medigraphic.com
Revista Latinoamericana de Microbiología

2001, Number 2

<< Back Next >>

Microbiología 2001; 43 (2)

Molecular epidemiology of extended-spectrum Β-Lactamase-producing Klebsiella pneumoniae isolated from neonatal intensive care unit patients involved in hospital infection cases in Rio de Janeiro, Brazil

Martins-Loureiro M, Aguiar MB, Lorenzato-Furtado MV, Rocha-Quadra MR, Santos-Pinheiro G, Dutra-Asensi M

Language: English
References: 40
Page: 88-95
PDF size: 144.89 Kb.


ABSTRACT

During a two years period, in this study was analyzed the demographic and bacteriologic data of 42 hospitalized newborns attempted by extended-spectrum Β-lactamase-producing Klebsiella pneumoniae sepsis in a neonatal intensive care unit of a public maternity hospital in Rio de Janeiro, Brazil. The newborns mean age was 10.4 days, with a major prevalence of hospital infection in males (55.0%) than females (45.0%), and a major frequency in vaginal delivery (65.0%) than cesarean delivery (35.0%). 31 patients (77.5%) received a mean of 3 antimicrobials during a 7.9 days before positive blood cultures. The most important underlying risk conditions were prematurely (87.5%), very low birth weight (55.0%) and asphyxia (40.0%). Among the isolated strains were detected high resistance proportion to ß-lactams, aminoglycosides, chloramphenicol and trimethoprim-sulfamethoxazole. 6 distinct clones in a cluster of 42 epidemiologically related strains were detected through PFGE profiles. The isolated strains presented 9 different antimicrobial resistance profiles (ARPs), where the most frequent clones (A, B and D) were distributed in 5, 3 and 5 ARPs, respectively. Based in the PFGE profiles and isolation periods, apparently the clones A plus A1, B and D caused 3 distinct outbreaks during the study period.


REFERENCES

  1. Ardanuy, C., J. Liñares, M. A. Domínguez, S. Hernández-Allés, V. J. Benedí, and L. Martínez-Martínez. 1998. Outer membrane profiles of clonally related Klebsiella pneumoniae isolates from clinical samples and activities of cephalosporins and carbapenens. Antimicrob. Agents Chemother. 42:1636-1640.

  2. Barroso, H., A. Freitas-Vieira, L. M. Lito, J. M. Cristino, M. J Salgado, H. F Neto, J. C. Sousa, G. Soveral, T. Moura, and A. Duarte. 2000. Survey of Klebsiella pneumoniae producing extended-spectrum ß-lactamases at a Portuguese hospital: TEM-10 as the endemic enzyme. J. Antimicrob. Chemother. 45:611-616.

  3. Branger, C., B. Bruneau, A. L. Lesimple, P. J. M. Bouvet, P. Berry, J. Sevali-Garcia, and N. Lambert-Zechovsky. 1997. Epidemiological typing of extended-spectrum ß-lactamase-producing Klebsiella pneumoniae isolates responsible for five outbreaks in a university hospital. J. Hosp. Infect. 36:23-36.

  4. Cordero, L., M. Sananes, and L. W. Ayers. 1999. Bloodstream infections in a neonatal intensive-care unit: 12 years’ experience with an antibiotic control program. Infect. Control Hosp. Epidemiol. 20:242-246.

  5. Decré, D., B. Gachot, J. C. Lucet, G. Arlet, E. Bergogne-Bérézin, and B. Régnier. 1998. Clinical and bacteriologic epidemiology of extended-spectrum ß-lactamase-producing strains of Klebsiella pneumoniae in a medical intensive care unit. Clin. Infect. Dis. 27:834-844.

  6. Digranes, A., C. A. Solberg, H. Sjurgesen, E. Skovlund, and J. Sander. 1997. Antibiotic susceptibility of blood culture isolates of Enterobacteriaceae from six Norwegian hospitals 1991-1992. APMIS. 105:854-860.

  7. Ewing, W. H. 1986. Edwards and Ewing’s identification of Enterobacteriaceae. Elsevier, New York.

  8. French, G. L., K. P. Shannon, and N. Simmons. 1996. Hospital outbreak of Klebsiella pneumoniae resistant to broad-spectum cephalosporins and ß-Lactam-ß-Lactamase inhibitor combinations by hyperproduction of SHV-5 ß-Lactamase. J. Clin. Microbiol. 34:358-363.

  9. Garner, J. S., W. R. Jarvis, T. G. Emori, T. C. Horan,and J. M. Hughers. 1988. CDC definitions for nosocomial infections. Am. J. Infect. Control 16:128-140.

