1. bookTom 23 (2015): Zeszyt 3 (August 2015)
Informacje o czasopiśmie
License
Format
Czasopismo
eISSN
2284-5623
Pierwsze wydanie
08 Aug 2013
Częstotliwość wydawania
4 razy w roku
Języki
Angielski
access type Otwarty dostęp

Emergence of Carbapenemase-producing Enterobacteriaceae, a Public Health Threat: a Romanian Infectious Disease Hospital Based Study / Emergenţa Enterobacteriaceaelor producătoare de carbapenemaze, o ameninţare pentru sănătatea publică: un studiu realizat într-un spital romanesc de boli infectioase

Data publikacji: 30 Sep 2015
Tom & Zeszyt: Tom 23 (2015) - Zeszyt 3 (August 2015)
Zakres stron: 295 - 301
Otrzymano: 12 Mar 2015
Przyjęty: 26 Jun 2015
Informacje o czasopiśmie
License
Format
Czasopismo
eISSN
2284-5623
Pierwsze wydanie
08 Aug 2013
Częstotliwość wydawania
4 razy w roku
Języki
Angielski
Abstract

Introduction: Hospital-acquired infections caused by Enterobacteriaceae producing different types of carbapenem- hydrolizing enzymes are now commonly observed and represent a great limitation for antimicrobial therapy. The purpose of the study was to evaluate the emergence of carbapenem-resistant Enterobaceriaceae among the strains isolated from hospitalized patients to the National Institute of Infectious Diseases, Bucharest (NIID) and the identification of different types of carbapenemases, using phenotypic methods.

Materials and methods: Between January - June 2014, 587 strains of Klebsiella pneumoniae, Enterobacter species and E.coli were isolated from various clinical specimens. We were included all non-susceptible strains to carbapenems, according to EUCAST 2014 clinical breakpoints, as determined by using microdilution MicroScan Panels (Siemens Healthcare Diagnostics). The modified Hodge test (MHT) was performed as phenotypic confirmatory test for carbapenemase production according to CLSI guidelines and the combination disk test (KPC, MBL , OXA-48 Confirm kit, Rosco Diagnostica) according to EUCAST guidelines.

Results: A total of 45 non-repeat Enterobaceriaceae (32 strains Klebsiella pneumoniae, 5 strains E.coli, 8 strains Enterobacter spp) were identified as non-susceptibile to one or more carbapenems (93,33% ertapenem, 53,33% meropenem, 48,88% imipenem). Most strains were isolated from urine (75,55%). MHT was positive in 55,6% (25/45) of carbapenem-resistant strains; in 24 cases the carbapenem-hydrolizing enzyme was identified as: OXA-48-like (n=16), KPC (n=4), MBL (n=1), KPC + MBL (n=2) and MBL + OXA-48-like (n=1). All carbapenemase- positive strains were 100% resistant to 3rd and 4th generation cephalosporins, showing less resistance to tigecycline (12,5% resistant and 25% intermediate), colistin (37,5%) and fosfomycin (41,6%).

Conclusion: During 6 months period, there were isolated 7,66% (45/587) carbapenem-resistant Enterobacteriaceae (K. pneumoniae 21,47%, E. coli 1,23%). Twenty four strains were carbapenemase-producers. The most frequent carbapenemase isolated in our study was OXA-48-like.

Keywords

1. Gaynes RP, Culver DH, Resistance to imipenem among selected gram-negative bacilli in the United States. Infect Control Hosp Epidemiol. 1992;13:10-4. DOI: 10.2307/30146962 DOI: 10.1086/64641710.2307/30146962Search in Google Scholar

2. Doumith M, Ellington MJ, Livermore DM, Woodford N. Molecular mechanisms disrupting porin expression in ertapenem-resistant Klebsiella and Enterobacter spp. clinical isolates from the UK. J Antimicrob Chemother. 2009;63:659-67. DOI: 10.1093/jac/dkp02910.1093/jac/dkp02919233898Search in Google Scholar

3. Naas T, Nordmann P. Analysis of carbapenem-hydrolyzing class A β-lactamase from Enterobacter cloacae and of its LysR-type regulatory protein. Proc Natl Acad Sci U S A. 1994;91:7693-7. DOI: 10.1073/ pnas.91.16.769310.1073/pnas.91.16.7693444688052644Search in Google Scholar

4. Nordmann P, Naas T, Poirel L. Global spread of carbapenemase- producing Enterobacteriaceae. Emerg Infect Dis. 2011;17:1791-8. DOI: 10.3201/eid1710.11065510.3201/eid1710.110655331068222000347Search in Google Scholar

