Prevalence, molecular characterization, and drug susceptibility of extended-spectrum ß-lactamase-producing Klebsiella pneumoniae, K. quasipneumoniae, and K. variicola in Japan.

Klebsiella pneumoniae is an extended-spectrum ß-lactamase (ESBL)-producing bacterium (ESBL-KP). Recently, K. quasipneumoniae and K. variicola were reclassified from K. pneumoniae based on genome sequencing. However, the molecular characteristics and antimicrobial susceptibility patterns of ESBL-producing K. quasipneumoniae (ESBL-KQ) and ESBL-producing K. variicola (ESBL-KV) remain unclear. Here, we aimed to distinguish ESBL-KQ and ESBL-KV from ESBL-KP in terms of frequency, genomic characteristics, and antimicrobial susceptibility patterns. Of the 74 ESBL-KP isolates, 12 (16.2%) were reclassified as ESBL-KQ and 1 (1.4%) as ESBL-KV. Patients with ESBL-KP and ESBL-KQ infections were of similar age; ESBL-KQ infection was more frequent in men. Infection-associated mortality seemed to be similar in patients with ESBL-KQ and ESBL-KP infections, without a statistically significant difference (p = 0.99). Genetic analysis revealed that 19.1% of ESBL-producing Klebsiella isolates harbored AmpC. The prevalence of AmpC was higher with ESBL-KP (31.1%) than with ESBL-KQ (8.3%), although this difference was not statistically significant (p = 0.52). The frequency of ESBL-KQ with AmpC and quinolone-resistance-associated genes in clinical samples increased annually (p = 0.04). The prevalence of Klebsiella with fluoroquinolone-resistance genes did not differ significantly between species (p > 0.99). The gene profiles of ESBL-KQ and ESBL-KP differed, and the prevalence of antimicrobial resistance via AmpC and fluoroquinolone-resistance genes increased. Further studies are required to distinguish ESBL-KP and ESBL-KQ and determine the mechanism underlying the spread of AmpC and quinolone-resistance genes to prevent further spread of these genes.

Risk factors and clinical outcomes of carbapenem-resistant Klebsiella pneumonia infection in intensive care unit: A retrospective observational study in a tertiary care hospital in Eastern India.

Background: Carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumonia, have become a severe global problem with a significant threat to public health, but few studies have investigated the risk factors and epidemiology of carbapenem-resistant K. pneumonia (CRKP) infections in India. Methods: We performed a retrospective observational study of 224 participants with K. pneumoniae who were admitted to the medical intensive care unit (ICU) of Institute of Medical Sciences and SUM Hospital, Bhubaneswar, India, between January 1 and December 30, 2020. Antibiotic susceptibility testing was done by automated broth microdilution VITEK® 2 (BioMerieux, Inc., Hazelwood, USA). The Clinical and Laboratory Standards Institute document M100-S22 (January 2020) was used to interpret antimicrobial susceptibility testing. Data were obtained from paper medical records. Results: Two hundred and twenty-four subjects with culture-positive for K. pneumonia were retrieved during the study period, out of which 108 had CRKP. The risk factors for univariate analysis were Acute Physiology and Chronic Health Evaluation II, ICU length of stay (LOS), invasive mechanical ventilator days, central venous catheter days, and arterial line days. The multivariate analysis showed invasive mechanical ventilation and ICU LOS were independent risk factors for CRKP infection. Mortality in the CRKP group was 48 (44%) compared to 27 (23%) in the carbapenem-sensitive K. pneumonia (CSKP) group, which was statistically significant (P < 0.01). Conclusion: Infection due to CRKP in the ICU was associated with 1.9 times higher mortality as compared to CSKP. Invasive mechanical ventilation and ICU LOS were found to be independent risk factors for CRKP infection.

Using Whole Genome Sequencing to Investigate a Mock-Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in Real-Time.

INTRODUCTION: Healthcare associated infections due to carbapenem-resistant Klebsiella pneumoniae (CRKP) are a major concern in Portuguese hospitals. Whole genome sequencing (WGS) can improve infection control, but this practice is not routinely used by hospital clinical laboratories in Portugal. We simulated the investigation of a CRKP outbreak based on WGS, with the aim of determining, in the minimum possible time, genetic relatedness between CRKP clinical and environmental isolates. MATERIAL AND METHODS: Ten CRKP clinical isolates routinely obtained in the hospital laboratory were used. Forty environmental samples - from sinks and sink drains of ward rooms - were collected. Environmental samples were plated on selective media and presumptive CRKP colonies were isolated. Total DNA was extracted from all putative CRKP isolates and sequenced. Clonal relatedness was determined by multi-locus sequence typing and core genome single nucleotide polymorphism analysis; the presence of carbapenemase genes was evaluated. RESULTS: Clinical isolates were characterized in 48 hours: eight strains were confirmed as CRKP, of which six were of ST13 and carried blaKPC-3. Environmental samples results were obtained in six days: eight CRKP were isolated from which five were of ST13 and carried blaKPC-3. Clinical and environmental ST13 isolates were highly related: ten (of 11) isolates differed from each other in < 0.001% of 2 172 367 core nucleotides. DISCUSSION: WGS can be used as a high-resolution effective tool to investigate healthcare associated infections and track routes of dissemination in real-time. CONCLUSION: In Portugal, routine use of WGS to improve infection control could thrive through collaborative initiatives between hospitals and research institutes.

