Prolonged Outbreak of Carbapenem and Colistin-Resistant Klebsiella pneumoniae at a Large Tertiary Hospital in Brazil.

Multidrug-resistant gram-negative bacteria, such as carbapenem and colistin-resistant Klebsiella pneumoniae (ColR-CRKP), represent a major problem for health systems worldwide and have high lethality. This study investigated the genetic relationship, antimicrobial susceptibility profile, and resistance mechanisms to ColR-CRKP isolates from patients infected/colonized in a tertiary hospital in Salvador, Bahia/Brazil. From September 2016 to January 2018, 46 patients (56 ColR-CRKP positive cultures) were enrolled in the investigation but clinical and demographic data were obtained from 31 patients. Most of them were men (67.7%) and elderly (median age of 62 years old), and the median Charlson score was 3. The main comorbidities were systemic arterial hypertension (38.7%), diabetes (32.2%), and cerebrovascular disease (25.8%). The average hospitalization stay until ColR-CRKP identification in days were 35.12. A total of 90.6% used mechanical ventilation and 93.7% used a central venous catheter. Of the 31 patients who had the data evaluated, 12 had ColR-CRKP infection, and seven died (58.4%). Previous use of polymyxins was identified in 32.2% of the cases, and carbapenems were identified in 70.9%. The minimum inhibitory concentration (MIC) for colistin was > 16 µg/mL, with more than half of the isolates (55%) having a MIC of 256 µg/mL. The bla KPC gene was detected in 94.7% of the isolates, bla NDM in 16.0%, and bla GES in 1.7%. The bla OXA-48, bla VIM, and bla IMP genes were not detected. The mcr-1 test was negative in all 56 isolates. Alteration of the mgrB gene was detected in 87.5% (n = 49/56) of the isolates, and of these, 49.0% (24/49) had alteration in size probably due to IS903B, 22.4% (11/49) did not have the mgrB gene detected, 20.4% (10/49) presented the IS903B, 6.1% (3/49) had a premature stop codon (Q30*), and 2.1% (1/49) presented a thymine deletion at position 104 - 104delT (F35fs). The PFGE profile showed a monoclonal profile in 84.7% of the isolates in different hospital sectors, with ST11 (CC-258) being the most frequent sequence type. This study presents a prolonged outbreak of ColR-CRKP in which 83.9% of the isolates belonged to the same cluster, and 67.6% of the patients evaluated had not used polymyxin, suggesting the possibility of cross-transmission of ColR-CRKP isolates.

Oral and tracheal microbiota of pediatric and adolescent patients in an intensive care unit.

OBJECTIVE: To characterize the oral and tracheal microbiota of patients admitted to a pediatric intensive care unit (PICU). METHODS AND RESULTS: This is an exploratory study conducted on patients aged 5 months to 13 years admitted to the PICU of a referral hospital. Two microbiological samples were collected with a swab in the posterior region of the tongue from patients receiving spontaneous and mechanical ventilation within the first 24 and 48 h after admission to the PICU. Among patients receiving mechanical ventilation, tracheal secretion was also collected in a second sampling. The caries experience was evaluated using the DMFT/dmf index, and the quality of oral hygiene was assessed based on the visual plaque index (VPI). A questionnaire was applied to obtain data on hospital routine and sample characteristics. The DMFT/dmf index was 1.66 (SD = 2.18) and the mean VPI was 43.03 (SD = 36.93). The most prevalent microorganisms were Klebsiella pneumoniae (15%). Oral colonization by opportunistic pathogens was significantly higher in patients receiving mechanical ventilation compared to those on spontaneous ventilation (p < .05). There was no relationship of VPI or DMFT/dmf with oral microbiological changes. CONCLUSION: The results indicate that PICU patients are susceptible to colonization by respiratory and opportunistic pathogens since the first hours of hospitalization.

Outbreak of Stenotrophomonas maltophilia and Burkholderia cepacia Bloodstream Infections at a Hemodialysis Center.

Patients undergoing hemodialysis are at an increased risk for bloodstream infections (BSIs). Infection usually occurs because of contamination of water supply, water treatment, distribution systems, or reprocessing dialyzers. Here, we report an outbreak of BSIs caused by Stenotrophomonas maltophilia (n = 21) and Burkholderia cepacia (n = 22) among dialyzed patients at a large hemodialysis center in Brazil. Overall, three patients died (7%), two of which had bacteremia caused by S. maltophilia and the other had a B. cepacia infection. We collected water samples from different points of the hemodialysis system for culture and typing. Genetic patterns were identified through polymerase chain reaction-random amplified polymorphic DNA (PCR-RAPD) and pulsed-field gel electrophoresis. The same genotypes of S. maltophilia and B. cepacia recovered from blood cultures were found in dialysis water. Also, multiple genetic profiles were identified among water isolates, suggesting heavy contamination. Bacteremia cases persisted even after implementing standard control measures, which led us to believe that the piping system was contaminated with microbial biofilms. Soon after we changed the entire plumbing system, reported cases dropped back to the number typically expected, and the outbreak came to an end.