KPC and VIM producing Enterobacter cloacae strain from a hospital in northeastern Venezuela.

An 83-year-old male patient is admitted to the central hospital in Cumana, Venezuela with severe urinary infection, history of hospitalizaions and prolonged antimicrobial treatments. A strain of Enterobacter cloacae was isolated showing resistance to multiple types of antibiotics (only sensitive to gentamicin), with phenotype of serine- and metallo-carbapenemases. Both, bla(VIM-2) and bla(KPC) genes were detected in the isolate. This is the first report of an Enterobacteriaceae species producing both KPC carbapenemase and VIM metallo carbapenemase in Venezuela. This finding has a great clinical and epidemiological impact in the region, because of the feasibility of transferring these genes, through mobile elements to other strains of Enterobacter and to other infection-causing species of bacteria.

[Frequency of enzymes associated with reduced sensitivity to beta-lactam antibiotics in enterobacteria isolates, Caracas, Venezuela]. / Frecuencia de enzimas asociadas a sensibilidad disminuida a betalactámicos en aislados de enterobacterias, Caracas, Venezuela.

OBJECTIVE: To determine the frequency of enzymatic mechanisms associated with reduced sensitivity to broad-spectrum beta-lactam antibiotics in enterobacteria isolates obtained at hospital centers in Caracas, Venezuela. METHODS: A cross-sectional study was conducted on enterobacteria isolated from patients at eight hospital centers in Caracas, Venezuela, from 15 October 2009 to 15 January 2010. The species were identified using conventional biochemical tests, and their susceptibility to antimicrobial drugs was assessed by antibiogram (Kirby-Bauer method), using the 2010 performance standards published by the Clinical and Laboratory Standards Institute. Beta-lactam-resistant genes were detected using an enhanced polymerase chain reaction assay. RESULTS: Of 1 235 isolates, 207 (16.8%) exhibited resistance to third- and fourth-generation cephalosporins, carbapenems, or both. They presented the following phenotypes: extended-spectrum beta-lactamase (ESBL), 93.8%; depressed AmpC, 4.3%; and carbapenemase, 1.9%. Further characterization of the first two phenotypes yielded the following breakdown of types: SHV, 36.7%; CTX-M-1 group, 22.3%; TEM, 21.7%; CTX-M-1 group with impermeability, 5.2%; two-enzyme combinations, 4.5%; CTX-M-2 group, 4.3%; PER, 3.4%; and KPC, 1.9%. The SHV type was predominant in the public hospital strains, whereas the CTX-M-1 group was most common in the strains from the private hospitals. CONCLUSIONS: Of the enzymatic mechanisms investigated, the SHV type was the most frequent, followed by the CTX-M-1 group and the TEM type. Also, a high percentage of type KPC was found. The research reported here is one of only a few multicenter studies that have been conducted in Venezuela to evaluate the frequency of this type of antimicrobial resistance mechanism, including phenotypical and molecular characterization. It was shown that the detection methods require proper interpretation of sensitivity profiles and molecular confirmation of the mechanism present.

First report of metallo-ß-lactamases producing Enterobacter spp. strains from Venezuela.

Clinical strains of Enterobacter were isolated from Cumana's Central Hospital in Venezuela, and classified as E. cloacae (21), E. aerogenes (7), E. intermedium (1), E. sakazakii (1) and three unclassified. The strains showed high levels of resistance, especially to SXT (58.1%), CRO (48.8%), CAZ (46.6%), PIP (46.4%), CIP (45.2%) and ATM (43.3%). This is the first report for South America of blaVIM-2 in two E. cloacae and one Enterobacter sp., which also showed multiple mechanisms of resistance. Both E. cloacae showed blaTEM-1, but only one showed blaCTX-M-15 gene, while no blaSHV was detected.

