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Detection and analysis of different interactions between resistance mechanisms and carbapenems in clinical isolates of Klebsiella pneumoniae.

Authors
  • Dalmolin, Tanise Vendruscolo1
  • Bianchini, Bianca Vendruscolo1
  • Rossi, Grazielle Guidolin1
  • Ramos, Ana Carolina2
  • Gales, Ana Cristina2
  • Trindade, Priscila de Arruda3
  • Campos, Marli Matiko Anraku de1
  • 1 Universidade Federal de Santa Maria (UFSM), Laboratório de Micobacteriologia, Santa Maria, RS, Brazil. , (Brazil)
  • 2 Universidade Federal de São Paulo (UNIFESP), Laboratório ALERTA, São Paulo, SP, Brazil. , (Brazil)
  • 3 Universidade Federal de Santa Maria (UFSM), Laboratório de Micobacteriologia, Santa Maria, RS, Brazil. Electronic address: [email protected] , (Brazil)
Type
Published Article
Journal
Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology]
Publication Date
Jan 01, 2017
Volume
48
Issue
3
Pages
493–498
Identifiers
DOI: 10.1016/j.bjm.2017.01.003
PMID: 28291698
Source
Medline
Keywords
License
Unknown

Abstract

Carbapenems are considered last-line agents for the treatment of serious infections caused by Klebsiella pneumoniae, and this microorganism may exhibit resistance to β-lactam antibiotics due to different mechanisms of resistance. We evaluated 27 isolates of K. pneumoniae resistant to carbapenems recovered from inpatients at the University Hospital of Santa Maria-RS from July 2013 to August 2014. We carried out antimicrobial susceptibility, carbapenemase detection, testing for the presence of efflux pump by broth microdilution and loss of porin by sodium dodecyl sulfate polyacrylamide gel electrophoresis. Genetic similarity was evaluated by ERIC-PCR. High levels of resistance were verified by the minimum inhibitory concentration for the antimicrobials tested. The blaKPC gene was present in 89% of the clinical isolates. Blue-Carba and combined disk with AFB tests showed 100% concordance, while the combined disk test with EDTA showed a high number of false-positives (48%) compared with the gold-standard genotypic test. Four isolates showed a phenotypic resistance profile consistent with the overexpression of the efflux pump, and all clinical isolates had lost one or both porins. The ERIC-PCR dendrogram demonstrated the presence of nine clusters. The main mechanism of resistance to carbapenems found in the assessed isolates was the presence of the blaKPC gene.

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