Introdução: As infeções associadas aos cuidados de saúde por Klebsiella pneumoniae resistente aos carbapenemos (CRKP) são uma preocupação nos hospitais portugueses. A sequenciação total do genoma [whole genome sequencing (WGS)] pode ajudar no controlo de infecção, mas esta prática não é comummente utilizada nos laboratórios clínicos hospitalares em Portugal. O objetivo deste estudo foi simular a investigação de um surto causado por CRKP, utilizando WGS. Pretendia-se testar a utilização desta técnica e determinar, no menor tempo possível, relações genéticas entre estirpes. Material e Métodos: Foram analisados dez isolados clínicos de CRKP. Foram obtidas quarenta amostras ambientais que foram inoculadas em meio seletivo para isolamento de colónias sugestivas de CRKP e depois sequenciado o DNA total dos isolados presumptivamente identificados como CRKP A relação clonal entre as estirpes foi determinada por multi-locus sequence typing e análise de single nucleotide polymorphisms no genoma core. Foi determinada a presença de genes de carbapenemases. Resultados: Os isolados clínicos foram caraterizados em 48 horas: oito isolados foram confirmados como CRKP. A maioria pertencia ao ST13 (n = 6) e possuía o gene blaKPC-3. As amostras ambientais foram caraterizadas em seis dias: foram isoladas oito CRKP, das quais cinco eram ST13 e continham o gene blaKPC-3. Os isolados ST13 clínicos e ambientais eram muito semelhantes entre si: dez dos 11 isolados diferiam entre si em menos de 0,001% dos 2 172 367 nucleótidos core analisados. Discussão: A sequenciação total do genoma pode ser usada como uma ferramenta útil para investigar infecções nosocomiais e rastrear cadeias de disseminação em tempo real. Conclusão: Em Portugal, o uso desta técnica em controlo de infecção pode ser implementado através de colaborações entre hospitais e institutos de investigação.

Clinical characteristics and prognostic factors of patients with Klebsiella pneumoniae bloodstream infection / 中华全科医师杂志

Objective:To analyze the clinical characteristics, antibiotic resistance and prognostic risk factors of patients with Klebsiella pneumoniae bloodstream infection (Kp BSI).Methods:The clinical data of 188 patients diagnosed with Kp BSI from January 1，2017 to December 1，2021 in Beijing Shijitan Hospital, Capital Medical University were retrospectively analyzed.There were 118 patients males (62.8%) with a median age 77.0(63.0, 85.0) years old. The median length of hospital stay was 20.0 days, and 78 patients (41.5%) were admitted to intensive care unit(ICU). There were 121 cases with carbapenem-sensitive Klebsiella pneumoniae (64.4%, CSKP group) and 67 cases with carbapenem-resistant Klebsiella pneumoniae (35.6%, CRKP group).Fifty six patients died within 28 days after admission (death group), and 132 patients survived (survival group).The clinical characteristics and bacterial drug resistance of Kp BSI patients were analyzed, and univariate analysis and multivariate logistic regression analysis were used to explore factors related to the CRKP infection and patient mortality.Results:The most common infection sites were respiratory system, abdominal cavity and biliary tract accounting for 39.4% (74/188), 18.1% (34/188) and 14.4% (27/188), respectively.The common comorbidities were coronary heart disease, hypertension, chronic kidney disease and diabetes, accounting for 63.8% (120/188), 59.6% (112/188), 46.3% (87/188) and 43.1% (81/188), respectively and 118 patients (62.8%) had 3 or more comorbidities. Most patients (146 cases, 77.7%) underwent ≥1 invasive procedures before bloodstream infection;and 90 patients (47.9%) had a history of antibiotic use. CRKP strains showed higher resistance rates to piperacillin, quinolones, cephalosporins and carbapenems. Univariate analysis showed that there were statistically significant differences in age (69.0 vs. 83.0 years), ICU admission 25.6%(31/121) vs. 70.1%(47/67)], invasive procedures [67.8%(82/121) vs. 95.5 %(64/67)], and antibiotic use [37.2% (45/121) vs. 67.2%(45/67)] between the CSKP group and the CRKP group ( Z=-5.73, χ 2=35.22, χ 2=19.15, χ 2=15.53, all P<0.001). Multivariate logistic regression analysis showed that age, ICU admission, invasive procedures and antibiotic use in recent 30 days were independent risk factors for CRKP infection( OR=1.06, P<0.001; OR=3.22, P=0.003; OR=5.93, P=0.009; OR=2.40, P=0.022). The total fatality rate was 29.8%(56/188). Univariate analysis showed that there were statistically significant differences in CRKP infection [19.7%(26/132) vs. 73.2% (41/56)], albumin level (32.6 vs. 27.8 g/L) and sequential organ failure assessment score (SOFA score, 2 vs. 8 score) between the survival group and the death group (χ 2=49.10, Z=-4.64, Z=-10.36,all P<0.001). Multivariate logistic regression analysis suggested that CRKP infection, low albumin and high SOFA score on the day of bloodstream infection were risk factors for death of Kp BSI patients( OR=5.13, P=0.021; OR=0.86, P=0.044; OR=3.04, P<0.001). Conclusion:Kp BSI patients have a high fatality rate and fairly severe drug resistance. CRKP infection, low albumin, high SOFA score on the day of bloodstream infection are associated with poor prognosis in Kp BSI patients.