Estudio comparativo de la sensibilidad entre el cultivo y la reacción en cadena de la polimerasa para la detección de bordetella pertussis a partir de muestras de hisopado nasofaríngeo / Comparative study of culture and sensitivity polymerase chain reaction in the diagnosis of bordetella pertussis from nasopharyngeal swab specimens

La tosferina es una enfermedad infecciosa causada por Bordetella pertussis, que se diagnostica mediante el cultivo como técnica de referencia, la cual tiene como limitante una baja sensibilidad. Es debido a esto, que el presente trabajo se centró en evaluar a la técnica de PCR a punto final amplificando las secuencias IS481 y PT, como una metodología alternativa diagnóstica a partir de 100 muestras pareadas de hisopado nasofaríngeo de pacientes provenientes de distintas regiones de Venezuela. Dichas muestras pareadas constaron de un hisopado para realizar el cultivo bacteriano y el otro para la detección de ADN específico. La identificación microbiológica de B. pertussis incluyó el aislamiento del microorganismo en agar Regan-Lowe, identificación bioquímica y la confirmación por coaglutinación. El análisis de los resultados fue realizado empleando el programa SPSS 21.0.0., usando como herramienta estadística el test de McNemar. La sensibilidad obtenida por el protocolo de PCR a punto final fue 50%, en concordancia con reportes previos. De acuerdo al valor de p=0,002 obtenido, la detección de B. pertussis mediante los dos métodos presentó una diferencia para el diagnóstico de tosferina estadísticamente significativa, por lo que no es indiferente emplear ambas técnicas diagnósticas. Sin embargo, se recomienda emplear en forma combinada ambas metodologías para incrementar la probabilidad de realizar el diagnóstico.

Whooping cough is an infectious disease caused by Bordetella pertussis, diagnosed by culture as a reference technique, which has low sensitivity as limiting. It is because of this that the present work focused on evaluating the PCR technique endpoint amplifying IS481 and PT sequences, as an alternative methodology diagnostic from 100 paired samples of nasopharyngeal swabs from patients from different regions of Venezuela. Such paired samples comprised a swab for bacterial culture and the other for detection of specific DNA. Microbiological identification of B. pertussis included the isolation of the microorganism in agar Regan-Lowe, biochemical identification and confirmation by Coagglutination. The analysis of the results was performed using the SPSS program 21.0.0., as a statistical tool using the McNemar test. The sensitivity obtained by the PCR protocol endpoint was 50%, consistent with previous reports. According to the value of p = 0.002 obtained, detection of B. pertussis by the two methods showed a difference for the diagnosis of pertussis statistically significant, so it is not indifferent both diagnostic techniques employed. However, it is recommended to use both methods in combination to increase the likelihood of diagnosis.

KPC and VIM producing Enterobacter cloacae strain from a Hospital in Northeastern Venezuela / Enterobacter cloacae productor de KPC y VIM en un Hospital del Noreste de Venezuela

An 83-year-old male patient is admitted to the central hospital in Cumaná, Venezuela with severe urinary infection, history of hospitalizations and prolonged antimicrobial treatments. A strain of Enterobacter cloacae was isolated showing resistance to multiple types of antibiotics (only sensitive to gentamicin), with phenotype of serine- and metallo-carbapenemases. Both, blaVIM-2 and blaKPC genes were detected in the isolate. This is the first report of an Enterobacteriaceae species producing both KPC carbapenemase and VIM metallo carbapenemase in Venezuela. This finding has a great clinical and epidemiological impact in the region, because of the feasibility of transferring these genes, through mobile elements to other strains of Enterobacter and to other infection-causing species of bacteria.

