25º Congresso Brasileiro de Microbiologia

25º Congresso Brasileiro de Microbiologia

ResumoID:487-2

Área: Microbiologia Clinica ( Divisão A )

HIGH LEVEL RESISTANCE IN KLEBSIELLA PNEUMONIAE ISOLATES HARBOURING SIMULTANEOUSLY KPC AND ESBL GENES

Anna Carolina Soares Almeida (UPE); Felipe Lira de Sá Cavalcanti (UFPE); Marinalda Anselmo Vilela (UPE); Marcos Antonio de Morais Júnior (UFPE); Márcia Maria Camargo de Morais (UPE)

Resumo

Carbapenem are regarded as the drugs of choice for serious infections with ESBL-producing organisms. For this reason, KPC carbapenemases represent a serious public health problem. KPC-producing K. pneumoniae became a frequent nosocomial pathogen, specially in bloodstream infections. Reports on production of multiple beta-lactamases in a single pathogen are increasing, as well as, the occurrence of other integron-borne resistance determinants. The ten strains used in this study showed decreased susceptibility to third-generation cephalosporin and were isolated from bloodstream infections from patients hospitalized in a teaching university hospital (HUOC), in Recife, Brazil. Susceptibilities were determined by the disk-diffusion method; screening for the ESBL and class A carbapenemase-producing phenotypes were performed and evaluated according to CLSI (2009) criteria. The presence of bla_KPC, bla_CTX-M, bla_TEM and class 1 integrase was determined by specific PCR. The positive PCR product for bla_KPCwas purified using the PCR Purification Kit (Promega). Sequencing was performed with the BigDye Terminator Cycle Sequencing Kit in ABI Prisma 3100 DNA sequencer (Applied Biosystems). Sequences were compared with database of GenBank. The results exhibited that the isolates were positive for ESBL (80%) and carbapenemase (60%) production; the presence of the bla_KPC was confirmed by sequencing. Antimicrobial susceptibility testing showed high resistance levels (more than 80%) to extended-spectrum cephalosporin, ertapenem, aminoglicosydes, monobactam, quinolones and beta-lactam/beta-lactamase inhibitor. Molecular investigations showed that all the isolates harbored class 1 integron. Moreover, 84%, 50% e 33% of the isolates exhibited simultaneous presence of bla_KPC/bla_CTX, bla_KPC/bla_TEM, and bla_KPC/bla_CTX/bla_TEM, respectively. The isolates showed a high rate of resistance to beta-lactam and non-beta-lactam antibiotics. This profile should be probably an effect of association of two or more bla genes, in addition to other gene cassetes inserted in class 1 integron. Our finding exhibited the coexistence of multiple resistant genes in the same isolate. Methods of surveillance should be implanting to control the spread of these MDR phenotypes.

Palavras-chave: Carbapenemase, KPC, ESBL, Klebsiella pneumoniae

਀