Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário
Autor(a) principal: | |
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Data de Publicação: | 2017 |
Tipo de documento: | Dissertação |
Idioma: | por |
Título da fonte: | Manancial - Repositório Digital da UFSM |
Texto Completo: | http://repositorio.ufsm.br/handle/1/18623 |
Resumo: | Resistance to antimicrobials in enterobacteria is a serious public health problem. The rapid spread of genes and antimicrobial resistance mechanisms limit the therapeutic options and imply an increase in the morbimortality rate of patients. Carbapenemase-producing bacteria such as Klebsiella pneumoniae are considered important agents of hospital infections due to the production of carbapenemases. The objective of this study was to evaluate 178 samples of carbapenem-resistant Enterobacteriaceae (CREs) by phenotypic methods of disc diffusion and Blue Carba, their antimicrobial susceptibility profile by automated system VITEK®2 (bioMérieux), and to detect by Polymerase chain reaction (PCR) the blaKPC type carbapenemase encoding gene. These isolates come from a University Hospital in Santa Maria (HUSM), Santa Maria/RS, and were collected in a period of one year (July 2014 to July 2015). Isolates were assessed using disk diffusion tests with β-lactamases inhibitors such as phenylboronic acid (AFB), cloxacillin (CLOXA), and ethylenediaminetetraacetic acid (EDTA). Isolates with differences in zone diameters ≥ 5mmfor disks supplemented or not were considered producers of carbapenemases. K. pneumoniae was the most prevalent CRE, which appeared in 80.3% cases (n=143). Among clinical materials the rectal swab was responsible for 43.4% of the isolations (n = 62). Among the CREs identified in this study the growth of 56.7% (n = 101) isolates which were putative producers of K. pneumoniae carbapenemase (KPC) were inhibited by AFB, whereas 7.3% (n = 13) isolates were inhibited by both AFB and CLOXA and were considered as putative producers of plasmid-mediated AmpC; approximately 3.4% (n = 6) were inhibited by EDTA, which possibly produced metallo-β-lactamase. Lastly, 32.6% (n = 58) cases showed negative results for AFB, CLOXA, and EDTA sensitivity, and represented another class of β-lactamases and/or mechanism of resistance. For genotypic detection, 172 samples of CRE from different clinical specimens were obtained. K. pneumoniae was a prevalent microorganism with 139 (80.81%) of the isolates. The most isolated clinical material was rectal swab (surveillance culture) with 48 samples (34.53%). The blaKPC gene was detected in 124 (72.09%) isolates. In the disk diffusion technique by AFB 111 (64.53%) were KPC and by Blue-Carba 121 (70.34%). Considering PCR as the gold standard for this mechanism of resistance, AFB showed 80% sensitivity and 75% specificity. The Blue-Carba biochemical test showed 90% sensitivity and 81% specificity. Resistance to colistin was identified in 25 isolates of carbapenem resistant Klebsiella pneumoniae (CR-Kp), and 10 (7.19%) patients died of CR-Kp and three (2.16%) of CR-Kp and resistant to colistin (CPR-Kp). The identification of these multiresistant bacteria by the laboratory is of paramount importance for the immediate patient isolation, besides the adoption of rigorous measures of prevention and control of infections for these multiresistant microorganisms. |
