Clones de alto riesgo de Klebsiella pneumoniae productores de BLEE que colonizan pacientes de UCI en Natal, noreste de Brasil
DOI:
https://doi.org/10.17058/reci.v13i3.18307Palabras clave:
Klebsiella pneumoniae, Unidad de Cuidados Intensivos, Control de infección, Resistencia a las drogas, Beta-lactamasasResumen
Justificación y objetivos: la colonización por Klebsiella pneumoniae productora de β-lactamasas de espectro extendido (BLEE) en pacientes de Unidades de Cuidados Intensivos (UCI) se considera un factor de riesgo para infecciones, y se presenta como una fuente de propagación de estas cepas en instalaciones hospitalarias. Este estudio tuvo como objetivo realizar la caracterización genética de aislamientos de K. pneumoniae productores de BLEE recuperados de hisopos de vigilancia en una UCI en el noreste de Brasil. Métodos: los aislamientos se recuperaron entre 2018-2019 de sitios nasales, axilares y rectales de 24 pacientes ingresados en la UCI. La identificación bacteriana se realizó mediante pruebas bioquímicas tradicionales. La susceptibilidad antimicrobiana se evaluó mediante difusión en disco, y el fenotipo BLEE se detectó mediante la prueba de sinergia de doble-disco. La polymerase chain reaction (PCR) para los genes blaCTX-M, blaSHV y blaTEM, PFGE y MLST se llevaron a cabo en aislamientos representativos. Resultados: se recuperaron 27 aislamientos de 18 pacientes (75%). La producción de ESBL se detectó en 85% de los aislamientos. La resistencia a ciprofloxacino, sulfametoxazol/trimetoprima y a la mayoría de los β-lactámicos evaluados fue recurrente, excepto a los carbapenémicos. Los genes blaSHV, blaTEM y blaCTX-M se encontraron en alta frecuencia, y se identificaron los grupos CTX-M-(1, 2 y 9). Se describieron siete sequence types (ST11, ST14, ST17, ST395, ST709, ST855 y ST3827), la mayoría consideradas de alto riesgo. Conclusión: estos hallazgos enfatizan la amenaza potencial de los clones de alto riesgo bien establecidos en una UCI, y resaltan la importancia de monitorear estos clones para prevenir infecciones.
Descargas
Citas
Martin RM, Cao J, Brisse S, et al. Molecular Epidemiology of Colonizing and Infecting Isolates of Klebsiella pneumoniae. mSphere. 2016;19;1(5):e00261-16. https://doi.org/10.1128/mSphere.00261-16
Vock I, Tschudin-Sutter S. Persisting intrahospital transmission of multidrug-resistant Klebsiella pneumoniae and challenges for infection control. Infect Control Hosp Epidemiol, 2019;40(8):904-9. https://doi.org/10.1017/ice.2019.153
Agência Nacional de Vigilância Sanitária – ANVISA. Boletim Segurança do Paciente e Qualidade em Serviços de Saúde. nº 23 - Avaliação Nacional dos indicadores de IRAS e RM – 2020, https://www.gov.br/anvisa/pt-br/centraisdeconteudo/publicacoes/servicosdesaude/publicacoes; 2020 [accessed 16 March 2022].
Viale P, Giannella M, Lewis R, et al. Predictors of mortality in multidrug-resistant Klebsiella pneumoniae bloodstream infections. Expert Rev Anti Infect Ther. 2013;11(10):1053-63. https://doi.org/10.1586/14787210.2013.836057
Karlowsky JA, Lob SH, DeRyke CA, et al. Prevalence of ESBL non-CRE Escherichia coli and Klebsiella pneumoniae among clinical isolates collected by the SMART global surveillance programme from 2015 to 2019. Int J Antimicrob Agents. 2022;59(3):106535. https://doi.org/10.1016/j.ijantimicag.2022.106535
Gorrie CL, Mirceta M, Wick RR, et al. Gastrointestinal Carriage Is a Major Reservoir of Klebsiella pneumoniae Infection in Intensive Care Patients. Clin Infect Dis. 2017;15;65(2):208-15. https://doi.org/10.1093/cid/cix270
Navon-Venezia S, Kondratyeva K, Carattoli A. Klebsiella pneumoniae: a major worldwide source and shuttle for antibiotic resistance. FEMS Microbiol Rev. 2017;41(3):252-75. https://doi.org/10.1093/femsre/fux013
Dorman MJ, Short FL. Genome watch: Klebsiella pneumoniae: when a colonizer turns bad. Nat Rev Microbiol. 2017;15(7):384. https://doi.org/10.1038/nrmicro.2017.64
BRASIL. Agência Nacional de Vigilância Sanitária - ANVISA. Microbiologia Clínica para o Controle de Infecção Relacionada à Assistência à Saúde. Módulo 6: Detecção e identificação de bactérias de importância médica Brasília: 1. ed. Brasília: ANVISA; 2010.
Clinical and Laboratory Standards Institute (CLSI): Performance Standards for antimicrobial susceptibility testing; thirtieth informational supplement. CLSI document M100-S30. Wayne, PA.
Clinical and Laboratory Standards Institute (CLSI): Performance Standards for antimicrobial susceptibility testing; twenty-sixth informational supplement. CLSI document M100-S26. Wayne, PA.