En un paciente masculino de 83 años, que ingresó al Hospital de Cumaná, Venezuela, con diagnóstico de infección urinaria severa, antecedentes de hospitalización y diferentes tratamientos antimicrobianos durante largos periodos de tiempo, se aisló una cepa de Enterobacter cloacae, la cual evidenció resistencia a múltiples tipos de antibióticos (solo sensible a gentamicina) y con fenotipo de carbapenemasas de tipo serina y metalobetalactamasa. Los genes blaVIM-2 y blaKPC fueron detectados en esta cepa. Este representa el primer reporte de una especie de Enterobacteriaceae productora simultánea de carbapenemasa KPC y metalobetalactamasa VIM en Venezuela. Esto tiene un gran impacto clínico y epidemiológico en la región por la posibilidad de transferencia de estos genes a otras cepas de Enterobacter u otras especies bacterianas causantes de infecciones, por medio de elementos móviles.

FIRST REPORT OF METALLO-β-LACTAMASES PRODUCING Enterobacter spp. STRAINS FROM VENEZUELA / Primer reporte de cepas de Enterobacter spp productoras de metalobetalactamasas de Venezuela

Clinical strains of Enterobacter were isolated from Cumana's Central Hospital in Venezuela, and classified as E. cloacae (21), E. aerogenes (7), E. intermedium (1), E. sakazakii (1) and three unclassified. The strains showed high levels of resistance, especially to SXT (58.1%), CRO (48.8%), CAZ (46.6%), PIP (46.4%), CIP (45.2%) and ATM (43.3%). This is the first report for South America of blaVIM-2 in two E. cloacae and one Enterobacter sp., which also showed multiple mechanisms of resistance. Both E. cloacae showed blaTEM-1, but only one showed blaCTX-M-15 gene, while no blaSHV was detected.

Cepas clínicas de Enterobacter fueron aisladas del Hospital central de Cumaná en Venezuela, y se clasificaron como E. cloacae (21), E. aerogenes (7), E. intermedium (1), E. sakazakii (1) y 3 sin clasificar. Las cepas mostraron altos niveles de resistencia, especialmente a SXT (58.1%), CRO (48.8%), CAZ (46.6%), PIP (46.4%), CIP (45.2%) and ATM (43.3%). Este es el primer reporte de América del Sur de blaVIM-2 en dos cepas de E. cloacae y una de Enterobacter sp., las cuales también mostraron múltiples mecanismos de resistencia. Ambas especies de E. cloacae mostraron genes blaTEM-1, pero solo una mostro el gen blaCTX-M-15, mientras que blaSHV no fue detectado.

First isolation of a VIM-producing Klebsiella pneumoniae from a seven-year-old child in Venezuela.

BACKGROUND: VIM-type metallo-betalactamases (MBLs) exhibit hydrolytic activity against most betalactam antibiotics, including carbapenems. So far, VIM-type-producing Klebsiella pneumoniae isolates had not been reported in Latin America. METHODOLOGY: In July 2005, a carbapenem-resistant Klebsiella pneumoniae was isolated from a urine sample collected from a 7-year-old girl hospitalized at the Hospital de Niños "J. M. de los Ríos" in Caracas, Venezuela. This strain was identified using conventional biochemical tests. The susceptibility analysis was conducted by disk diffusion, and MICs for Imipenem and Meropenem were performed by agar dilution. For the phenotypic detection of MBL we used the Imipenem-EDTA/SMA double-disk diffusion method. The hydrolytic activity against carbapenems was determined by the Masuda microbiological method. Purified protein was subjected to isoelectric focusing (IEF). Detection of antimicrobial resistance genes was performed by PCR amplification with specific VIM primers. RESULTS: The strain showed resistance to most betalactam antibiotics, quinolones and amynoglicosides, but remained susceptible to Aztreonam and Cefepime. The use of phenotypic and microbiological methods detected the presence of a metallobetalactamase. By IEF we visualized three bands at pI 5.4, 7.6 and 7.9, corresponding to reduced-spectrum betalactamases, and a band at pI 5.8 that corresponded to the metallobetalactamase. PCR screening of bla genes revealed the presence of blaVIM, with an amplicon of 261 bp. CONCLUSIONS: This is the first report of a MBL-mediated carbapenem-resistant Klebsiella pneumoniae in Latin America, which constitutes a public health concern in our region since their transference to other microorganisms with multiple antibiotic resistance mechanisms will increase the antimicrobial resistance problem.