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2019-10-18T18:36:56Z2019-10-18T18:36:56Z2017-05-31http://repositorio.ufsm.br/handle/1/18623Resistance to antimicrobials in enterobacteria is a serious public health problem. The rapid spread of genes and antimicrobial resistance mechanisms limit the therapeutic options and imply an increase in the morbimortality rate of patients. Carbapenemase-producing bacteria such as Klebsiella pneumoniae are considered important agents of hospital infections due to the production of carbapenemases. The objective of this study was to evaluate 178 samples of carbapenem-resistant Enterobacteriaceae (CREs) by phenotypic methods of disc diffusion and Blue Carba, their antimicrobial susceptibility profile by automated system VITEK®2 (bioMérieux), and to detect by Polymerase chain reaction (PCR) the blaKPC type carbapenemase encoding gene. These isolates come from a University Hospital in Santa Maria (HUSM), Santa Maria/RS, and were collected in a period of one year (July 2014 to July 2015). Isolates were assessed using disk diffusion tests with β-lactamases inhibitors such as phenylboronic acid (AFB), cloxacillin (CLOXA), and ethylenediaminetetraacetic acid (EDTA). Isolates with differences in zone diameters ≥ 5mmfor disks supplemented or not were considered producers of carbapenemases. K. pneumoniae was the most prevalent CRE, which appeared in 80.3% cases (n=143). Among clinical materials the rectal swab was responsible for 43.4% of the isolations (n = 62). Among the CREs identified in this study the growth of 56.7% (n = 101) isolates which were putative producers of K. pneumoniae carbapenemase (KPC) were inhibited by AFB, whereas 7.3% (n = 13) isolates were inhibited by both AFB and CLOXA and were considered as putative producers of plasmid-mediated AmpC; approximately 3.4% (n = 6) were inhibited by EDTA, which possibly produced metallo-β-lactamase. Lastly, 32.6% (n = 58) cases showed negative results for AFB, CLOXA, and EDTA sensitivity, and represented another class of β-lactamases and/or mechanism of resistance. For genotypic detection, 172 samples of CRE from different clinical specimens were obtained. K. pneumoniae was a prevalent microorganism with 139 (80.81%) of the isolates. The most isolated clinical material was rectal swab (surveillance culture) with 48 samples (34.53%). The blaKPC gene was detected in 124 (72.09%) isolates. In the disk diffusion technique by AFB 111 (64.53%) were KPC and by Blue-Carba 121 (70.34%). Considering PCR as the gold standard for this mechanism of resistance, AFB showed 80% sensitivity and 75% specificity. The Blue-Carba biochemical test showed 90% sensitivity and 81% specificity. Resistance to colistin was identified in 25 isolates of carbapenem resistant Klebsiella pneumoniae (CR-Kp), and 10 (7.19%) patients died of CR-Kp and three (2.16%) of CR-Kp and resistant to colistin (CPR-Kp). The identification of these multiresistant bacteria by the laboratory is of paramount importance for the immediate patient isolation, besides the adoption of rigorous measures of prevention and control of infections for these multiresistant microorganisms.A resistência aos antimicrobianos em enterobactérias é um grave problema de saúde pública. A rápida disseminação de genes e mecanismos de resistência aos antimicrobianos limitam as opções terapêuticas e implicam em um aumento na taxa de morbimortalidade dos pacientes. As bactérias produtoras de carbapenemase, como Klebsiella pneumoniae são consideradas importantes agentes de infecções hospitalares, devido à produção de carbapenemases. O objetivo deste estudo foi avaliar 178 amostras de enterobactérias resistentes aos carbapenêmicos (ERC) por métodos fenotípicos de difusão em disco e Blue-Carba, o seu perfil de sensibilidade aos antimicrobianos pelo sistema automatizado VITEK®2 (bioMérieux), além de detectar por Reação de cadeia de polimerase (PCR), o gene codificador de carbapenemase do tipo blaKPC. Essas amostras foram provenientes do Hospital Universitário de Santa Maria (HUSM), Santa Maria/RS, e foram coletadas no período de um ano (julho de 2014 a julho de 2015). As amostras foram avaliadas através do teste de difusão em disco