5. Giske CG, Martinez-Martinez L, Cantón R, Stefani S, Skov R, Glupczynski Y et al. EUCAST guidelines for detection of resistance mechanisms and specific resistances of clinical and/or epidemiological importance. 2013. Version 1.0:4-10.Search in Google Scholar

6. Monaco M, Giani T, Raffone M, Arena F, Garcia-Fernandez A, Pollini S, et al. Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill. 2014;19(42):pii=20939. DOI: 10.2807/1560-7917.es2014.19.42.2093910.2807/1560-7917.ES2014.19.42.20939Search in Google Scholar

7. Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of oxacillinase-mediated reistance to imipenem in Klebsiella pneumoniae. Antimicrob Agents Chemother. 2004;48(1):15-22. DOI: 10.1128/AAC.48.1.15-22.200410.1128/AAC.48.1.15-22.200431016714693513Search in Google Scholar

8. Glasner C, Albiger B, Buist G, Tambić Andraśević A, Canton R, Carmeli Y, et al. The European Survey on Carbapenemase-Producing Enterobacteriaceae (Eu- SCAPE) working group. Carbapenemase-producing Enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013. Euro Surveill. 2013;18(28):pii=20525.10.2807/1560-7917.ES2013.18.28.2052523870096Search in Google Scholar

9. Djahmi N, Dunyach-Remy C, Pantel A, Dekhil M, Sotto A, Lavigne JP. Epidemiology of carbapenemase-producing Enterobaceriaceae and Acinetobacter baumannii in Mediterranean Countries. BioMed Research International. 2014. Article ID 305784, 11 pages.10.1155/2014/305784405262324955354Search in Google Scholar

10. Pavelkovich A, Balode A, Edquist P, Egorova S, Ivanova M, Kaftyreva L, et al. Detection of carbapenemase- producing Enterobacteriaceae in the Baltic countries and St. Petersburg area. BioMed Research International. 2014. Article ID 548960, 7 pages.10.1155/2014/548960395877524724086Search in Google Scholar

11. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2013. Annual Report of the European Antimicrobial Resistance Surveillance Network (EARS-Net). Stockholm: ECDC; 2014.Search in Google Scholar

12. Székely E, Damjanova I, Jánvári L, Vas KE, Molnár S, Bilca DV, et al. First description of blaNDM-1, bla- OXA-48, blaOXA-181 producing Enterobacteriaceae strains in Romania. Int J Med Microbiol. 2013;303:697-700. DOI: 10.1016/j.ijmm.2013.10.00110.1016/j.ijmm.2013.10.00124183483Search in Google Scholar

13. Mirioagou V, Tzelepi E, Kotsakis SD, Daikos GL, Bou Casals J, Tzouvelekis LS. Combined disk methods for the detection of KPC- and/or VIM-positive Klebsiella pneumoniae: improving reliability for the double carbapenemase producers. Clin Microbiol Infect. 2013;19:412-5. DOI: 10.1111/1469-0691.1223810.1111/1469-0691.1223823627340Search in Google Scholar

14. Tzouvelekis LS, Markogiannakis A, Piperaki E, Souli M, Daikos GL. Treating infections caused by carbapenemase- producing Enterobacteriaceae. Clin Microbiol Infect. 2014;20:862-872. DOI: 10.1111/1469-0691.1269710.1111/1469-0691.1269724890393Search in Google Scholar

15. Monaco M, Giani T, Raffone M, Arena F, Garcia-Fernandez F, Pollini S, et al. Colistin resistance superimposed to endemic carbapenem-resistant Klebsiella pneumoniae: a rapidly evolving problem in Italy, November 2013 to April 2014. Euro Surveill. 2014; 19(42):pii=20939. DOI: 10.2807/1560-7917.es2014.19.42.2093910.2807/1560-7917.ES2014.19.42.2093925358041Search in Google Scholar

16. Woodford N, Eastaway AT, Ford M, Leanord A, Keane C, Quayle RM, et al. Comparison of BD Phoenix, Vitek 2, and MicroScan automated systems for detection and inference of mechanisms responsible for carbapenem resistance in Enterobacteriaceae. J Clin Microbiol. 2010. 48(8):2999-3002. DOI: 10.1128/JCM.00341-10 10.1128/JCM.00341-10291663220534805Search in Google Scholar

Polecane artykuły z Trend MD

Zaplanuj zdalną konferencję ze Sciendo