Epidemic of Klebsiella pneumoniae ST11 Clone Coproducing KPC-2 and 16S rRNA Methylase RmtB in a Chinese University HospitalReportar como inadecuado




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BMC Infectious Diseases

, 12:373

Bacterial and fungal diseases

Abstract

BackgroundEmergence of rmtB-positive Klebsiella pneumoniae carbapenemase KPC-producing K. pneumoniae KPC-KP poses a great threat to antimicrobial treatment options.

MethodsFrom January 2010 to December 2010, non-duplicate KPC-KP isolates from our hospital were screened for rmtB and multiple other resistance determinants with PCR. Subsequent studies included MIC determination, PFGE, and multilocus sequence typing. Records from patients with KPC-KP isolated were retrospectively reviewed. Comparisons of molecular and clinical characteristics between rmtB-positive and rmtB–negative isolates were systematically performed, as well as the environmental colonization study in ICU wards.

ResultsA total of 84 KPC-KP strains were collected, including 48 rmtB-positive KPC-KP RPKP and 36 rmtB-negative KPC-KP RNKP isolates. All KPC-KP isolates were multidrug resistant, with colistin and tigecycline being the most active agents. Compared with RNKP, RPKP displayed a much severer resistance phenotype. Susceptibility rates for amikacin 0% for RPKP versus 88.9% for RNKP, p < 0.01, fosfomycin 8.5% for RPKP versus 88.9% for RNKP, p < 0.01, and minocycline 6.7% for RPKP versus 52.8% for RNKP, p < 0.01, were all significantly lower in RPKP strains. Isolates belonging to PFGE pulsetype A and sequence type 11 were predominant in both groups, including 39 81.3% RPKP and 22 61.1% RNKP isolates. Nevertheless, RNKP showed more complex genetic backgrounds compared with RPKP. Diverse clinical characteristics were found in both cohorts, however, no significant differences were observed between RPKP and RNKP patients.

ConclusionsRPKP strains have spread widely and gradually replaced RNKP in our hospital. They seemed to show much severer resistance phenotypes compared with RNKP and had a bigger dissemination potential. Prudent use of available active agents combined with good control practices is therefore mandatory.

KeywordsCarbapenem Aminoglycoside KPC rmtB Epidemic AbbreviationsKPCKlebsiella pneumoniae carbapenemase

KPC-KPKlebsiella pneumoniae carbapenemase-producing K. pneumoniae

RPKPrmtB-positive Klebsiella pneumoniae carbapenemase-producing K. pneumoniae

RNKPrmtB-negative Klebsiella pneumoniae carbapenemase-producing K. pneumoniae

CLSIClinical and Laboratory Standards Institute

PFGEPulse field gel electrophoresis

MLSTMultilocus sequence typing

BHIBrain and heart infusion

PTsPulsetypes

STsSequence types

MICMinimal inhibition concentration

PCRPolymerase chain reaction

ICUIntensive care unit.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2334-12-373 contains supplementary material, which is available to authorized users.

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Autor: Jun-Jie Li - Zi-Ke Sheng - Mei Deng - Sheng Bi - Fei-Shu Hu - Hai-Feng Miao - Zhong-Kang Ji - Ji-Fang Sheng - Lan-Juan Li

Fuente: https://link.springer.com/







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