Edelstein M, Pimkin M, Palagin I, et al. Prevalence and molecular epidemiology of CTX-M extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae in Russian hospitals. Antimicrob Agents Chemother. 2003;47(12):3724-32. https://doi.org/10.1128/AAC.47.12.3724-3732.2003
Minarini LA, Gales AC, Palazzo IC, et al. Prevalence of community-occurring extended spectrum beta-lactamase-producing Enterobacteriaceae in Brazil. Curr Microbiol. 2007;54(5):335-41. https://doi.org/10.1007/s00284-006-0307-z
Reich F, Atanassova V, Klein G. Extended-spectrum β-lactamase- and AmpC-producing enterobacteria in healthy broiler chickens, Germany. Emerg Infect Dis. 2013;19(8):1253-9. https://doi.org/10.3201/eid1908.120879
Hansen DS, Skov R, Benedí JV, et al. Klebsiella typing: pulsed-field gel electrophoresis (PFGE) in comparison with O:K-serotyping. Clin Microbiol Infect. 2002;8(7):397-404. https://doi:10.1046/j.1469-0691.2002.00411.x
Heras J, Domínguez C, Mata E, et al. GelJ--a tool for analyzing DNA fingerprint gel images. BMC Bioinformatics. 2015;26;16:270. https://doi.org/10.1186/s12859-015-0703-0
Aires CAM, Pereira PS, Rocha-de-Souza CM, et al. Population Structure of KPC-2-Producing Klebsiella pneumoniae Isolated from Surveillance Rectal Swabs in Brazil. Microb Drug Resist. 2020;26(6):652-60. https://doi.org/10.1089/mdr.2019.0166
Ebrahimi F, Mózes J, Monostori J, et al. Comparison of rates of fecal colonization with extended-spectrum beta-lactamase-producing enterobacteria among patients in different wards, outpatients and medical students. Microbiol Immunol. 2016;60(5):285-94. https://doi.org/10.1111/1348-0421.12373
Calfee D, Jenkins SG. Use of active surveillance cultures to detect asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care unit patients. Infect Control Hosp Epidemiol. 2008;29(10):966-8. https://doi.org/10.1086/590661
Maroncle N, Rich C, Forestier C. The role of Klebsiella pneumoniae urease in intestinal colonization and resistance to gastrointestinal stress. Res Microbiol. 2006;157(2):184-93. https://doi.org/10.1016/j.resmic.2005.06.006
Robberts FJ, Kohner PC, Patel R. Unreliable extended-spectrum beta-lactamase detection in the presence of plasmid-mediated AmpC in Escherichia coli clinical isolates. J Clin Microbiol. 2009;47(2):358-61. https://doi.org/10.1128/JCM.01687-08
Zahar JR, Blot S, Nordmann P, et al. Screening for Intestinal Carriage of Extended-spectrum Beta-lactamase-producing Enterobacteriaceae in Critically Ill Patients: Expected Benefits and Evidence-based Controversies. Clin Infect Dis. 2019;30;68(12):2125-30. https://doi.org/10.1093/cid/ciy864
Castanheira M, Simner PJ, Bradford PA. Extended-spectrum β-lactamases: an update on their characteristics, epidemiology and detection. JAC Antimicrob Resist. 2021;16;3(3):dlab092. https://doi.org/10.1093/jacamr/dlab092
Sánchez-López J, Cantón R. Current status of ESKAPE microorganisms in Spain: Epidemiology and resistance phenotypes. Rev Esp Quimioter. 2019;32 Suppl 2(Suppl 2):27-31.
Lee AHY, Porto WF, de Faria C Jr, et al. Genomic insights into the diversity, virulence and resistance of Klebsiella pneumoniae extensively drug resistant clinical isolates. Microb Genom. 2021;7(8):000613. https://doi.org/10.1099/mgen.0.000613
Rodrigues YC, Lobato ARF, Quaresma AJPG, et al. The Spread of NDM-1 and NDM-7-Producing Klebsiella pneumoniae Is Driven by Multiclonal Expansion of High-Risk Clones in Healthcare Institutions in the State of Pará, Brazilian Amazon Region. Antibiotics (Basel). 2021;14;10(12):1527. https://doi.org/10.3390/antibiotics10121527
Rodrigues C, Hauser K, Cahill N, et al. High Prevalence of Klebsiella pneumoniae in European Food Products: a Multicentric Study Comparing Culture and Molecular Detection Methods. Microbiol Spectr. 2022;23;10(1):e0237621. https://doi.org/10.1128/spectrum.02376-21
Cerdeira L, Monte DFM, Fuga B, et al. Genomic insights of Klebsiella pneumoniae isolated from a native Amazonian fish reveal wide resistome against heavy metals, disinfectants, and clinically relevant antibiotics. Genomics. 2020;112(6):5143-46. https://doi.org/10.1016/j.ygeno.2020.09.015
##submission.downloads##
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2023 Isabela Maria Fortaleza Neves Bomfim, Marcileide Almeida Amaral, Yan Corrêa Rodrigues, Dra. Danielle Murici Brasiliense, Caio Augusto Martins Aires, Renato Motta Neto
Esta obra está bajo una licencia internacional Creative Commons Atribución 4.0.
The author must state that the paper is original (has not been published previously), not infringing any copyright or other ownership right involving third parties. Once the paper is submitted, the Journal reserves the right to make normative changes, such as spelling and grammar, in order to maintain the language standard, but respecting the author’s style. The published papers become ownership of RECI, considering that all the opinions expressed by the authors are their responsibility. Because we are an open access journal, we allow free use of articles in educational and scientific applications provided the source is cited under the Creative Commons CC-BY license.
