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A hospital-based matched case–control study to identify clinical outcome and risk factors associated with carbapenem-resistant Klebsiella pneumoniae infection
Correa Luci,Martino Marines Dalla Valle,Siqueira Itacy,Pasternak Jacyr
BMC Infectious Diseases , 2013, DOI: 10.1186/1471-2334-13-80
Abstract: Background Healthcare-associated infections caused by Klebsiella pneumoniae isolates are increasing and few effective antibiotics are currently available to treat patients. We observed decreased carbapenem susceptibility among K. pneumoniae isolated from patients at a tertiary private hospital that showed a phenotype compatible with carbapenemase production although this group of enzymes was not detected in any sample. The aim of this study was to describe the epidemiology and clinical outcomes associated with carbapenem-resistant K. pneumoniae and to determine the antimicrobial resistance mechanisms. Methods Risk factors associated with carbapenem-resistant K. pneumoniae infections were investigated by a matched case–control study from January 2006 through August 2008. A cohort study was also performed to evaluate the association between carbapenem resistance and in-hospital mortality. Bacterial identification and antimicrobial susceptibility were determined by Vitek 2 and Etest. Carbapenemase activity was detected using spectrophotometric assays. Production of beta-lactamases and alterations in genes encoding K. pneumoniae outer membrane proteins, OmpK35 and OmpK36, were analyzed by PCR and DNA sequencing, as well as SDS-Page. Genetic relatedness of carbapenem resistant isolates was evaluated by Pulsed Field Gel Electrophoresis. Results Sixty patients were included (20 cases and 40 controls) in the study. Mortality was higher for patients with carbapenem-resistant K. pneumoniae infections compared with those with carbapenem-susceptible K. pneumoniae (50.0% vs 25.7%). The length of central venous catheter use was independently associated with carbapenem resistance in the multivariable analysis. All strains, except one, carried blaCTX-M-2, an extended-spectrum betalactamase gene. In addition, a single isolate also possessed blaGES-1. Genes encoding plasmid-mediated AmpC beta-lactamases or carbapenemases (KPC, metallo-betalactamases or OXA-carbapenemases) were not detected. Conclusions The K. pneumoniae multidrug-resistant organisms were associated with significant mortality. The mechanisms associated with decreased K. pneumoniae carbapenem susceptibility were likely due to the presence of cephalosporinases coupled with porin alterations, which resulted from the presence of the insertion sequences in the outer membrane encoding genes.
Infected Ewing′s sarcoma of spine.
Kumar R,Prasad K,Krishnani N,Chhabra D
Neurology India , 2000,
Abstract: An unusual case of extradural, intraspinal Ewing′s sarcoma with significant extraspinal extension is reported. In view of associated constitutional symptoms, suggestive signs, leucocytosis, elevated ESR and operative findings, the initial diagnosis of Pott′s spine was entertained. The lesion however turned out to be infected Ewing′s sarcoma on histopathology and bacteriological examination.
Klebocin typing of Klebsiella species isolated from nosocomial infection in intensive care unit.
Pal R,Rebello J,Banker D,Jain P
Journal of Postgraduate Medicine , 1997,
Abstract: Klebocin typing and antibiotic resistance have been studied for 518 strains of Klebsiella pneumoniae, [106 from intensive care unit (ICU) sites, 182 from ICU staff flora, 192 from patient flora and 38 from clinical specimens]. The overall typability was 71.62%. The most common mnemonic types among various sources were 111, 211, and 112. Of the total strains tested, 28.37% strains were found to be untypable. These strains are labelled as "444". When klebocin typing was used in association with antibiogram, in 86.84% cases of clinical infection probable source of infection could be detected. Thus a combination of two typing methods poses a significant contribution in epidemiological studies.
Sepsis nosocomial
Bembibre Taboada,Rubén; González ávalos,Enrique; Quintero La O,Cristina;
Revista Cubana de Medicina , 1997,
Abstract: a l-year period study was carried out at "gustavo aldereguía lima" provincial clinical and surgical hospital from january, 1st 1994 to january, 1st 1995 with the aim of knowing the present situation of nosocomial infection in our center. a number of 299 patients was studied, and it was proved that the most frequent sepsis were respiratory sepsis, phlebitis, and surgical sepsis; isolated germs were found to be klebsiella, staphylococcus, pseudomona, and escherichia coli; males were more affected than females. a microbiological verification was performed in 30.43 % of cases and services most reported accounted for medical care to seriously ill patients and were related to a greater volume of admission. geriatric age groups were found to be a risk factor. the most frequent infections have a direct and indirect relationship to the aggression of the nosocomial germ.
Bombay experience in intensive respiratory care over 6 years.
Kamat S,Heera S,Potdar P,Shah S
Journal of Postgraduate Medicine , 1989,
Abstract: The experience of the intensive respiratory care in 930 cases treated from 1983 for 4 years and in 404 cases over the next 2 years is reported. The background operational problems are stressed. Those between age 10 and 50 years did significantly better (p less than 0.05). The survival over the first 4 years in IPPR cases was 16.3% and in non IPPR group 71.8%; over the next 2 years, the former group, survival was 32.4 and 36.3%. The survival in asthmatic patients was high (76%). In cases with organophosphorus poisoning (without IPPR), survival was 81% while in IPPR group it was 29%. In 1988, the results in this group were better due to more aggressive management. In autopsy data on 85 cases, infection was not a major feature in those dying within 24 hours. The survival in COPD cases showed significant relation to age (p less than 0.05), initial arterial pO2 below 60 mm (p less than 0.01) and arterial pH below 7.3 (p less than 0.01). In cases with pneumonia (also asthma) younger cases did better (p less than 0.05) as also those with pneumonia and initial pO2 above 60 mm (p less than 0.01) and pH above 7.3 (p less than 0.001). When pneumonia was community acquired, survival (64.8%) was better than when it was hospital acquired (24%; p less than 0.01). Only the need for IPPR affected survival in trauma group. The major cause of death was infection with Klebsiella, Pseudomonas, Staphylococci and other gram--ve organisms. It is concluded that with proper planning and training, the IRCU does provide a useful mode of treatment in selected patients with respiratory problems.
