RESUMO
Thirteen (44.8%) CTX-M-2-producing K. pneumoniae clinical isolates were identified among 29 strains collected from single patients with serious infection hospitalized in an intensive care unit of a tertiary hospital located in São Paulo, Brazil. These isolates belonged to 9 different typing clusters and showed great diversity of plasmid content. Their bla(CTX-M-2)was carried in an ISCR1/sul1-type integron structure located in transferable plasmids of different sizes or in the chromosome.
Assuntos
Infecção Hospitalar/epidemiologia , Unidades de Terapia Intensiva , Infecções por Klebsiella/epidemiologia , beta-Lactamases/genética , Southern Blotting , Brasil , Infecção Hospitalar/genética , Farmacorresistência Bacteriana Múltipla/genética , Humanos , Infecções por Klebsiella/genética , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/isolamento & purificação , Testes de Sensibilidade Microbiana , Plasmídeos , Reação em Cadeia da Polimerase , PrevalênciaRESUMO
INTRODUCTION: Klebsiella pneumoniae is of high prevalence in hospital infections, mainly in bloodstream infections (BSI), and some produce extended-spectrum beta-lactamase (ESBL). For hospitals with a high prevalence of strains producing this enzyme, there is no reference material to show whether the use of the E-test method for their detection, which can be quite expensive, is actually required. OBJECTIVE: To evaluate the cost-benefit of the disk diffusion and E-test methods for the detection of ESBL-producing K. pneumoniae strains in hospitals where a high prevalence of this resistance mechanism in BSI is found. METHODS: One hundred and eight patients with K. pneumoniae BSI were evaluated retrospectively. ESBL-producing strains were identified by the disk diffusion method and by the E-test method. We estimated the costs of both diagnostic methods based on antimicrobial therapy adequacy. RESULTS: Fifty-two percent of K. pneumoniae infections were due to ESBL-producing strains. The disk diffusion method yielded a positive predictive value (PPV) of 94.7% (95% CI: 88.9-100%) and a negative predictive value (NPV) of 96.1% (CI 95%: 90.8-101.4%) in relation to the E-test. We evaluated cost-effectiveness, i.e., we analyzed the cost of both E-test and disk diffusion methods with carbapenem and cephalosporins, and found that the use of the disk diffusion method accounts for approximately US$3300. CONCLUSIONS: In hospitals with a high prevalence of ESBL-producing strains, the disk diffusion method can be used to detect ESBL-producing K. pneumoniae without compromising the clinical progression of patients with BSI. The E-test showed higher accuracy but this method was more expensive than the disk diffusion method. However, the use of the E-test method was demonstrated to be more cost-effective, as we evaluated cost based on antimicrobial therapy adequacy.