  10. Gazouli, M., M. E. Kaufmann, E. Tzelepi, H. Dimopoulou, O. Paniara, and L. S. Tzouvelekis. 1997. Study of an outbreak of cefoxitin-resistant Klebsiella pneumoniae in a general hospital. J. Clin. Microbiol. 35:508-510.

  11. Gouby, A., C. Neuwirth, G. Bourg, N. Bouziges, M. J. Carles-Nurit, E. Despaux, and M. Ramuz. 1994. Epidemiological study by Pulsed-Field Gel Electrophoresis of an outbreak of extended-spectrum ß-lactamase-producing Klebsiella pneumoniae in geriatric hospital. J. Clin. Microbiol. 32:301-305.

  12. Hambraeus, A., A. Lagerqvist-Widh, U. Zettersten, S. Engberg, G. Sedin, and L. Sjöberg. 1991. Spread of Klebsiella in neonatal ward. Scand. J. Infect. Dis. 23:189-194.

  13. Hanberger, H., J. A. Garcia-Rodriguez, M. Gobernado, H. Goossens, L. E. Nilsson, M. J. Struelens and the French and Portuguese ICU Study Groups. 1999. Antibiotic susceptibility among aerobic Gram-negative bacilli in intensive care units in 5 European countries. JAMA. 281:67-71.

  14. Hernández-Allés, S., V. J. Benedí, L. Martínez-Martínez, A. Pascual, A. Aguilar, J. M. Tomás, and S. Albertí. 1999. Development of resistance during antimicrobial therapy caused by insertion sequence interruption of porin genes. Antimicrob. Agents Chemother. 43:937-939.

  15. Hernández-Allés, S., M. C. Conejo, A. Pascual, J. M. Tomás, V. J. Benedí, and L. Martínez-Martínez. 2000. Relationship between outer membrane alterations and susceptibility to antimicrobial agents in isogenic strains of Klebsiella pneumoniae. J. Antimicrob. Chemother. 46:273-277.

  16. Jacoby, G. A., and P. Han. 1996. Detection of extended-spectrum ß-lactamases in clinical isolates of Klebsiella pneumoniae and Escherichia coli. J. Clin. Microbiol. 34:908-911.

  17. Jamal, W. Y., K. El-Din, V. O. Rotimi, and T. D. Chugh. 1999. An analysis of hospital-acquired bacteraemia in intensive care unit patients in university hospital in Kuwait. J. Hosp. Infect. 43: 49-56.

  18. Kim, J., Y. Kwon, H. Pai, J-W. Kim, and D-T. Cho. 1998. Survey of Klebsiella pneumoniae strains producing extended-spectrum ß- lactamases: prevalence of SHV-12 and SHV-2a in Korea. J. Clin. Microbiol. 36:1446-1449.

  19. Leroyer, A., A. Bedu, P. Lombrail, L. Desplanques, B. Diakite, E. Bingen, Y. Aujard, and M. Brodin. 1997. Prolongation of hospital stay and extra costs due to hospital-acquired infection in a neonatal unit. J. Hosp. Infect. 35:37-45.

  20. Lhopital, S., S. Bonacorsi, D. Meis, N. Brahimi, S. Mathy, J. Navarro, Y. Aigrain, and E. Bingen. 1997. Molecular markers for differentiation of multiresistant Klebsiella pneumoniae isolates in a pediatric hospital. Infect. Control Hosp. Epidemiol. 18:743-748.

  21. Linder, N., R. Dagan, J. Kuint, N. Keler, G. Keren, and B. Reichman. 1994. Ventriculitis caused by Klebsiella pneumoniae successfully treated with perfloxacin in a neonate. Infection, 22:60-62.

  22. Lipuma, J. J. 1998. Molecular tools for epidemiologic study of infectious diseases. Pediatr. Infect. Dis. J. 17:667-675.

  23. Livermore, D. M., and M. Yuan. 1996. Antibiotic resistance and production of extended-spectrum ß-lactamases amongst Klebsiella spp. from intensive care units in Europe. J. Antim. Chemoter. 38: 409-424.

  24. Livrelli, V., C. Champs, P. Martino, A. Darfeuille-Michaud, C. Forestier, and B. Joly. 1996. Adhesive properties and antibiotic resistance of Klebsiella, Enterobacter, and Serratia clinical isolates involved in nosocomial infections. J. Clin. Microbiol. 34:1963-1969.

  25. Liu, P. Y. F., J. C. Tung, S. C. Ke, and S. L. Chen. 1998. Molecular epidemiology of extended-spectrum ß-lactamase-producing Klebsiella pneumoniae isolates in a district hospital in Taiwan. J. Clin. Microbiol. 36:2759-2762.