Diseminación de enterobacterias productoras de carbapenemasas tipo KCP en Venezuela / Spread of carbapenemase-producing Enterobacteriaceae type KCP in Venezuela

La resistencia a carbapenems en la familia Enterobacteriaceae constituye un problema creciente a nivel mundial, siendo el mecanismo de mayor impacto clínico, epidemiológico y microbiológico, la producción de serino-carbapenemasas KPC. Investigar la presencia de carbapenemasas tipo KPC en aislados de Enterobacterias resistentes a carbapenems, provenientes de diversos centros de salud a nivel nacional, durante el período mayo 2010 - junio 2011. En esta investigación se analizaron 91 aislados de Enterobacterias: K pneumoniae (48), E. cloacae (30), E. aerogenes (4), E. coli (2), C. koseri (1), C. freundil (6), con resistencia a carbapenems provenientes de 14 centros de salud. La susceptibilidad antimicrobiana se evaluó siguiendo los criterios de la CLSI 2011. La detección fenotípica de carbapenemasas se realizó mediante el test de Hodge modificado y evaluando la sinergia con el ácido 3-aminofenilborónico 300 µg/disco. Se realizó el Test de Hodge "doble modificado" a los aislados de Enterobacter y Citrobacter. La detección genotípica de carbapenemasas se llevó a cabo mediante PCR utilizando iniciadores para el gen blaKPC. Todos los aislados presentaron a los deinhibición < 22 mm para meropenem y ertapenem. El 95% de los aislados resultaron positivos para el test de Hogde modificado, el test con ácido borónico, y para el gen blaKPC. En el test de Hodge "doble modificado", se observó 100% de positividad. La resistencia a carbapenems mediada por Carbapenemasas KPC, se ha incrementado en los últimos años en el país y el carácter plasmídico de estas enzimas les permite su fácil diseminación entre diversos géneros de Enterobacterias.

Resistance to carbapenems is the family Enterobacteriaceae is a growing problem around the world, being production of KPC serino-carbapenemase, the mayor impact clinical, epidemiological and microbiological mechanism. To investigate the presence of KPC carbapenemases in isolates of Enterobacterias resistant to carbapenems, from various health centers nationwide, during the period May-2010 June 2011. In this study were analyzed 91 Enterobacterias isolates: K. pneumoniae (48), E. cloacae (30), E. aerogenes (4), E. coli (2), C. koseri (1), C. freundii (6), with resistance to carbapenems from 14 health centers. Antimicrobial susceptibility was evaluated according to the criteria of the CLSI 2011. Phenotypic detection of carbapenemases was performed by Modified Hodge Test and it was evaluated the synergy with the 3-aminophenylboronic 300 µg/disc. Test were done with "double Modified" Hodge to Enterobacter and Citrobacter isolates. Genotypic detection of carbapenemases was performed out by using PCR primers for the gene blaKPC. All isolated showed inhibition zones <22 mm for meropenem and ertapemen. The 95% of the isolates were positive for Hogde Modified Test, test with boronic acid, and to blaKPC gene. By performing "Double Modified" Hodge`s essay , we observed a 100% of positivity. Resistance to carbapenems mediated by KPC carbapenemases has increased in the last few years in the country, and plasmidic characterization of these enzymes allows easily dissemination among different genera of Enterobacteriaceae.