Prioritization of potential drug targets and antigenic vaccine candidates against Klebsiella aerogenes using the computational subtractive proteome-driven approach.

Klebsiella aerogenes is a multidrug-resistant Gram-negative bacterium that causes nosocomial infections. The organism showed resistance to most of the conventional antibiotics available. Because of the high resistance of the species, the treatment of K. aerogenes is difficult. These species are resistant to third-generation cephalosporins due to the production of chromosomal beta-lactams with cephalosporin activity. The lack of better treatment and the development of therapeutic resistance in hospitals hinders better/new broad-spectrum-based treatment against this pathogen. This study identifies potential drug targets/vaccine candidates through a computational subtractive proteome-driven approach. This method is used to predict proteins that are not homologous to humans and human symbiotic intestinal flora. The resultant proteome of K. aerogenes was further searched for proteins, which are essential, virulent, and determinants of antibiotic/drug resistance. Subsequently, their druggability properties were also studied. The data set was reduced based on its presence in the pathogen-specific metabolic pathways. The subtractive proteome analysis predicted 13 proteins as potential drug targets for K. aerogenes. Furthermore, these target proteins were annotated based on their spectrum of activity, cellular localization, and antigenicity properties, which ensured that they are potent candidates for broad-spectrum antibiotic and vaccine design. The results open up new opportunities for designing and manufacturing powerful antigenic vaccines against K. aerogenes and the detection and release of new and active drugs against K. aerogenes without altering the gut microbiome. Supplementary Information: The online version contains supplementary material available at 10.1007/s42485-021-00068-9.

Importation of Entamoeba histolytica and predominance of Klebsiella pneumoniae in liver abscesses: a 7-year retrospective cohort study from the United Arab Emirates.

BACKGROUND: There is a dearth of information on liver abscesses in the United Arab Emirates. Herein, we describe the clinical features of liver abscesses and determine their incidence rates and clinical outcomes. METHODS: We retrospectively reviewed the clinical charts of adult patients with a primary diagnosis of liver abscess at a major hospital over a 7-year period. RESULTS: Amongst 45 patients, 82.2% (37/45) had a pyogenic liver abscess (PLA) and 17.8% (8/45) had amoebic liver abscesses (ALA). Overall, patients were young (median age 42 years, IQR 35-52), mostly males (77.8%, 35/45) from the Indian subcontinent (55.6%, 25/45), presented with fever (88.9%, 40/45) and abdominal pain (88.9%, 40/45), and had a solitary abscess on imaging (71.1% (32/45). Crude annual incidence rates were 35.9/100,000 hospital admissions (95% CI 26.2-48.0) and 5.9/100,000 inhabitants (95% CI 4.3-7.9). All ALA patients were from the Indian subcontinent (100%, 8/8). Klebsiella pneumoniae was the most frequent pathogen in PLA (43.2% [16/37], 95% CI 27.1-60.5%). The hospital stay was shorter in ALA (7.5 days, IQR 7-8.5) than in PLA (14 days, IQR 9-17). No deaths were recorded within 30 days of hospitalisation. CONCLUSIONS: ALA was exclusively seen in migrants from the Indian subcontinent, suggesting importation. Further research to characterise K. pneumoniae isolates and assess potential risk factors is needed.

Infecção de loja de cardioversor-desfibrilador implantável (CDI) por klebsiella sp. Carbapenem-resistente / Klebsiella sp. carbapenem-resistant pocket infection of an Implantable Cardioverter Defibrillator (ICD)

RESUMO: As infecções associadas aos Dispositivos Cardíacos Eletrônicos Implantáveis (DCEI) apresentam uma incidência de até 3,4% e notável impacto na morbidade e mortalidade dos pacientes. As bactérias Gram-positivas, especialmente do gênero Staphylococcus sp. representam 60-70% dos agentes isolados. Por sua vez, as Gram-negativas correspondem até 9% dos casos. Relatamos uma infecção de loja de gerador de Cardioversor-desfibrilador implantável (CDI) por uma Klebsiella sp. resistente aos carbapenêmicos, em um paciente masculino jovem, cujo desafiador diagnóstico de certeza desse caso somente foi possível após exploração cirúrgica e cultura do material da loja do CDI, haja vista a apresentação clínica oligossintomática. Embora já descritas, Klebsiella sp. são raras nesse contexto e em nosso conhecimento, esse é o primeiro relato de uma infecção de DCEI por uma enterobactéria resistente a carbapenêmico. (AU)

ABSTRACT: Infections associated with Implantable Electronic Cardiac Devices (IECD) have an incidence of up to 3.4% and a notable impact on patient morbidity and mortality. Gram-positive bacteria, especially Staphylococcus sp. represent 60-70% of isolated agents. In turn, gram-negatives account for up to 9% of cases. We report an Implantable Cardioverter-Defibrillator (ICD) generator pocket infection by a Carbapenem Resistant Klebsiella sp., in a young male patient, whose challenging diagnosis of certainty was only possible after surgical exploration and culture of the material from the ICD pocket, given the oligosymptomatic clinical presentation. Although already described, Klebsiella sp. are rare in this context and to our knowledge, this is the first report of an IECD infection by a carbapenem-resistant enterobacterium. (AU)

