Evaluation of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Rio Grande do Sul, Brazil

Lorenzoni, Vinícius Victor; Silva, Danielly da Costa; Rampelotto, Roberta Filipini; Brites, Patrícia Chaves; Villa, Bárbara; Hörner, Rosmari

doi:10.1590/0037-8682-0209-2017

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Short Communication • Rev. Soc. Bras. Med. Trop. 50 (05) • Sep-Oct 2017 • https://doi.org/10.1590/0037-8682-0209-2017 copy

Evaluation of carbapenem-resistant Enterobacteriaceae in a tertiary-level reference hospital in Rio Grande do Sul, Brazil

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

INTRODUCTION:

The rapid global spread of carbapenem-resistant Enterobacteriaceae (CRE) is a threat to the health system.

METHODS:

We evaluated the antimicrobial susceptibility profiles of 70 CRE isolated in a tertiary hospital in Brazil between August and December 2015, and determined their resistance mechanisms.

RESULTS:

The most prevalent microorganism was Klebsiella pneumoniae (95.7%); it showed high-level resistance to carbapenems (>98%), with sensitivity to colistin (91.4%) and amikacin (98.6%). The bla _KPC gene was detected in 80% of the CRE isolates.

CONCLUSIONS:

Evaluation of bacterial resistance contributes to an appropriate treatment, and the reduction of morbimortality and dissemination of resistance.

Keywords:
Enterobacteriaceae; Klebsiella pneumoniae carbapenemase; Multiresistance

Antimicrobial agents	MIC range (µg/mL)	MIC50 (µg/mL)^*	Resistant n (%)
Amikacin	2-64	≤ 16	1 (1.42)
Ampicillin	1-32	≥ 32	70 (100.0)
Cefepime	1-64	≥ 64	68 (97.1)
Ceftazidime	1-64	≥ 64	69 (98.6)
Ceftriaxone	1-64	≥ 64	67 (95.7)
Ciprofloxacin	0.25-16	≥ 4	66 (94.3)
Colistin	0.5-16	≤ 0.5	6 (8.6)
Ertapenem	0.5-8	≥ 8	70 (100.0)
Gentamicin	1-16	≥ 16	46 (65.7)
Imipenem	0.25-16	≥ 16	69 (98.6)
Meropenem	0.25-16	≥ 16	69 (98.6)
Piperacillin-tazobactam	4-128	≥ 128	69 (98.6)
Tigecycline	0.25-8	≥ 8	66 (94.3)

Microorganism	Unit	Specimen	n	Phenotype				Genotype
				PBA	EDTA	CN	BC	PCR
Citrobacter freundii	Clinic	Urine	1	+	-	+	+	bla _KPC
Enterobacter cloacae	Adult emergency room	Urine	1	-	-	-	-	-
Escherichia coli	Semi-intensive care unit	Rectal swab	1	+	-	+	+	bla _KPC
Klebsiella pneumoniae	Clinic	SLB	1	+	-	+	+	bla _KPC
		Feces	1	-	-	-	-	-
		Rectal swab	1	+	-	+	+	bla _KPC
		Rectal swab	1	-	-	-	-	-
		Urine	1	+	-	+	+	bla _KPC
	Surgical block	Fibrin	1	+	-	+	+	bla _KPC
	TCCAC	Axillary secretion	1	+	-	+	+	bla _KPC
		Rectal swab	1	+	-	+	+	bla _KPC
		Urine	1	-	-	-	-	-
	Nephrology	Rectal swab	2	+	-	+	+	bla _KPC
	Nephrology	Rectal swab	1	+	-	+	+	bla _KPC
	Adult emergency room	Sputum	1	+	-	+	+	bla _KPC
		Blood	1	+	-	+	+	bla _KPC
		Urine	3	+	-	+	+	bla _KPC
		Urine	2	-	-	-	-	-
	Psychiatric	Urine	1	-	-	-	-	-
	Semi-intensive care unit	Sputum	1	+	-	+	+	bla _KPC
		Feces	1	+	-	+	+	bla _KPC
		Rectal swab	1	+	-	+	+	bla _KPC
		Rectal swab	3	+	-	+	+	bla _KPC
		Urine	1	+	-	+	+	bla _KPC
	MIWHU	Feces	1	-	-	-	-	-
	General surgery unit	Sputum	1	+	-	+	+	bla _KPC
		BAL	1	-	-	-	-	-
		Catheter tip	1	+	-	+	+	bla _KPC
		Blood	1	-	-	-	-	-
		SWF	1	+	-	+	+	bla _KPC
		Rectal swab	6	+	-	+	+	bla _KPC
		Rectal swab	3	+	-	+	+	bla _KPC
		Urine	3	+	-	+	+	bla _KPC
		Urine	1	-	-	-	-	-
	Cardiac intensive care unit	Rectal swab	1	+	-	+	+	bla _KPC
	Cardiac intensive care unit	Rectal swab	1	+	-	+	+	bla _KPC
	Intensive care unit	Leg lesion	1	+	-	+	+	bla _KPC
		Abdominal fluid	1	+	-	+	+	bla _KPC
		Tracheal secretion	1	+	-	+	+	bla _KPC
		Rectal swab	7	+	-	+	+	bla _KPC
			2	+	-	+	+	bla _KPC
			1	-	-	-	-	-
		Urine	2	+	-	+	+	bla _KPC
		Urine	2	+	-	+	+	bla _KPC
			2	-	-	-	-	-

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[1] Corresponding author: Dra. Rosmari Hörner. e-mail:rosmari.ufsm@gmail.com