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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.
Morbidity and Mortality Related to Infectious Diseases in the Roi Boudouin Paediatric Ward in Senegal  [PDF]
Guillaye Diagne, Aliou Abdoulaye Ndongo, Djeneba Fafa Cissé, Sidy Lamine Mbaye, Jean Baptiste Niokhor Diouf, Fatou Ly
Open Journal of Pediatrics (OJPed) , 2024, DOI: 10.4236/ojped.2024.144069
Abstract: Introduction: Infant and child morbidity and mortality linked to infections remain a major concern in both developed and developing countries. The general objective was to determine the characteristics of hospital morbidity and mortality linked to infectious pathologies in the pediatric department of the King Baudouin hospital center in Dakar. Methods: This was a retrospective, descriptive and analytical study focusing on children hospitalized from January 1, 2018 to December 31, 2021 in the pediatric department of the King Baudouin hospital center in Dakar. Results: During the study period, 1474 children were hospitalized for an infectious pathology in the pediatric department. The sex ratio was 1.48. Children aged between one and twelve months represented 34.12%. Morbidity due to respiratory and digestive infections was 42.33% and 33.45%, respectively. Pediatric hospital mortality was 0.75% with a predominance noted in infants between 1 and 12 months (55.86%). Respiratory, digestive infections, sepsis and neurological infections were the main causes of death. Factors associated with mortality were age (1 to 12 months) with p < 0.05 and the presence of underlying pathologies such as sickle cell SS, heart disease and HIV infection. Conclusion: Reducing infant and child mortality linked to infectious diseases remains a crucial challenge to address for improving children’s health. Early detection of related signs, prevention of infections, and adequate care and monitoring of infants and children can contribute to this reduction.
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.
Klebsiella Pneumoniaeoxa-48 in a Urology Patient: Case Report
Bedeni？, Branka,Ben？i？, Ana,Jaji？, Ines,Pezelj, Ivan,Ru？i？, Boris,Siroglavi？, Marko,Zarfel, Gernot
- , 2017, DOI: 10.20471/acc.2017.56.01.23
Abstract: Sa？etak We present an isolate of Klebsiella pneumoniaeOXA-48 isolated in a 68-year-old man who underwent radical prostatectomy due to prostate cancer. Th e antibiotic susceptibility testing to a wide range of antibiotics was performed by disk diffusion method and determination of minimal inhibitory concentrations. Th e isolate was classified as multidrug-resistant. It showed intermediate susceptibility to imipenem and meropenem, resistance to ertapenem, and sensitivity only to colistin, amikacin, and trimethoprim-sulfamethoxazole. Th e isolate was positive for ESBLs, negative for AmpC. Polymerase chain reaction and sequencing revealed blaOXA-48, blaCTX-M-15 and blaSHV-11. The plasmid encoding OXA-48 ？-lactamase did not belong to any known PCR-based replicon typing. According to genotyping, the isolate belonged to ST37
Risk factors and mortality in the Carbapenem-resistant Klebsiella pneumoniae infection: case control study
Fethiye Akgul,Hakan Leblebicioglu,Ilkay Bozkurt,Mustafa Sunbul,Saban Esen
- , 2016, DOI: 10.1080/20477724.2016.1254976
Abstract: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has been known as a nosocomial pathogen, both for the last 10 years in Turkey and for 20 years worldwide. Due to limited treatment options and high mortality rates, despite improvements in the field of medicine at the present time, CRKP is still a big threat for public health. This study was carried out between the dates of January 2010 and September 2014. Patients ≥18 who were hospitalized for at least 72 h and who also had CRKP growth were included in the study as a case group. In the same period patients, who were hospitalized in the same ward and did not have CRKP growth were selected as the control group. It was determined that no glycopeptides and steroids use nor tracheostomy as protective factors would be employed in terms of non-development of CRKP. Mechanical ventilation, tracheostomy, urinary catheter presence, central venous catheterization, nasogastric tube placement, advanced age, acute renal insufficiency, total parenteral nutrition, carbapenem, glycopeptide, and piperacillin tazobactam were all detected as risk factors in terms of CRKP infection development. As a result, rational usage of antibiotics for preventing infections developing with CRKP should be targeted
Rinoscleroma
Raymundo, Igor Teixeira;Pádua, Sharlene Castanheira;Pinheiro, Thaís Gon？alves;Azevedo, Ana Emília Borges de;Nakanishi, Márcio;Oliveira, Carlos Augusto Costa Pires de;
Arquivos Internacionais de Otorrinolaringologia , 2011, DOI: 10.1590/S1809-48722011000400019
Abstract: introduction: rhinoscleroma is a chronic granulomatous infectious disease, caused by the bacterium klebsiella rhinoscleromatis. affects the respiratory tract mucosa, more frequent in the nose. is considered endemic in certain regions like africa and central america, but is rare in brazil. the nasal involvement occurs in 3 phases: catarrhal, granulomatous and sclerotic stage. in all its course the disease presents nonspecific symptoms, and because of that, the difficulty of being diagnosed. its diagnosis is established by culture or by the meeting of mikulicz cell or russel corpuscles in the anatomopathological study. the treatment consists in a long-term antibiotic, associated or not to a surgery. objective: this report aims ilustrate a case of rhinoscleroma in a female young patient complaining of bilateral nasal obstruction, long standing and headache. the intent is alert the otorhinolaringologists in diagnosing this rare disease, which presents itself with nonspecific symptoms as like numerous pathologies that affect the nasal region.