Factores relacionados con el control yeliminación de un brote de Klebsiella Pneumoniae productora de Carbapenemasas en la Unidad de Neonatología del Hospital Metropolitano de Quito / Factors related to the control and elimination of an outbreak of Carbapenemase-producing Klebsiella Pneumoniae in the Neonatology Unit of the Hospital Metropolitano de Quito

Introducción: Las infecciones nosocomiales ocasionan un costo para el sistema de salud. En este estudio se reporta los datos observacionales de un brote de Klebsiella Pneumoniae en una Unidad de neonatología, y sus medidas posteriores a la identificación. Métodos: Con un diseño descriptivo observacional, ambispectivo se estudiaron casos de infecciones nosocomiales. Se realizaron medidas de barrera estrictas con listas de chequeo y uso de cámaras de vigilancia en una Unidad de Neonatología. Se reportan las observaciones del estudio. Se utiliza estadística descriptiva. Resultados: 6 casos fueron diagnosticados con Klebsiella Pneumoniae, todos fueron pacientes recién nacidos prematuros, tres de ellos extremos. Cuatro pacientes con sepsis temprana. Las muestras de cultivos fueron 3 Hemocultivos, 2 Urocultivos y 1 cultivo de secreción faríngea. Junto con el cultivo de Klebsiella pneumoniae, se identificaron otros patógenos. La coinfección de Klebsiella con S. aureus fue la que se mantuvo más días en aislamiento, en relación al aislamiento de Klebsiella sola. De todos los cultivos, 2 fueron positivos para Klebsiella pneumoniae productora de BLEE, y cuatro para Klebsiella pneumoniae multisensible. Luego de la intervención no se presentaron nuevo casos con un seguimiento de 12 meses posteriores al brote. Conclusiones: Luego del brote de 6 casos de Klebsiella Pneumoniae en la unidad de Neonatología se establecieron medidas estrictas de bioseguridad, las mismas que fueron cumplidas con el registro en listas de chequeo y monitorizadas por cámaras de seguridad. Se logró la eliminación de infecciones nosocomiales en un período de control posterior a 12 meses luego de la implementación

Introduction: Nosocomial infections cause a cost for the health system. This study reports the observational data of an outbreak of Klebsiella Pneumoniae in a neonatology unit, and its measures after identification. Methods: With a descriptive, observational, ambispective design, nosocomial infections were studied. Strict barrier measures were carried out with checklists and the use of surveillance cameras in a Neonatology Unit. Study observations are reported. Descriptive statistics are used. Results: 6 cases were diagnosed with Klebsiella Pneumoniae, all were premature newborn patients, three of them extreme. Four patients with early sepsis. The culture samples were 3 blood cultures, 2 urine cultures and 1 culture of pharyngeal secretion. Along with the Klebsiella pneumoniae culture, other pathogens were identified. Klebsiella co-infection with S. aureus was the one that remained in isolation for more days, in relation to Klebsiella isolation alone. Of all the cultures, 2 were positive for ESBL-producing Klebsiella pneumoniae, and four for multisensitive Klebsiella pneumoniae. After the intervention, no new cases were presented with a follow-up of 12 months after the outbreak. Conclusions: After the outbreak of 6 cases of Klebsiella Pneumoniae in the Neonatology unit, strict biosafety measures were established, which were complied with with the registration in checklists and monitored by security cameras. Elimination of nosocomial infections was achieved in a control period after 12 months after implementation

Características clínicas y microbiológicas de infecciones por Klebsiella pneumoniae productora de carbapenemasa MBL, tipo NDM, Hospital Geriátrico San Isidro Labrador EsSalud, 2018 / Clinical and microbiological characteristics of New Delhi MBL (NDM)-producing Klebsiella pneumoniae infections at the Hospital Geriátrico San Isidro Labrador EsSalud, 2018

RESUMEN Objetivo Determinar las características clínico-microbiológicas de 7 casos de infección nosocomial por Klebsiella pneumoniae productora de carbapenemasa MBL, tipo NDM, en el Hospital Geriátrico San Isidro Labrador (HG SIL) en el periodo de febrero a mayo de 2018. Materiales y métodos Es un estudio descriptivo y retrospectivo realizado en adultos mayores con infecciones urinarias, neumonías, úlceras sacras e infecciones de herida operatoria que recibieron terapia antibiótica múltiple no protocolizada. El método usado para detectar la MBL fue el de doble disco con ácido fenilborónico (APB) y ácido etilendiaminotetraacético (EDTA) en los aislados de Klebsiella pneumoniae con sensibilidad disminuida a carbapenémicos. La identificación del gen NDM se realizó en el Instituto Nacional de Salud mediante reacción en cadena de la polimerasa. Resultados En total, fueron 7 casos positivos para el gen NDM y todos resistentes al meropenem lo que confirmó el brote epidémico. La mortalidad fue 28,6 % (2 de 7 pacientes) pero, debido a la existencia de comorbilidades en todos los casos, no se pudo determinar la mortalidad atribuible. Conclusiones Destacan el rol clave inicial del laboratorio para detectar y tipificar las carbapenemasas y las medidas de control integral de las infecciones. Además, son los primeros casos reportados en nuestra red asistencial.