Frecuencia de enzimas asociadas a sensibilidad disminuida a betalactámicos en aislados de enterobacterias, Caracas, Venezuela / Frequency of enzymes associated with reduced sensitivity to beta-lactamantibiotics in enterobacteria isolates, Caracas, Venezuela

Objective. To determine the frequency of enzymatic mechanisms associated with reduced sensitivity to broad-spectrum beta-lactam antibiotics in enterobacteria isolates obtained at hospital centers in Caracas, Venezuela.Methods. A cross-sectional study was conducted on enterobacteria isolated from patients at eight hospital centers in Caracas, Venezuela, from 15 October 2009 to 15 January 2010. The species were identified using conventional biochemical tests, and their susceptibility to antimicrobial drugs was assessed by antibiogram (Kirby-Bauer method), using the 2010 performance standards published by the Clinical and Laboratory Standards Institute. Beta-lactam-resistant genes were detected using an enhanced polymerase chain reaction assay.Results. Of 1 235 isolates, 207 (16.8%) exhibited resistance to third- and fourthgeneration cephalosporins, carbapenems, or both. They presented the following phenotypes: extended-spectrum beta-lactamase (ESBL), 93.8%; depressed AmpC, 4.3%; and carbapenemase, 1.9%. Further characterization of the first two phenotypes yielded the following breakdown of types: SHV, 36.7%; CTX-M-1 group, 22.3%; TEM, 21.7%; CTX-M-1 group with impermeability, 5.2%; two-enzyme combinations, 4.5%;CTX-M-2 group, 4.3%; PER, 3.4%; and KPC, 1.9%. The SHV type was predominant in the public hospital strains, whereas the CTX-M-1 group was most common in the strains from the private hospitals. Conclusions. Of the enzymatic mechanisms investigated, the SHV type was the most frequent, followed by the CTX-M-1 group and the TEM type. Also, a high percentageof type KPC was found. The research reported here is one of only a few multicenter studies that have been conducted in Venezuela to evaluate the frequency of this type of antimicrobial resistance mechanism, including phenotypical and molecular characterization...

Objetivo. Determinar la frecuencia de los mecanismos enzimáticos asociados a sensibilidad disminuida a los antibióticos betalactámicos de amplio espectro en aislados de enterobacteriasobtenidos de centros hospitalarios de Caracas, Venezuela. Métodos. Se realizó un estudio transversal con enterobacterias aisladas de pacientes de ocho centros hospitalarios de Caracas, Venezuela, desde el 15 de octubre de 2009 al 15 de enero de2010. La identificación se realizó mediante pruebas bioquímicas convencionales, y la susceptibilidada los antimicrobianos mediante antibiograma (Kirby-Bauer), según las normas de 2010 del Instituto de Estándares Clínicos y de Laboratorio. La detección de los genes de resistenciaa betalactámicos se realizó mediante amplificación por reacción en cadena de polimerasa. Resultados. De 1 235 aislados, 207 (16,8%) mostraron resistencia a cefalosporinas de terceray cuarta generación o a carbapenemes o a ambos. De esos, 93,8% presentaron fenotipo betalactamasa de espectro extendido (BLEE); 4,3%, fenotipo AmpC derreprimido, y 1,9%, fenotipocarbapenemasa. La caracterización de los dos primeros fenotipos determinó que 36,7% eran tipo SHV; 22,3%, grupo CTX-M-1; 21,7%, tipo TEM; 5,2%, grupo CTX-M-1 + impermeabilidad; 4,5%, combinación de dos enzimas; 4,3%, grupo CTX-M-2; 3,4%, tipo PER, y 1,9%, tipo KPC.Se observó un predominio del tipo SHV en las cepas obtenidas de hospitales públicos y del grupo CTX-M-1, en los privados. Conclusiones. De los mecanismos enzimáticos investigados, el tipo SHV fue el más frecuente,seguido del grupo CTX-M-1 y tipo TEM. Asimismo, se encontró un alto porcentaje de carbapenemasas tipo KPC. Este es uno de los pocos estudios multicéntricos realizados enVenezuela donde se evalúa la frecuencia de este tipo de mecanismo de resistencia a los antimicrobianos,incluida la caracterización fenotípica y molecular...