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 tertia...
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ftdoajarticles:oai:doaj.org/article:9e0242546dc746a6854392e46f20116f 2024-09-09T19:27:32+00:00 Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil Icaro Boszczowski Matias Chiarastelli Salomão Maria Luísa Moura Maristela Pinheiro Freire Thais Guimarães Ana Paula Cury Flávia Rossi Camila Fonseca Rizek Roberta Cristina Ruedas Martins Silvia Figueiredo Costa https://doi.org/10.1590/s1678-9946201961029 https://doaj.org/article/9e0242546dc746a6854392e46f20116f EN eng Universidade de São Paulo (USP) http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652019005000213&lng=en&tlng=en https://doaj.org/toc/1678-9946 1678-9946 doi:10.1590/s1678-9946201961029 https://doaj.org/article/9e0242546dc746a6854392e46f20116f Revista do Instituto de Medicina Tropical de São Paulo, Vol 61 Colistin resistance Hospital epidemiology Antibiotic therapy Genome sequencing Polymyxins Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 article ftdoajarticles https://doi.org/10.1590/s1678-9946201961029 2024-08-05T17:49:30Z 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. Article in Journal/Newspaper Arctic Directory of Open Access Journals: DOAJ Articles Arctic Revista do Instituto de Medicina Tropical de São Paulo 61 |
institution |
Open Polar |
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Directory of Open Access Journals: DOAJ Articles |
op_collection_id |
ftdoajarticles |
language |
English |
topic |
Colistin resistance Hospital epidemiology Antibiotic therapy Genome sequencing Polymyxins Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
spellingShingle |
Colistin resistance Hospital epidemiology Antibiotic therapy Genome sequencing Polymyxins Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 Icaro Boszczowski Matias Chiarastelli Salomão Maria Luísa Moura Maristela Pinheiro Freire Thais Guimarães Ana Paula Cury Flávia Rossi Camila Fonseca Rizek Roberta Cristina Ruedas Martins Silvia Figueiredo Costa Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil |
topic_facet |
Colistin resistance Hospital epidemiology Antibiotic therapy Genome sequencing Polymyxins Arctic medicine. Tropical medicine RC955-962 Infectious and parasitic diseases RC109-216 |
description |
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. |
format |
Article in Journal/Newspaper |
author |
Icaro Boszczowski Matias Chiarastelli Salomão Maria Luísa Moura Maristela Pinheiro Freire Thais Guimarães Ana Paula Cury Flávia Rossi Camila Fonseca Rizek Roberta Cristina Ruedas Martins Silvia Figueiredo Costa |
author_facet |
Icaro Boszczowski Matias Chiarastelli Salomão Maria Luísa Moura Maristela Pinheiro Freire Thais Guimarães Ana Paula Cury Flávia Rossi Camila Fonseca Rizek Roberta Cristina Ruedas Martins Silvia Figueiredo Costa |
author_sort |
Icaro Boszczowski |
title |
Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil |
title_short |
Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil |
title_full |
Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil |
title_fullStr |
Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil |
title_full_unstemmed |
Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil |
title_sort |
multidrug-resistant klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in brazil |
publisher |
Universidade de São Paulo (USP) |
url |
https://doi.org/10.1590/s1678-9946201961029 https://doaj.org/article/9e0242546dc746a6854392e46f20116f |
geographic |
Arctic |
geographic_facet |
Arctic |
genre |
Arctic |
genre_facet |
Arctic |
op_source |
Revista do Instituto de Medicina Tropical de São Paulo, Vol 61 |
op_relation |
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0036-46652019005000213&lng=en&tlng=en https://doaj.org/toc/1678-9946 1678-9946 doi:10.1590/s1678-9946201961029 https://doaj.org/article/9e0242546dc746a6854392e46f20116f |
op_doi |
https://doi.org/10.1590/s1678-9946201961029 |
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Revista do Instituto de Medicina Tropical de São Paulo |
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61 |
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