com inibidores de β-lactamases, tais como ácido fenilborónico (AFB), cloxacilina (CLOXA) e ácido etilenodiaminotetracético (EDTA), onde cepas com diferenças de diâmetros de halo ≥ 5mm para discos suplementados ou não com os inibidores de β-lactamases foram consideradas produtoras de carbapenemases. K. pneumoniae foi a ERC prevalente, que apareceu em 80,3% dos casos (n = 143). Entre os materiais clínicos, o swab retal foi responsável por 43,4% dos isolamentos (n=62). Dos isolados de ERC identificados, 56,7% (n=101) foram supostos produtores de K. pneumoniae carbapenemase (KPC), inibidos pelo AFB, enquanto que 7,3% (n=13) dos isolados foram inibidos tanto por AFB e CLOXA e foram considerados como supostos produtores de AmpC mediado por plasmídeo. Aproximadamente 3,4% (n=6) foram inibidos por EDTA, sendo possíveis produtores de metalo-β-lactamase (MBL); 32,6% (n=58) apresentaram resultados negativos para a AFB, CLOXA e EDTA e representaram outra classe de β-lactamases ou mecanismo de resistência. Para detecção genotípica, foram utilizadas 172 amostras de ERC de diferentes espécimes clínicos. K. pneumoniae foi microrganismo prevalente com 139 (80,81%) dos isolados. O material clínico de maior isolamento foi swab retal (cultura de vigilância) com 48 amostras (34,53%). O gene blaKPC foi detectado em 124 (72,09%) isolados. Na técnica de difusão de disco pelo AFB, 111 (64,53%) foram KPC e por Blue-Carba 121 (70,34%). Considerando a PCR como padrão ouro para este mecanismo de resistência, AFB evidenciou 80% de sensibilidade e 75% de especificidade. O teste bioquímico Blue-Carba apresentou 90% de sensibilidade e 81% de especificidade. A resistência à colistina foi identificada em 25 isolados de K. pneumoniae resistente aos carbapenêmicos (CR-Kp), sendo que 10 (7,19%) pacientes evoluíram a óbito por cepas CR-Kp e três (2,16%) por CR-Kp e resistente à colistina (CPR-Kp). A identificação dessas bactérias multirresistentes pelo laboratório é de suma importância para o isolamento imediato do paciente, além da adoção de medidas rigorosas de prevenção e controle de infecções para estes microrganismos multirresistentes.Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - CAPESporUniversidade Federal de Santa MariaCentro de Ciências da SaúdePrograma de Pós-Graduação em Ciências FarmacêuticasUFSMBrasilAnálises Clínicas e ToxicológicasAttribution-NonCommercial-NoDerivatives 4.0 Internationalhttp://creativecommons.org/licenses/by-nc-nd/4.0/info:eu-repo/semantics/openAccessEnterobacteriaceaeKlebsiella pneumoniaeCarbapenêmicosResistência bacterianaCarbapenemsBacterial resistanceCNPQ::CIENCIAS DA SAUDE::FARMACIAAvaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciárioEvaluation of carbapenemic-resistant enterobacteria isolated in a tertiary hospitalinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesisHorner, Rosmarihttp://lattes.cnpq.br/5907084134183708Oliveira, Caio Fernando dehttp://lattes.cnpq.br/7893274559998625Tizotti, Maísa Kräulichhttp://lattes.cnpq.br/3693326727640042http://lattes.cnpq.br/4879449637507771Silva, Danielly da Costa4003000000056005fdaffc5-abc5-4607-8952-fc5c4760b0045ec04ca0-66dc-4afa-9766-ec9150c24cc23cc5ed9d-bbe2-4b70-8f15-b2c23c4792bcb1a9486e-5784-4f4e-872b-677222f4fdd0reponame:Manancial - Repositório Digital da UFSMinstname:Universidade Federal de Santa Maria (UFSM)instacron:UFSMORIGINALDIS_PPGCF_2017_SILVA_DANIELLY.pdfDIS_PPGCF_2017_SILVA_DANIELLY.pdfDissertação de Mestradoapplication/pdf1185792http://repositorio.ufsm.br/bitstream/1/18623/1/DIS_PPGCF_2017_SILVA_DANIELLY.pdf73028486a61d80eed56b31516ca412ebMD51CC-LICENSElicense_rdflicense_rdfapplication/rdf+xml; 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dc.title.por.fl_str_mv |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário |
dc.title.alternative.eng.fl_str_mv |
Evaluation of carbapenemic-resistant enterobacteria isolated in a tertiary hospital |
title |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário |
spellingShingle |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário Silva, Danielly da Costa Enterobacteriaceae Klebsiella pneumoniae Carbapenêmicos Resistência bacteriana Carbapenems Bacterial resistance CNPQ::CIENCIAS DA SAUDE::FARMACIA |
title_short |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário |
title_full |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário |
title_fullStr |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário |
title_full_unstemmed |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário |
title_sort |
Avaliação de enterobactérias resistentes aos carbapenêmicos isoladas em um hospital terciário |
author |
Silva, Danielly da Costa |
author_facet |
Silva, Danielly da Costa |
author_role |
author |
dc.contributor.advisor1.fl_str_mv |
Horner, Rosmari |
dc.contributor.advisor1Lattes.fl_str_mv |
http://lattes.cnpq.br/5907084134183708 |
dc.contributor.referee1.fl_str_mv |
Oliveira, Caio Fernando de |
dc.contributor.referee1Lattes.fl_str_mv |
http://lattes.cnpq.br/7893274559998625 |
dc.contributor.referee2.fl_str_mv |
Tizotti, Maísa Kräulich |
dc.contributor.referee2Lattes.fl_str_mv |
http://lattes.cnpq.br/3693326727640042 |
dc.contributor.authorLattes.fl_str_mv |
http://lattes.cnpq.br/4879449637507771 |
dc.contributor.author.fl_str_mv |
Silva, Danielly da Costa |
contributor_str_mv |
Horner, Rosmari Oliveira, Caio Fernando de Tizotti, Maísa Kräulich |
dc.subject.por.fl_str_mv |
Enterobacteriaceae Klebsiella pneumoniae Carbapenêmicos Resistência bacteriana |
topic |
Enterobacteriaceae Klebsiella pneumoniae Carbapenêmicos Resistência bacteriana Carbapenems Bacterial resistance CNPQ::CIENCIAS DA SAUDE::FARMACIA |
dc.subject.eng.fl_str_mv |
Carbapenems Bacterial resistance |
dc.subject.cnpq.fl_str_mv |
CNPQ::CIENCIAS DA SAUDE::FARMACIA |
description |
Resistance to antimicrobials in enterobacteria is a serious public health problem. The rapid spread of genes and antimicrobial resistance mechanisms limit the therapeutic options and imply an increase in the morbimortality rate of patients. Carbapenemase-producing bacteria such as Klebsiella pneumoniae are considered important agents of hospital infections due to the production of carbapenemases. The objective of this study was to evaluate 178 samples of carbapenem-resistant Enterobacteriaceae (CREs) by phenotypic methods of disc diffusion and Blue Carba, their antimicrobial susceptibility profile by automated system VITEK®2 (bioMérieux), and to detect by Polymerase chain reaction (PCR) the blaKPC type carbapenemase encoding gene. These isolates come from a University Hospital in Santa Maria (HUSM), Santa Maria/RS, and were collected in a period of one year (July 2014 to July 2015). Isolates were assessed using disk diffusion tests with β-lactamases inhibitors such as phenylboronic acid (AFB), cloxacillin (CLOXA), and ethylenediaminetetraacetic acid (EDTA). Isolates with differences in zone diameters ≥ 5mmfor disks supplemented or not were considered producers of carbapenemases. K. pneumoniae was the most prevalent CRE, which appeared in 80.3% cases (n=143). Among clinical materials the rectal swab was responsible for 43.4% of the isolations (n = 62). Among the CREs identified in this study the growth of 56.7% (n = 101) isolates which were putative producers of K. pneumoniae carbapenemase (KPC) were inhibited by AFB, whereas 7.3% (n = 13) isolates were inhibited by both AFB and CLOXA and were considered as putative producers of plasmid-mediated AmpC; approximately 3.4% (n = 6) were inhibited by EDTA, which possibly produced metallo-β-lactamase. Lastly, 32.6% (n = 