ABSTRACT Objective To determine the clinical and microbiological characteristics of seven (7) cases of New Delhi MBL (NDM)- producing Klebsiella pneumoniae nosocomial infections at the Hospital Geriátrico San Isidro Labrador (HG SIL) from February to May 2018. Materials and methods A descriptive and retrospective study conducted in elderly people with urinary infections, pneumonia, sacral ulcers and surgical wound infection who received multiple non-protocolized antibiotic therapy. The methods used to detect MBLs in the Klebsiella pneumoniae isolates that showed decreased sensitivity to carbapenems were the phenylboronic acid-based (PBA) and ethylenediaminetetraacetic acid-based (EDTA) double disk tests. The identification of the NDM gene was performed by polymerase chain reaction at the Instituto Nacional de Salud. Results In total, the seven cases were positive for the NDM gene and resistant to meropenem, which confirmed the epidemic outbreak. Mortality accounted for 28.6 % (2 of 7 patients) of the cases. However, due to the presence of comorbidities in all cases, the attributable mortality could not be determined. Conclusions Labs have a key initial role for detecting and classifying the carbapenemases and the measures of comprehensive control of infections. The aforementioned cases are the first ones reported in our healthcare network.

Successful Endovascular Treatment of an Infected Aortic Aneurysm Induced by Klebsiella pneumoniae.

Aortic aneurysms infected by Klebsiella pneumoniae are rarely seen. We describe a 50-year-old man with infected aortic aneurysm that was successfully treated with endovascular aneurysm repair (EVAR). Diagnosis was confirmed using blood culture and computed tomography (CT). Intravenous antibiotics were immediately administered, with improvements in clinical findings and negative blood cultures before the procedure. Twenty-four months after the procedure, the patient was stable and serial CT revealed regression of the infected aortic aneurysm. Therefore, after controlling bacteremia and fever with targeted antibiotic therapy, EVAR can be considered as an alternative for patients who have serious comorbidities and are ineligible for conventional surgery.

Mortality attributable to different Klebsiella susceptibility patterns and to the coverage of empirical antibiotic therapy: a cohort study on patients admitted to the ICU with infection.

PURPOSE: To evaluate the prognostic importance of different Klebsiella spp. sensitivity patterns: multi-susceptible Klebsiella (MS-K), extended-spectrum cephalosporin-resistant, but carbapenem-susceptible Klebsiella (ESCR-CS-K), and carbapenem-resistant Klebsiella (CR-K). METHODS: We developed a prognostic model to predict hospital mortality in patients with infection on admission to the intensive care units (ICUs), and assessed its calibration in the subgroups of interest: patients with infections due to MS-K, ESCR-CS-K, CR-K. We assessed the calibration of the model also in ESCR-CS-K treated empirically with carbapenems and with piperacillin-tazobactam. RESULTS: A total of 13,292 adults with an ongoing infection were admitted to 137 Italian ICUs in 2012-2013. Of 801 Klebsiella spp. infected patients, 451 had MS-K, 116 ESCR-CS-K, and 234 CR-K. The prognostic model calibrated well for the MS-K and ESCR-CS-K subgroups. In the CR-K subgroup there were more deaths than predicted (standardized mortality ratio 1.20; 95% CI 1.08-1.31), indicating a negative prognostic role of the infection, mainly in the medium and high risk-of-death patients. When infection was caused by ESCR-CS-K, treatment with piperacillin-tazobactam increased adjusted mortality among the most severe patients (similarly to CR-K), while treatment with carbapenems did not (similarly to MS-K). CONCLUSIONS: In low risk-of-death patients admitted to the ICU with a Klebsiella spp. infection, the appropriateness of empirical antibiotic therapy seemed uninfluential to eventual mortality, while it appeared to be crucial in high-risk ones. The use of piperacillin-tazobactam may be inappropriate in severe patients with ESCR-CS-K infection. CR-K is associated to a significant 20% increase of adjusted mortality, only for patients at higher risk of death.

Klebsiella Pneumoniaeoxa-48 in a Urology Patient: Case Report

We present an isolate of Klebsiella pneumoniae OXA-48 isolated in a 68-year-old man who underwent radical prostatectomy due to prostate cancer. The antibiotic susceptibility testing to a wide range of antibiotics was performed by disk diffusion method and determination of minimal inhibitory concentrations. The isolate was classified as multidrug-resistant. It showed intermediate susceptibility to imipenem and meropenem, resistance to ertapenem, and sensitivity only to colistin, amikacin, and trimethoprim-sulfamethoxazole. The isolate was positive for ESBLs, negative for AmpC. Polymerase chain reaction and sequencing revealed bla(OXA-48)', bla(CTX-M-15) and bla(SHV-11). The plasmid encoding OXA-48 ß-lactamase did not belong to any known PCR-based replicon typing. According to genotyping, the isolate belonged to ST37.

