Journal Information
Vol. 15. Issue 1.
Pages 28-33 (January - February 2011)
Share
Share
Download PDF
More article options
Vol. 15. Issue 1.
Pages 28-33 (January - February 2011)
Original Article
Open Access
β-lactamase producing enterobacteria isolated from surveillance swabs of patients in a Cardiac Intensive Care Unit in Rio de Janeiro, Brazil
Visits
3040
Marcia Regina G. Vasques1,
Corresponding author
mrgvasques@hotmail.com

Correspondence to: Vasques Rua Thompson Flores, 148, Méier, Rio de Janeiro – RJ.
, Alexandre Ribeiro Bello2, Cristiane da Cruz Lamas3, Juarez Correa4, José Augusto Adler Pereira5
1 Especialist, Hospitalar Infection Control and Prevention; Master's degree, Medical Microbiology; Nurse, Hospitalar Infection Control, Instituto Nacional de Cardiologia – RJ
2 PhD, Parasitology; Adjunct Professor, Department of Microbiology, Immunology and Parasitology (DMIP), Universidade do Estado do Rio de Janeiro – UERJ; Professor, Post-Graduation Programme, UERJ
3 MD, Infectologist, Infection Control, Instituto Nacional de Cardiologia; Professor, UNIGRANRIO
4 Biochemical Pharmacist; Microbiologist, Laboratório LABOSERV, Rio de Janeiro
5 Professor, Medical Microbiology; Associate Professor, Department of Microbiology, Immunology and Parasitology (DMIP), UERJ; Professor, Post-Graduation Programme, UERJ
This item has received

Under a Creative Commons license
Article information
Abstract
Bibliography
Download PDF
Statistics
Abstract

There is a high incidence of infections caused by betalactamase-producing Gram-negative microorganisms in Brazil. These organisms are of clinical and epidemiological importance, since their mobile genetic elements facilitate cross-infection. The present study was conducted in sentinel rectal swabs from patients admitted to a cardiac surgery hospital in Rio de Janeiro, from January through December 2007, in a consecutive manner. The aim of the study was to characterize the genotype and phenotype of these isolates from colonized patients. Biochemical tests, antimicrobial susceptibility tests, a confirmatory test for the expression of extended spectrum betalactamase (ESBL) production and polymerase chain reaction for the blaTEM, blaSHV, CTX-M1, Toho-1 and AmpC genes were performed at the University Hospital of Universidade do Estado do Rio de Janeiro (UERJ). The most frequently isolated bacteria were Escherichia coli 9/41 (21.95%) and Klebsiella pneumoniae 14/41 (34.1%). In 24/41 (58%), the ESBL genotype was confirmed. The most prevalent genes in samples that expressed ESBL were blaTEM 13/24 (54%), AmpC 12/24 (50%), blaSHV 6/24 (25%), CTX-M1 7/24 (29%), and Toho-1 6/24 (25%). Of these, 14/24 (58%) presented more than one genotype for the tested primers. In nine (37%) samples other than E. coli, K. pneumoniae or Proteus spp., the phenotype for ESBL was found and confirmed by PCR. The most sensitive substrate in the approximation test in ESBL positive samples was ceftriaxone (83%). Fifty percent of the samples expressed AmpC were associated with other genes. Intermediate susceptibility to ertapenem was found in 2/41 (5%).

