Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery

Kesia Esther da Silva; Wirlaine Glauce Maciel; Flávia Patussi Correia Sacchi; Cecilia Godoy Carvalhaes; Fernanda Rodrigues-Costa; Ana Carolina Ramos da Silva; Mariana Garcia Croda; Fábio Juliano Negrão; Julio Croda; Ana Cristina Gales; Simone Simionatto

doi:10.1099/jmm.0.000254

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Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery

Journal article

Open access

Peer reviewed

Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery

Kesia Esther da Silva, Wirlaine Glauce Maciel, Flávia Patussi Correia Sacchi, Cecilia Godoy Carvalhaes, Fernanda Rodrigues-Costa, Ana Carolina Ramos da Silva, Mariana Garcia Croda, Fábio Juliano Negrão, Julio Croda, Ana Cristina Gales, …

Journal of medical microbiology, Vol.65(6), pp.547-553

06/2016

DOI: 10.1099/jmm.0.000254

PMID: 27002853

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Abstract

This study describes the molecular characteristics and risk factors associated with carbapenem-resistant Klebsiella pneumoniae strains. Risk factors associated with KPC-producing K. pneumoniae strains were investigated in this case-control study from May 2011 to May 2013. Bacterial identification was performed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined by broth microdilution. Carbapenemase production was assessed by both modified Hodge test (MHT) and ertapenem hydrolysis using MALDI-TOF MS. The presence of β-lactamase-encoding genes was evaluated by PCR and DNA sequencing. Alterations in genes encoding K. pneumoniae outer membrane proteins were analysed by PCR and DNA sequencing as well as SDS-PAGE. Genetic relatedness among strains was determined by pulsed-field gel electrophoresis. This study included 94 patients. Longer hospitalisation, mechanical ventilation, catheters, and previous surgery were associated with KPC-producing K. pneumoniae. Sixty-eight strains showed resistance to carbapenems. Carbapenemase production was detected by MHT in 67 K. pneumoniae strains and by MALDI-TOF MS in 57. The presence of the blaKPC-2 gene was identified in 57 strains. The blaKPC-2 gene was not found in 11 carbapenem-resistant K. pneumoniae; instead, the blaCTX-M-1-like, blaCTX-M-2-like, blaCTX-M-8 like, blaCTX-M-14-like and blaSHV- like genes associated with OmpK35 and OmpK36 alterations were observed. Thirty-three KPC-producing K. pneumoniae strains were clonally related, and patients infected with these strains had a higher mortality rate (78.78 %). Our results show that KPC-producing K. pneumoniae was associated with several healthcare-related risk factors, including recent surgery.

beta-Lactamases - genetics

beta-Lactamases - metabolism

Case-Control Studies

Drug Resistance, Bacterial - genetics

Gene Expression Regulation, Bacterial

Gene Expression Regulation, Enzymologic

Humans

Klebsiella Infections - microbiology

Klebsiella pneumoniae - enzymology

Klebsiella pneumoniae - genetics

Klebsiella pneumoniae - metabolism

Middle Aged

Risk Factors

Surgical Wound Infection - microbiology

Details

Title: Subtitle: Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery
Creators: Kesia Esther da Silva - Universidade Federal da Grande Dourados
Wirlaine Glauce Maciel - Universidade Federal da Grande Dourados
Flávia Patussi Correia Sacchi - Universidade Federal da Grande Dourados
Cecilia Godoy Carvalhaes - Universidade Federal de São Paulo
Fernanda Rodrigues-Costa - 3 Laboratório ALERTA, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
Ana Carolina Ramos da Silva - 3 Laboratório ALERTA, Disciplina de Infectologia, Departamento de Medicina, Universidade Federal de São Paulo - UNIFESP, São Paulo, Brazil
Mariana Garcia Croda - Universidade Federal da Grande Dourados
Fábio Juliano Negrão - Universidade Federal da Grande Dourados
Julio Croda - 4 Fundação Osvaldo Cruz, Campo Grande, Mato Grasso do Sul, Brazil
Ana Cristina Gales - Universidade Federal da Grande Dourados
Simone Simionatto - Universidade Federal da Grande Dourados
Resource Type: Journal article
Publication Details: Journal of medical microbiology, Vol.65(6), pp.547-553
DOI: 10.1099/jmm.0.000254
PMID: 27002853
NLM abbreviation: J Med Microbiol
ISSN: 0022-2615
eISSN: 1473-5644
Language: English
Date published: 06/2016
Academic Unit: Pathology
Record Identifier: 9984183984602771

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34 Times Cited - Web of Science