  26. Loureiro, M. M., B. A. de Moraes, M. R. R. Quadra, G. S. Pinheiro, P. N. Suffys, and M. D. Asensi. 2000. Molecular epidemiology of methicillin resistant Staphylococcus aureus isolated from newborns in a hospital in Rio de Janeiro, Brazil. Mem. Inst. Oswaldo Cruz. 95: 776-782.

  27. Martínez-Martínez, L., S. Hernández-Allés, S. Albertí, J. M. Tomás, V. J. Benedi, and G. A. Jacoby. 1996. In vivo selection of porin-deficient mutants of Klebsiella pneumoniae with increased resistance to cefoxitin and expanded-spectrum cephalosporins. Antimicrob. Agents Chemother. 40:342-348.

  28. Monnet, D. L., J. W. Biddle, J. R. Edwards, D. H. Culver, J. S. Tolson, W. J. Martone, F. C. Tenover, R. P. Gaynes, and the National Nosocomial Infections Surveillance System. 1997. Evidence of interhospital transmission of extended-spectrum ß-lactam-resistant Klebsiella pneumoniae in the United States, 1986 to 1993. Infect. Control Hosp. Epidemiol.18: 492-498.

  29. National Committee for Clinical Laboratory Standards. 1997. Performance Standards for Antimicrobial Susceptibility Testing. Document M7-A4. Villanova, PA: NCCLS.

  30. Pitout, J. D. D., K. S. Thomson, N. D. Hanson, A. F. Ehrhardt, E. S. Moland, and C. C. Sanders. 1998. ß-lactamases responsible for resistance to expanded-spectrum cephalosporins in Klebsiella pneumoniae, Escherichia coli and Proteus mirabilis isolates recovered in South Africa. Antimicrob. Agents Chemother. 42:1350-1354.

  31. Prodinger, W. M., M. Fille, A. Bauernfeind, I. Stemplingler, S. Amann, B. Pfausler, C. Lass-Flörl, and M. P. Dierich. 1996. Molecular epidemiology of Klebsiella pneumoniae producing SHV-5 ß-lactamase: parallel outbreaks due to multiple plasmid transfer. J. Clin. Microbiol. 34:564-568.

  32. Rojo, D., A. Pinedo, E. Clavijo, A. García-Rodriguez, and V. García. 1999. Analysis of risk factors associated with nosocomial bacteraemias. J. Hosp. Infect. 42:135-141.

  33. Royle, J., S. Halasz, G. Eagles, G. Gilbert, D. Dalton, P. Jelfs, and D. Isaacs. 1999. Outbreak of extended spectrum b lactamase producing Klebsiella pneumoniae in a neonatal unit. Arch. Dis. Child. Fetal Neonatal. 80:64-F68.

  34. Sader, H. S. 2000. Antimicrobial resistance in Brazil: comparison of results from two multicenter studies. BJID 4:91-99.

  35. Sader, H. S., M. A. Pfaller, R. N. Jones, G. V. Doern, A. C. Gales, P. L. Winokur, K. C. Kugler, and The SENTRY Latin American Study Group. 1999. Bacterial pathogens isolated from patients with bloodstream infections in Latin America, 1997: frequency of occurrence and antimicrobial susceptibility patterns from the SENTRY Antimicrobial Surveillance Program. BJID. 3:97-110.

  36. Sader, H. S., A. C. Pignatari, R. Hollis, and R. N. Jones. 1994. Evaluation of interhospitalary spread of methicillin-resistant Staphylococcus aureus in São Paulo, Brazil, using pulsed field gel electrophoresis of chromosomal DNA. Infect. Control Hosp. Epidemiol. 15:320-323.

  37. Schumacher, H., U. Skibsted, D. S. Hansen, and J. Scheibel. 1997. Cefuroxime resistance in Klebsiella pneumoniae. APMIS. 105:708-716.

  38. Tenover, F. C., R. D. Airbeit, R. V. Goering, P. A. Mickelsen, B. E. Murray, D. H. Persing, and B. Swaminathan. 1995. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: Criteria for bacterial strain typing. J. Clin. Microbiol. 33:2233-2239.

  39. Van der Zwet, W. C., G. A. Parlevliet, P. H. M. Savelkoul, J. Stoof, A. M. Kaiser, J. G. M. Koeleman, and C.M. J. E. Vandenbroucke-Grauls. 1999. Nosocomial outbreak of gentamicin-resistant Klebsiella pneumoniae in a neonatal intensive care unit controlled by a change in antibiotic policy. J. Hosp. Infect. 42:295-302.

  40. Xiang, X., K. Shannon and G. French. 1997. Mechanism and stability of hyperproduction of the extended-spectrum ß-lactamase SHV-5 in Klebsiella pneumoniae. J. Antim. Chemoter. 40:525-532.




2020     |     www.medigraphic.com