[Klebsiella pneumoniae from K1 and Hypervirulent Clone ST23: First Documented Case in Portugal]. / Klebsiella pneumoniae do Serotipo K1 e do Clone Hipervirulento ST23: Primeiro Caso Documentado em Portugal.

The hypervirulent K1 serotype Klebsiella pneumoniae is responsible for a new invasive syndrome, typically associated to hepatic abscesses with extra-hepatic complications. Initially described in Taiwan, it has significantly spread to several Asian countries and more recently to Europe and North America, thus constituting an emerging and global problem. The authors describe a case report of a 64-years-old portuguese caucasian woman without any previous diseases or epidemiological risk factors such as trips or contact with Asian products or population, diagnosed with a pyogenic liver abscess with pleural effusion caused by this hyper-virulent strain. A successful clinical cure was achieved after the etiological identification and treatment with antimicrobial therapy combined with catheter drainage. This is the first identification of hypervirulent Klebsiella pneumonia ST 23 clone in Portugal in the context of an invasive syndrome.

A estirpe híper-virulenta Klebsiella pneumoniae serotipo K1 é responsável por uma síndrome invasiva infeciosa, caracterizada por abcessos hepáticos com manifestações extra-hepáticas. Inicialmente identificada em Taiwan, tem aumentado significativamente em vários países da Ásia, e mais recentemente na Europa e América do Norte, conferindo a esta entidade um caracter emergente e global. Os autores apresentam o caso clinico de uma mulher de 64 anos, caucasiana, portuguesa, sem antecedentes pessoais ou epidemiológicos como viagens ou exposição a produtos asiáticos, na qual foi diagnosticada, abcesso hepático piogénico complicado de derrame pleural por esta estirpe híper-virulenta. Após conhecimento do diagnóstico e instituição de terapêutica antibiótica combinada com drenagem percutânea, foi possível a resolução do caso clínico com sucesso. Este caso permitiu a identificação do primeiro caso de síndroma invasiva infeciosa, por Klebsiella pneumoniae do clone híper-virulento ST23 documentado em Portugal.

Treatment experience of intracranial infection after severe traumatic brain injury caused by multi drug-resistant Klebsiella pneumonia:a case report / 天津医药

Intracranial infection is a common and serious complication of acute severe traumatic brain injury, with high mortality and disability rates, which significantly affects the prognosis. In recent years, with the widespread use of antibiotics, antibiotic-resistance rates of pathogens have risen year by year, and the choice of sensitive antibiotics is less and less, sometimes even in difficulties of no drugs available. This paper reviewed the treatment process of 1 case with intracranial infection caused by multi drug-resistant Klebsiella pneumonia after severe traumatic brain injury . The aim is to summarize the clinical experience.

Úlcera genital por Klebsiella granulomatis (Donovanosis) en una pareja heterosexual / Genital ulcer due to Klebsiella granulomatis (Donovanosis) in a heterosexual couple

ANTECEDENTES: La Donovanosis o granuloma inguinal, es una enfermedad infecciosa, inflamatoria crónica, usualmente ulcerativa, preferentemente de localización ano-genital, trasmitida sexualmente y causada por la bacteria Klebsiella granulomatis. Se caracteriza por la presencia de los cuerpos de Donovan, en la microscopía de la secreción de las úlceras. El objetivo es presentar un caso de donovanosis en una pareja heterosexual, que consultaron por la presencia simultánea de lesiones en la vulva y en el pene. CASO CLÍNICO: pareja conformada por una mujer de 21 años de edad y su pareja masculina de 24 años, de elevado nivel socioeconómico, que observaron simultáneamente la aparición de una lesión indolora, ulcerada, de bordes elevados y fondo limpio, tanto en el labio mayor de la vulva como en el cuerpo del pene. Negaron la práctica de coito anal o promiscuidad. Se sospechó Donovanosis, por lo cual se realizó extendido citológico de la secreción de la lesión y se encontraron con la tinción de Giemsa, los cuerpos de Donovan en la lesión de la mujer. La muestra tomada al varón fue insuficiente para el estudio. Se realizó manejo de la pareja con doxiciclina. El varón tuvo completa mejoría, pero la mujer por presentar recidiva se le agregó azitromicina. A los cuatro meses del diagnóstico, ambos estaban asintomáticos y con una pequeña área de cicatriz. CONCLUSIÓN: La donovanosis es un cuadro infeccioso que amerita diagnóstico y adecuado tratamiento, ya que tiene potenciales complicaciones genitales e incluso extragenitales, que son consideradas secundarias y pueden llevar a graves afectaciones para la salud.

