A hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection

Página do item simplificado
dc.contributor.authorCorrea, Luci [UNIFESP]
dc.contributor.authorMartino, Marines Dalla Valle
dc.contributor.authorSiqueira, Itacy
dc.contributor.authorPasternak, Jacyr
dc.contributor.authorGales, Ana Cristina [UNIFESP]
dc.contributor.authorSilva, Claudia Vallone
dc.contributor.authorCamargo, Thiago Zinsly Sampaio
dc.contributor.authorScherer, Patricia Faria
dc.contributor.authorMarra, Alexandre Rodrigues [UNIFESP]
dc.contributor.institutionHosp Israelita Albert Einstein
dc.contributor.institutionUniversidade Federal de São Paulo (UNIFESP)
dc.date.accessioned2016-01-24T14:31:16Z
dc.date.available2016-01-24T14:31:16Z
dc.date.issued2013-02-11
dc.description.abstractBackground: Healthcare-associated infections caused by Klebsiella pneumoniae isolates are increasing and few effective antibiotics are currently available to treat patients. We observed decreased carbapenem susceptibility among K. pneumoniae isolated from patients at a tertiary private hospital that showed a phenotype compatible with carbapenemase production although this group of enzymes was not detected in any sample. the aim of this study was to describe the epidemiology and clinical outcomes associated with carbapenem-resistant K. pneumoniae and to determine the antimicrobial resistance mechanisms.Methods: Risk factors associated with carbapenem-resistant K. pneumoniae infections were investigated by a matched case-control study from January 2006 through August 2008. A cohort study was also performed to evaluate the association between carbapenem resistance and in-hospital mortality. Bacterial identification and antimicrobial susceptibility were determined by Vitek 2 and Etest. Carbapenemase activity was detected using spectrophotometric assays. Production of beta-lactamases and alterations in genes encoding K. pneumoniae outer membrane proteins, OmpK35 and OmpK36, were analyzed by PCR and DNA sequencing, as well as SDS-Page. Genetic relatedness of carbapenem resistant isolates was evaluated by Pulsed Field Gel Electrophoresis.Results: Sixty patients were included (20 cases and 40 controls) in the study. Mortality was higher for patients with carbapenem-resistant K. pneumoniae infections compared with those with carbapenem-susceptible K. pneumoniae (50.0% vs 25.7%). the length of central venous catheter use was independently associated with carbapenem resistance in the multivariable analysis. All strains, except one, carried bla(CTX-M-2), an extended-spectrum betalactamase gene. in addition, a single isolate also possessed bla(GES-1). Genes encoding plasmid-mediated AmpC beta-lactamases or carbapenemases (KPC, metallo-betalactamases or OXA-carbapenemases) were not detected.Conclusions: the K. pneumoniae multidrug-resistant organisms were associated with significant mortality. the mechanisms associated with decreased K. pneumoniae carbapenem susceptibility were likely due to the presence of cephalosporinases coupled with porin alterations, which resulted from the presence of the insertion sequences in the outer membrane encoding genes.en
dc.description.affiliationHosp Israelita Albert Einstein, Infect Control Unit, BR-05652000 São Paulo, Brazil
dc.description.affiliationHosp Israelita Albert Einstein, Microbiol Lab, BR-05651901 São Paulo, Brazil
dc.description.affiliationUniversidade Federal de São Paulo UNIFESP EPM, Div Infect Dis, BR-04024002 São Paulo, Brazil
dc.description.affiliationHosp Israelita Albert Einstein, Intens Care Unit, BR-05651901 São Paulo, Brazil
dc.description.affiliationUnifespUniversidade Federal de São Paulo UNIFESP EPM, Div Infect Dis, BR-04024002 São Paulo, Brazil
dc.description.sourceWeb of Science
dc.description.sponsorshipInstituto Israelita de Ensino e Pesquisa Israelita Albert Einstein
dc.description.sponsorshipIDInstituto Israelita de Ensino e Pesquisa Israelita Albert Einstein: 449.08
dc.format.extent8
dc.identifierhttp://dx.doi.org/10.1186/1471-2334-13-80
dc.identifier.citationBmc Infectious Diseases. London: Biomed Central Ltd, v. 13, 8 p., 2013.
dc.identifier.doi10.1186/1471-2334-13-80
dc.identifier.fileWOS000315403100002.pdf
dc.identifier.issn1471-2334
dc.identifier.urihttp://repositorio.unifesp.br/handle/11600/35973
dc.identifier.wosWOS:000315403100002
dc.language.isoeng
dc.publisherBiomed Central Ltd
dc.relation.ispartofBmc Infectious Diseases
dc.rightsinfo:eu-repo/semantics/openAccess
dc.subjectKlebsiella pneumoniaeen
dc.subjectCarbapenem-resistant Klebsiellaen
dc.subjectHealthcare associated infectionsen
dc.subjectKlebsiella infections/microbiologyen
dc.subjectKlebsiella infections/mortalityen
dc.titleA hospital-based matched case-control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infectionen
dc.typeinfo:eu-repo/semantics/article
Arquivos
Pacote Original
Agora exibindo 1 - 1 de 1
Imagem de Miniatura
Nome:
WOS000315403100002.pdf
Tamanho:
214.12 KB
Formato:
Adobe Portable Document Format
Descrição:
Baixar
Coleções
Em verificação - Geral