Aetiological aspects of lung abscess.
Kharkar R,Ayyar V
Journal of Postgraduate Medicine , 1981,
Abstract:
Open Conversion after Aortic Endograft Infection Caused by Colistin-Resistant, Carbapenemase-Producing Klebsiella pneumoniae
Danilo Menna,Francesco Speziale,Laura Capoccia,Nunzio Montelione,Pasqualino Sirignano,Wassim Mansour
- , 2016, DOI: 10.14503/THIJ-15-5265
Abstract: A 62-year-old man presented with fever, abdominal pain, and malaise 13 months after emergency endovascular aortic repair. Computed tomographic angiograms showed a periprosthetic fluid and gas collection, so infection was diagnosed. Open conversion was performed, involving endograft explantation and in situ aortic reconstruction. Cultures and the explanted prosthesis were positive for carbapenemase-producing Klebsiella pneumoniae, resistant to colistin. Because of the sparse data on endograft infections caused by this pathogen, we placed the patient on an empiric double-carbapenem regimen for 4 weeks. Symptomatic recovery occurred after 21 days. On the 30th day, we deployed a stent to treat a new pseudoaneurysm. Three years later, the patient had no signs of persistent or recurrent infection. We think that this is the first report of aortic endograft infection caused by colistin-resistant, carbapenemase-producing K. pneumoniae
Low Virulence of Escherichia Coli Strains Causing Exacerbation of Chronic Pyelonephritis
Ivan？i？, Bla？enka,Sch？nwald, Slavko,Vrane？, Jasmina,？terk-Kuzmanovi？, Nata？a
- , 2001,
Abstract: Sa？etak Escherichia (E.) coli, which cause over 80% of uncomplicated urinary tract infections, may simultaneously express a number of virulence factors of relevance for urinary tract infections. Some of the recognized E. coli virulence factors are adherence to uroepithelial cells, certain O and K serotypes, hemolysin production, and aerobactin production. One of E. coli adhesins, P-fimbriae, is known as a major virulence factor in the development of acute uncomplicated pyelonephritis. The aim of this study was to determine the virulence properties of E. coli strains isolated from the urine of patients with chronic pyelonephritis, and to compare them to the properties of strains isolated from patients with acute pyelonephritis, acute cystitis, and asymptomatic bacteriuria. For each strain, O-serogroup, adhesin type, motility, production of hemolysin, and the amount of capsular polysaccharide were examined. The strains isolated from patients with acute pyelonephritis were found to mostly express all five or four virulence markers tested, while the less virulent strains were detected in the group of patients with chronic pyelonephritis, where most strains expressed up to three virulence markers. The lowest virulence was observed among the strains isolated in the group of patients with asymptomatic bacteriuria. Expression of P-fimbriae and production of hemolysin were found to be the most important virulence factors with the highest power for discrimination between chronic and acute upper urinary tract infection (p<0.01)
Caracterización de la región variable de integrones clase 1 presentes en cepas nosocomiales de Klebsiella pneumoniae
GUZMáN,MILITZA; ALONSO,GUILLERMINA;
Revista médica de Chile , 2010, DOI: 10.4067/S0034-98872010000300010
Abstract: background: integrons are responsible for the capture and dissemination of resistance genes in gram-negative bacteria. aim: to characterize the variable region within class 1 integrons in nosocomial strains of klebsiella pneumoniae. material and methods: twenty-nine klebsiella pneumoniae strains isolated from hospitalized patients were analyzed. the variable region of class 1 integrons was characterized by polymerase chain reaction and direct sequencing. genetic localization of class 1 integrons was determined by bacterial conjugation. results: ten strains contained class 1 integrons, with sizes ranging from 750 to 2000 base pairs. one integrant element was present in nine strains and two elements in one single strain. integrons were associated to plasmids. cassettes aada, aac(6)-iq, orfd, dfra]7, aada5 and aadb were found. conclusions: the presence of class 1 integrons may play an important role in the dissemination of hospital resistance against amino glycosides.
Caracterización de la región variable de integrones clase 1 presentes en cepas nosocomiales de Klebsiella pneumoniae Characterization of the variable region within class 1 integrons in Klebsiella pneumoniae nosocomials strains
MILITZA GUZMáN,GUILLERMINA ALONSO
Revista médica de Chile , 2010,
Abstract: Background: Integrons are responsible for the capture and dissemination of resistance genes in Gram-negative bacteria. Aim: To characterize the variable region within class 1 integrons in nosocomial strains of Klebsiella pneumoniae. Material and Methods: Twenty-nine Klebsiella pneumoniae strains isolated from hospitalized patients were analyzed. The variable region of class 1 integrons was characterized by polymerase chain reaction and direct sequencing. Genetic localization of class 1 integrons was determined by bacterial conjugation. Results: Ten strains contained class 1 integrons, with sizes ranging from 750 to 2000 base pairs. One integrant element was present in nine strains and two elements in one single strain. Integrons were associated to plasmids. Cassettes aadA, aac(6)-Iq, orfD, dfrA]7, aadA5 and aadB were found. Conclusions: The presence of class 1 integrons may play an important role in the dissemination of hospital resistance against amino glycosides.
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