confirmed by the microdilution broth test. Polymerase chain reaction (PCR) was performed for blaKPC, blaNDM, blaOXA-48 and blamcr-1 genes in the isolates, and Whole Genome Sequencing (WGS) was performed in six isolates. Seventeen (61%) patients were female and the mean age was 50 years old. In-hospital and 30-day mortality were 64% (18/28) and 53% (15/28), respectively. Central line-associated bloodstream infection in addition to bacteremia episodes due to other sources were the most frequent (61%). Mean APACHE and Charlson comorbidity index were 16 and 5, respectively. Twenty patients (71%) received at least one active drug and ten (35%) received two drugs: tigecycline 46% (13/28); amikacin 21% (6/28) and fosfomycin 3% (1 case). Twenty-six out of 28 tested cases were positive for blaKPC. Eight different clusters were identified. Four STs were detected (ST11, ST23, ST340, and ST437). Mutations on pmrA, arnB, udg, and yciM genes were present in all six isolates submitted to WGS; lpxMand mgrB mutations were also detected in all but one isolate. In conclusion, we observed resistance to polymyxin in severely ill patients mostly from intensive care units and/or immunosuppressed patients with high mortality rates in whom a diversity of ColRKP clusters was identified and might indicate selective pressure. SN - 1678-9946 UR - https://www.unboundmedicine.com/medline/citation/31241658/Multidrug-resistant_Klebsiella_pneumoniae:_genetic_diversity,_mechanisms_of_resistance_to_polymyxins_and_clinical_outcomes_in_a_tertiary_teaching_hospital_in_Brazil L2 - http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652019005000213&lng=en&nrm=iso&tlng=en DB - PRIME DP - Unbound Medicine ER -