RESUMO
Kidney transplant recipients are at risk for infections due to carbapenem-resistant Enterobacteriaceae (CRE). Polymyxin-resistant CRE (PR-CRE) infections are especially difficult to treat. The aim of this study was to characterize PR-CRE infections among kidney transplant recipients and identify risk factors for treatment failure. This retrospective cohort study involved all kidney transplant recipients with PR-CRE infection between 2013 and 2017 at our center. Minimal inhibitory concentrations for polymyxin B were determined by broth microdilution. Carbapenem-resistant genes (blaKPC, blaNDM, and blaOXA-48), aminoglycoside-resistance genes, and polymyxin-resistant gene mcr-1 were identified by polymerase chain reaction. All but one of the 47PR-CRE infections identified were due to Klebsiella pneumoniae. The most common type of infection (in 54.3%) was urinary tract infection (UTI). Monotherapy was used in 10 cases. Combined treatment regimens included double-carbapenem therapy in 19 cases, oral fosfomycin in 19, and amikacin in 13. Treatment failure occurred in 21 cases (45.7%). Clinical success was achieved 78.9% of patients who used aminoglycosides versus 37.0% of those who not used this drug (p = 0.007). Multivariate analysis showed diabetes mellitus to be a risk factor for treatment failure; amikacin use and UTI were found to be protective. Nine strains were RmtB producers. Although aminoglycosides constitute an important therapeutic option for PR-CRE infection, the emergence of aminoglycoside resistance could have a major impact on the management of CRE infection.
Assuntos
Aminoglicosídeos/uso terapêutico , Antibacterianos/uso terapêutico , Enterobacteriáceas Resistentes a Carbapenêmicos/efeitos dos fármacos , Infecções por Enterobacteriaceae/tratamento farmacológico , Enterobacteriaceae/efeitos dos fármacos , Polimixinas/farmacologia , Adulto , Idoso , Amicacina/uso terapêutico , Farmacorresistência Bacteriana Múltipla/genética , Quimioterapia Combinada , Enterobacteriaceae/genética , Infecções por Enterobacteriaceae/mortalidade , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Feminino , Fosfomicina/uso terapêutico , Humanos , Transplante de Rim , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Masculino , Testes de Sensibilidade Microbiana , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Transplantados , Falha de Tratamento , Resultado do TratamentoRESUMO
Complete nucleotide sequences were determined for two plasmids bearing rmtD group 16S rRNA methyltransferase genes. pKp64/11 was 78 kb in size, belonged to the IncL/M group, and harbored blaTEM-1b, sul1, qacEΔ1, dfrA22, and rmtD1 across two multidrug resistance regions (MRRs). pKp368/10 was 170 kb in size, belonged to the IncA/C group, and harbored acrB, sul1, qacEΔ1, ant(3â³)-Ia, aac(6')-Ib, cat, rmtD2, and blaCTX-M-8 across three MRRs. The rmtD-containing regions shared a conserved motif, suggesting a common origin for the two rmtD alleles.
Assuntos
Farmacorresistência Bacteriana Múltipla/genética , Proteínas de Membrana Transportadoras/genética , Metiltransferases/genética , Plasmídeos/genética , RNA Ribossômico 16S/genética , beta-Lactamases/genética , Antibacterianos/farmacologia , Proteínas de Bactérias/genética , Sequência de Bases , Escherichia coli/efeitos dos fármacos , Escherichia coli/genética , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Testes de Sensibilidade Microbiana , Análise de Sequência de RNARESUMO
During a Brazilian multicentric antimicrobial resistance surveillance study, colistin resistance was investigated in 4,620 Enterobacteriaceae isolated from human, animal, food and environmental samples collected from 2000 to 2016. We present evidence that mcr-1-positive Escherichia coli has been emerging in South America since at least 2012, supporting a previous report on the possible acquisition of mcr-1-harbouring E. coli by European travellers visiting Latin American countries.
Assuntos
Animais Domésticos/microbiologia , Colistina/uso terapêutico , Infecções por Escherichia coli/microbiologia , Proteínas de Escherichia coli/metabolismo , Escherichia coli/efeitos dos fármacos , Escherichia coli/isolamento & purificação , Ração Animal/microbiologia , Animais , Antibacterianos/uso terapêutico , Infecções Assintomáticas/epidemiologia , Farmacorresistência Bacteriana , Escherichia coli/classificação , Infecções por Escherichia coli/epidemiologia , Infecções por Escherichia coli/veterinária , Contaminação de Alimentos/análise , Microbiologia de Alimentos/estatística & dados numéricos , Saúde Global/estatística & dados numéricos , Humanos , América do Sul/epidemiologiaRESUMO
Eight Klebsiella pneumoniae clinical strains with high-level aminoglycoside resistance were collected from eight hospitals in São Paulo State, Brazil, in 2010 and 2011. Three of them produced an RmtD group 16S rRNA methyltransferase, RmtD1 or RmtD2. Five strains were found to produce a novel 16S rRNA methyltransferase, designated RmtG, which shared 57 to 58% amino acid identity with RmtD1 and RmtD2. Seven strains coproduced KPC-2 with or without various CTX-M group extended-spectrum ß-lactamases, while the remaining strain coproduced CTX-M-2.
Assuntos
Antibacterianos/farmacologia , Klebsiella pneumoniae/genética , Metiltransferases/metabolismo , RNA Ribossômico 16S/metabolismo , beta-Lactamases/metabolismo , Sequência de Bases , Farmacorresistência Bacteriana Múltipla/efeitos dos fármacos , Humanos , Isoenzimas/genética , Isoenzimas/metabolismo , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Klebsiella pneumoniae/enzimologia , Klebsiella pneumoniae/isolamento & purificação , Metiltransferases/genética , Testes de Sensibilidade Microbiana , Dados de Sequência Molecular , Filogenia , RNA Ribossômico 16S/genética , beta-Lactamases/genéticaRESUMO
IncX-type plasmids have achieved clinical significance for their contribution in the dissemination of genes confering resistance to carbapenems (most blaKPC- and blaNDM-type genes) and polymyxins (mcr-type genes), both antibiotics considered last resort for multidrug-resistant Gram-negative infections. In this study, we report the identification and complete sequence analysis of an IncX3 plasmid (designated pKP1194a) carrying a non-Tn4401 genetic element (NTEKPC) of tnpR-tnpA (partial)-blaKPC-2-ΔISKpn6/traN, originating from a hospital-associated lineage of K. pneumoniae belonging to the ST340/CG258, with epidemiological link to Brazil.
Assuntos
Farmacorresistência Bacteriana Múltipla/genética , Sequências Repetitivas Dispersas/genética , Klebsiella pneumoniae/efeitos dos fármacos , Klebsiella pneumoniae/genética , Plasmídeos/genética , beta-Lactamases/genética , Antibacterianos/uso terapêutico , Sequência de Bases , Carbapenêmicos/uso terapêutico , Infecção Hospitalar/microbiologia , Humanos , Infecções por Klebsiella/tratamento farmacológico , Infecções por Klebsiella/microbiologia , Testes de Sensibilidade Microbiana , Polimixinas/uso terapêutico , Análise de Sequência de DNARESUMO
We report here the draft genome sequence of a Klebsiella pneumoniae strain 1194/11, belonging to the hospital-associated sequence type 340 (ST340; clonal complex CC258), isolated from a catheter tip culture from a pediatric patient. The multidrug-resistant strain coproduced the 16S rRNA methyltransferase rRNA RmtG and ß-lactamases KPC-2 and CTX-M-15.