BACKGROUND: The Donovanosis or granuloma inguinale is an infectious, chronic inflammatory and usually ulcerative disease, preferentially of anogenital location, that is sexually transmitted and caused by the bacteria Klebsiella granulomatis. It is characterized by the presence of the Donovan bodies in the microscopy of the secretion of the ulcers. The objective is to present a case of Donovanosis in a heterosexual couple, who consulted by the simultaneous presence of an injury in the vulva and penis. CASE RECORD: Couple of a 21 year-old woman and a 24 year-old man of high socioeconomic level that observed simultaneously the apparition of a painless and ulcerated injury of elevated edge and clear base, as much in the labia majora of the vulva as in the body of the penis. They denied the practice of anal coitus or promiscuity. The Donovanosis was suspected and the cytological study of the secretion of the injury was carried out. The Donovan bodies were found in the injury of the woman with the Giemsa stain. The sample of the man was insufficient for the study. The treatment of the couple was done with Doxycycline. The man had complete improvement but the woman presented recurrence for what Azithromycin was added to the treatment. To the four months of the diagnosis, both of them were asymptomatic and they had a small area of scar. CONCLUSION: The Donovanosis is an infectious disease that merits diagnosis and appropriate treatment due to it has potential genital and extragenital complications that are considered side effect and could carry to severe alterations for the health.

KPC and NDM-1 genes in related Enterobacteriaceae strains and plasmids from Pakistan and the United States.

To characterize the genomic context of New Delhi metallo-ß-lactamase-1 (NDM-1) and Klebsiella pneumoniae carbapenemase (KPC), we sequenced 78 Enterobacteriaceae isolates from Pakistan and the United States encoding KPC, NDM-1, or no carbapenemase. High similarities of the results indicate rapid spread of carbapenem resistance between strains, including globally disseminated pathogens.

Antimicrobial resistant mechanisms of carbapenem-resistant Klebsiella pneumonia infection in newborns / 中华检验医学杂志

Objective To investigate the antimicrobial resistant and transmission mechanisms of carbapenem-resistant K.pneumonia (CR-KP) infection of newborns.Methods A retrospective study was conducted on totally 37 non-repetitive CR-KP which were isolated from patients hospitalized between April 2011 and October 2013.Resistance genes were identified by PCR and sequencing.Plasmid was analyzed by pulsed-field gel electrophoresis (PFGE).Conjugation experiments were performed to determine the transferability of beta-lactamase.Multilocus sequence typing (MLST) was used to determine the genotypes and homology of these isolates.Out-membrane proteins were examined by PCR and sodium dodecyl sulfate polyacrylamide gel electrophoresis (SDS-PAGE).Results Thirty-seven CR-KP isolates were tested.The resistant rates of imipenem, meropenem, ertapenem were 89.2％ (33/37), 83.8％ (31/37) ,97.3％ (36/ 37), respectively.All the 37 CR-KP exhibited 100％ (37/37) sensitivity to tigecycline, colistin, levofloxacin and amikacin, while resistance to most of the other antibiotics.By PCR, 67.6％ (25/37) isolates were blaNDM-1 positive, 35.1％ (13/37) isolates were blaIMP-4 positive and 2.7％ (1/37) isolate were blaIMP-8 positive, including two isolates carrying both blaNDM-1 and blaIMP-4.PFGE results showed that the isolates carried 2-4 plasmids and both blaNDM-1 and blaIMP-4 were transferable by plasmids.MLST assigned them to sequence type (ST) 20, ST17, ST54, ST705, ST290,which showed that there were infectious outbreaks caused by NDM-1-producing and IMP-4-producing respectively among newborns.SDS-PAGE result indicated that there was no absence of outer membrane proteins OmpK35 and OmpK36.Conclusions The main resistant mechanisms of CR-KP causing infection in newborns were those the isolates carried carbapenemase of blaNDM-1 or blaIMP-4 and the K.pneumonia with two kinds of carbapemenase were detected.

Perfil dos pacientes colonizados por enterobactérias produtoras de KPC em hospital terciário de Porto Alegre, Brasil / Characteristics of patients colonized by KPC-producing enterobacteriaceae in a tertiary hospital from Porto Alegre, Brazil

Enterobactérias produtoras de carbapenemase do tipo Klebsiella pneumoniae (KPC) são cada vez mais identificadas em pacientes hospitalizados, porém pouco se conhece sobre o perfil e o prognóstico dos pacientes colonizados por elas. Este estudo objetiva avaliar o perfil epidemiológico e a mortalidade total intra-hospitalar dos pacientes colonizados por KPC em um centro de referência. Métodos: Estudo de coorte retrospectivo em adultos colonizados por KPC em internação clínica de novembro/2012 a março/2013 no Hospital Nossa Senhora da Conceição, Porto Alegre (RS). Foram definidos como colonizados pacientes com exame de rastreio (swab) positivo para bactérias produtoras de KPC durante a internação. Resultados: Foram incluídos 75 pacientes, sendo 40 homens, com mediana de 52 anos. O tempo desde o início da internação até a positivação do swab apresentou uma mediana e amplitude interquartil de 18 (9-33) dias, com período de internação de 36 (24-56) dias. Foi identificado uso de cateter central em 93%, sondagem vesical de demora 88%, sondagem nasogástrica/nasoentérica 87%, ventilação mecânica 81% e hemodiálise 40%. Dois terços dos pacientes apresentaram pelo menos um evento infeccioso após a colonização. O escore de Charlson (OR 1,53 por cada ponto; IC95% 1,25-1,97) e diálise prévia (OR 4,35; IC95% 1,39-15,37) foram preditores independentes de mortalidade. Óbito ocorreu em 56% dos pacientes (n=42). Conclusão: Pacientes colonizados por KPC apresentam mortalidade total intra-hospitalar elevada. Comorbidades prévias à colonização foram associadas com mortalidade. O presente estudo não permite definir qual o papel da colonização no desfecho clínico dos pacientes...

Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae have been increasingly identified in hospitalized patients, but little is known about the profile and prognosis of patients colonized by these bacteria. This study aims to assess the epidemiological profile and overall in-hospital mortality of patients colonized by KPC in a reference center. Methods: This is a retrospective cohort study in adult patients colonized by KPC and admitted to clinical units of Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil, between November/2012 and March/2013. Those patients with screening culture test positive for KPC-producing bacteria during hospitalization were defined as colonized. Results: Seventy-five patients were included, 40 of which were males, and the median age was 52 years. The median and interquartile range of time from onset of hospitalization until colonization was 18 [9-33] days, with a median hospital stay of 36 (24-56) days. Considering the other risk factors for colonization, there was a high prevalence in the use of central access catheter (93%), indwelling catheter (88%), nasogastric/enteral tube (87%), mechanical ventilation (81%), and need for hemodialysis (40%). Two thirds of patients had at least one infectious event after colonization. Charlson score (OR 1.53 for each point; 95%CI1.25-1.97) and previous dialysis (OR 4.35; 95%CI1.39-15.37) were independent predictors for mortality. In hospital mortality was 56%. Conclusion: Patients colonized by KPC have high in-hospital overall mortality. Comorbidities were associated with mortality. This study does not enable to define the role of colonization in defining patients’ clinical outcomes...

Purple urine bag syndrome in end-stage chronic kidney disease

Introduction: When faced with violet, purple or purplish-blue urine, clinicians should consider urinary tract infection in their differential diagnosis. Case report: A 60-year-old woman with end-stage kidney disease and non-adherence to renal replacement therapy was admitted to our hospital for placement of hemodialysis catheter. During her hospitalization she had purple urine, and purple urine bag syndrome (PUBS) was diagnosed. She was effectively treated with antibiotics and her urine returned to a dark yellow color. Discussion: Although this condition is often easily treated, diagnosing PUBS in chronic renal patients probably means an increased serum concentration of indoxyl sulfate, metabolite that is involved in the progression of both CKD and cardiovascular disease. Conclusion: Hence, in the context of our renal patients, perhaps PUBS is not as benign as supposed. .

Revisión sistemática de la farmacorresistencia en enterobacterias de aislamientos hospitalarios en Colombia / Systematic review of antimicrobial resistance in Enterobacteriaceae isolates from Colombian hospitals

Introducción. La resistencia bacteriana es un problema de salud pública a nivel mundial que compromete seriamente la capacidad de tratar las infecciones. Objetivo. Describir el perfil de resistencia a los antimicrobianos marcadores en enterobacterias identificadas en hospitales colombianos. Materiales y métodos. Se hizo una revisión bibliográfica sistemática de las publicaciones indexadas en Medline, Embase y Lilacs, además de la búsqueda manual de todos los números de revistas colombianas reconocidas en el campo de la infectología y otros afines para identificar referencias no disponibles electrónicamente. Resultados. Se identificaron 43 estudios y reportes de vigilancia epidemiológica con información sobre la resistencia de las enterobacterias en hospitales, principalmente de Bogotá, Cali y Medellín. La tasa de resistencia en Escherchia coli oscila entre 3 y 11 %, 5 y 20 % y 0,2 a 0,8 % para piperacilina-tazobactam, cefalosporinas de tercera generación y carbapenémicos, respectivamente. En aislamientos de Klebsiella pneumoniae , la resistencia oscila entre 21,8 y 48,1 % frente a piperacilina-tazobactam, 20 y 35 % frente a cefalosporinas de amplio espectro y 3 y 8 % frente a carbapenémicos, con variaciones importantes por ciudades, niveles de atención y circunstancias clínicas. Conclusiones. La diseminación de la resistencia bacteriana en enterobacterias aisladas en hospitales colombianos es un problema creciente que requiere medidas prontas para cortar las cadenas de transmisión.

Introduction: Bacterial resistance is a public health problem worldwide that seriously compromises the possibility to treat infections. Objective: To identify levels of resistance to antibiotic markers in Enterobacteriaceae isolates from Colombian hospitals. Materials and methods: A systematic literature survey was done including articles indexed in Medline, Embase and LILACS. A manual search was made of Colombian scientific journals and other publications on infectious disease that were not available electronically. Results: In total, 43 observational studies and epidemiological reports were identified with information about resistance among Enterobacteriaceae isolates in Colombian hospitals, mainly from Bogotá, Cali and Medellín. The resistance rate of Escherichia coli ranges from 3 to 11%, 5 to 20% and from 0.2 to 0.8% for piperacillin-tazobactam, third generation cephalosporins and carbapenems, respectively. For Klebsiella pneumoniae resistance rates ranges from 21.8 to 48.1% to piperacillin-tazobactam, 20 to 35% to broad-spectrum cephalosporins and 3 to 8% to carbapenems, with significant variations by cities, levels of care and clinical settings. Conclusions: The spread of bacterial resistance in Enterobacteriaceae isolated in Colombian hospitals is a growing problem that calls for priority action to cut the chains of transmission.