Risk factors for infection by extended-spectrum beta-lactamase producing Klebsiella pneumoniae in a tertiary hospital in Salvador, Brazil
Silva, Nanci;Oliveira, Márcio;Bandeira, Antonio Carlos;Brites, Carlos;
Brazilian Journal of Infectious Diseases , 2006, DOI: 10.1590/S1413-86702006000300007
Abstract: nosocomial infection caused by extended-spectrum beta-lactamase producing klebsiella pneumoniae (esbl-kp) have been frequently reported worldwide. we have no information on such problems in bahia, brazil. objectives: evaluate the risk factors for nosocomial infections caused by esbl-kp, in a tertiary hospital, in bahia, brazil. material and methods: we evaluated all reported cases of nosocomial infections caused by esbl-kp in a private, tertiary hospital, in salvador, brazil, from 2000 through 2004. we compared patients with a diagnosis of esbl-kp (cases) and patients infected by non-esbl producing k. pneumoniae (controls). mean age, underlying disease, and frequency of invasive procedures were compared between the two groups. history of previous use of antibiotics was also analyzed. results: based on multivariate analysis, previous use of antibiotics, diagnosis of malignant diseases, and diabetes mellitus were independent risk factors for acquisition of esbl-kp infection. no correlation was found for age, use of corticosteroids, diagnosis of chronic renal failure or aids, and infection by esbl-kp. conclusion: our findings suggest that the use of antibiotics or underlying disease that increases the chance of antibiotic are the main risk factors for esbl-kp infections. programs focusing on rational use of antibiotics are mandatory for prevention and control of such infections.
Rhinoscleroma
Raymundo, Igor Teixeira,Pádua, Sharlene Castanheira,Pinheiro, Thaís Gon？alves,Azevedo, Ana Emília Borges de
International Archives of Otorhinolaryngology , 2011,
Abstract: Introduction: Rhinoscleroma is a chronic granulomatous infectious disease, caused by the bacterium Klebsiella rhinoscleromatis. Affects the respiratory tract mucosa, more frequent in the nose. Is considered endemic in certain regions like Africa and Central America, but is rare in Brazil. The nasal involvement occurs in 3 phases: catarrhal, granulomatous and sclerotic stage. In all its course the disease presents nonspecific symptoms, and because of that, the difficulty of being diagnosed. Its diagnosis is established by culture or by the meeting of Mikulicz cell or Russel corpuscles in the anatomopathological study. The treatment consists in a long-term antibiotic, associated or not to a surgery. Objective: This report aims ilustrate a case of rhinoscleroma in a female young patient complaining of bilateral nasal obstruction, long standing and headache. The intent is alert the otorhinolaringologists in diagnosing this rare disease, which presents itself with nonspecific symptoms as like numerous pathologies that affect the nasal region.
Prevalence and Antibiotic Resistance Pattern of Escherichia coli and Klebsiella pneumoniae in Urine Tract Infections at the La Paz Medical Center, Malabo, Equatorial Guinea  [PDF]
Aleksey Shatalov
Open Journal of Medical Microbiology (OJMM) , 2015, DOI: 10.4236/ojmm.2015.54022
Abstract: The study was conducted to isolate and determine the antibiotic resistance in Escherichia coli and Klebsiella pneumonia from urine samples over a 2-year period (August 2013-September 2015) at the La Paz Medical Center, Malabo. A retrospective analysis of 785 urine culture samples over a 2-year period August 2013-September 2015 was carried out according to the routine protocol of urinalysis. Bacterial etiological agents were isolated from 155 (19.7%) samples with highest prevalence of Escherichia coli (55.5%) followed by Klebsiella pneumonia (23.2%), Proteus mirabilis (4.5%), Pseudomonas species (3.2%), Enterobacter species (2.6%), Enterococcus faecalis (2.6%) and others species (8.4%). The E. coli and K. pneumonia represent 78.7% of all isolated bacterial strains. The E. coli and K. pneumoniae isolates possess highly resistant to ampicillin, Trimethoprim/Sulfamethoxazole, Doxycycline, Amoxicicline/Clavulanic acid. Whereas K. pneumonia demonstrated also to be highly resistant to Gentamycin, Cefuroxime and Ceftriaxon, low level of resistance to Piperacilin/Tazobactam, Amikacin and the lowest to Imipenem. The alarming level of MDR strains to the first choice antibiotics treatment was observed.
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