58) cases showed negative results for AFB, CLOXA, and EDTA sensitivity, and represented another class of β-lactamases and/or mechanism of resistance. For genotypic detection, 172 samples of CRE from different clinical specimens were obtained. K. pneumoniae was a prevalent microorganism with 139 (80.81%) of the isolates. The most isolated clinical material was rectal swab (surveillance culture) with 48 samples (34.53%). The blaKPC gene was detected in 124 (72.09%) isolates. In the disk diffusion technique by AFB 111 (64.53%) were KPC and by Blue-Carba 121 (70.34%). Considering PCR as the gold standard for this mechanism of resistance, AFB showed 80% sensitivity and 75% specificity. The Blue-Carba biochemical test showed 90% sensitivity and 81% specificity. Resistance to colistin was identified in 25 isolates of carbapenem resistant Klebsiella pneumoniae (CR-Kp), and 10 (7.19%) patients died of CR-Kp and three (2.16%) of CR-Kp and resistant to colistin (CPR-Kp). The identification of these multiresistant bacteria by the laboratory is of paramount importance for the immediate patient isolation, besides the adoption of rigorous measures of prevention and control of infections for these multiresistant microorganisms. |
publishDate |
2017 |
dc.date.issued.fl_str_mv |
2017-05-31 |
dc.date.accessioned.fl_str_mv |
2019-10-18T18:36:56Z |
dc.date.available.fl_str_mv |
2019-10-18T18:36:56Z |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/masterThesis |
format |
masterThesis |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://repositorio.ufsm.br/handle/1/18623 |
url |
http://repositorio.ufsm.br/handle/1/18623 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.cnpq.fl_str_mv |
400300000005 |
dc.relation.confidence.fl_str_mv |
600 |
dc.relation.authority.fl_str_mv |
5fdaffc5-abc5-4607-8952-fc5c4760b004 5ec04ca0-66dc-4afa-9766-ec9150c24cc2 3cc5ed9d-bbe2-4b70-8f15-b2c23c4792bc b1a9486e-5784-4f4e-872b-677222f4fdd0 |
dc.rights.driver.fl_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ info:eu-repo/semantics/openAccess |
rights_invalid_str_mv |
Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/ |
eu_rights_str_mv |
openAccess |
dc.publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.publisher.program.fl_str_mv |
Programa de Pós-Graduação em Ciências Farmacêuticas |
dc.publisher.initials.fl_str_mv |
UFSM |
dc.publisher.country.fl_str_mv |
Brasil |
dc.publisher.department.fl_str_mv |
Análises Clínicas e Toxicológicas |
publisher.none.fl_str_mv |
Universidade Federal de Santa Maria Centro de Ciências da Saúde |
dc.source.none.fl_str_mv |
reponame:Manancial - Repositório Digital da UFSM instname:Universidade Federal de Santa Maria (UFSM) instacron:UFSM |
instname_str |
Universidade Federal de Santa Maria (UFSM) |
instacron_str |
UFSM |
institution |
UFSM |
reponame_str |
Manancial - Repositório Digital da UFSM |
collection |
Manancial - Repositório Digital da UFSM |
bitstream.url.fl_str_mv |
http://repositorio.ufsm.br/bitstream/1/18623/1/DIS_PPGCF_2017_SILVA_DANIELLY.pdf http://repositorio.ufsm.br/bitstream/1/18623/2/license_rdf http://repositorio.ufsm.br/bitstream/1/18623/3/license.txt http://repositorio.ufsm.br/bitstream/1/18623/4/DIS_PPGCF_2017_SILVA_DANIELLY.pdf.txt http://repositorio.ufsm.br/bitstream/1/18623/5/DIS_PPGCF_2017_SILVA_DANIELLY.pdf.jpg |
bitstream.checksum.fl_str_mv |
73028486a61d80eed56b31516ca412eb 4460e5956bc1d1639be9ae6146a50347 2f0571ecee68693bd5cd3f17c1e075df b6fa19b630dac2927812992c61999e4b 0b48df91b21551aab5a2ae30f9928053 |
bitstream.checksumAlgorithm.fl_str_mv |
MD5 MD5 MD5 MD5 MD5 |
repository.name.fl_str_mv |
Manancial - Repositório Digital da UFSM - Universidade Federal de Santa Maria (UFSM) |
repository.mail.fl_str_mv |
|
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1801223692654477312 |