Keywords:
polymerase chain reaction
infection control
enterobacteriaceae infections
Full text is only aviable in PDF
References
[1.]
P.R. Murray, K.S. Rosenthal, M.A. Pfaller.
Elsevier, (2006),
[2.]
M.A. Souza Jr.
β-lactamase de Espectro Ampliado (ESBL): um importante mecanismo de resistência Bacteriana e sua detecção no Laboratório Clínico.
Newslab, 63 (2004), pp. 152-174
[3.]
G.A. Jacoby.
AmpC beta-lactamases.
Clin Microbiol Rev, 22 (2009), pp. 161-182
[4.]
F. Rossi, D.B. Andreazzi.
Resistência Bacteriana, interpretando o antibiograma.
São Paulo, Editora Atheneu, (2005),
[5.]
G.A. Jacoby, L.S. Munoz-Price.
The new beta-lactamases.
N Engl J Med, 352 (2005 Jan 27), pp. 380-391
[6.]
A.M. Queenan, K. Bush.
Carbapenemases: the versatile beta-lactamases.
Clin Microbiol Rev, 20 (2007), pp. 440-458
[7.]
Z. Samra, O. Ofir, Y. Lishtzinsky, L. Madar-Shapiro, J. Bishara.
Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel.
Int J Antimicrob Agents, 30 (2007), pp. 525-529
[8.]
G. Peirano, L.M. Seki, V.L. Val Passos, M.C. Pinto, L.R. Guerra, M.D. Asensi.
Carbapenem-hydrolysing beta-lactamase KPC-2 in Klebsiella pneumoniae isolated in Rio de Janeiro, Brazil.
J Antimicrob Chemother, 63 (2009), pp. 265-268
[9.]
M.V. Villegas, K. Lolans, A. Correa, et al.
First detection of the plasmid-mediated class A carbapenemase KPC-2 in clinical isolates of Klebsiella pneumoniae from South America.
Antimicrob Agents Chemother, 50 (2006), pp. 2880-2882
[10.]
MMWR. Guidance for Control of infection with carbapenemresistant or carbapenemase-producing Enterobacteriaceae in Acute care Facilities, 2009, 58: 256-260.
[11.]
S. Bratu, D. Landman, M. Alam, E. Tolentino, J. Quale.
Detection of KPC carbapenem-hydrolyzing enzymes in Enterobacter spp. from Brooklyn, New York.
Antimicrob Agents Chemother, 49 (2005), pp. 776-778
[12.]
Clinical and Laboratory Standards Institute Performance. Standards for antimicrobial Susceptibility Testing, 2009.
[13.]
J. Silva, R. Gatica, C. Aguilar, et al.
Outbreak of infection with extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in a Mexican hospital.
J Clin Microbiol, 39 (2001), pp. 3193-3196
[14.]
J.D. Pitout, A. Hossain, N.D. Hanson.
Phenotypic and molecular detection of CTX-M-beta-lactamases produced by Escherichia coli and Klebsiella spp.
J Clin Microbiol, 42 (2004), pp. 5715-5721
[15.]
T. Conceição, N. Faria, L. Lito, J. Melo Cristino, M.J. Salgado, A. Duarte.
Diversity of chromosomal AmpC beta-lactamases from Enterobacter cloacae isolates in a Portuguese hospital.
FEMS Microbiol Lett, 230 (2004), pp. 197-202
[16.]
J.D. Pitout, P. Nordmann, K.B. Laupland, L. Poirel.
Emergence of Enterobacteriaceae producing extended-spectrum beta-lactamases (ESBLs) in the community.
J Antimicrob Chemother, 56 (2005), pp. 52-59
[17.]
I.S. Martins, C.L. Pessoa-Silva, S.A. Nouer, et al.
Endemic extended-spectrum beta-lactamase-producing Klebsiella pneumoniae at an intensive care unit: risk factors for colonization and infection.
Microb Drug Resist, 12 (2006), pp. 50-58
[18.]
J.D. Pitout, K.B. Laupland.
Extended-spectrum beta-lactamase-producing Enterobacteriaceae: an emerging public-health concern.
Lancet Infect Dis, 8 (2008), pp. 159-166
[19.]
M.H. Kollef, S. Wards.
The influence of mini BAL cultures on patient outcomes: implications for the antibiotic management of ventilator-associated pneumonia.
Chest, 113 (1998), pp. 412-420
[20.]
Clinical and Laboratory Standards Institute Performance. Standards for antimicrobial Susceptibility Testing, 2008.
[21.]
Clinical and Laboratory Standards Institute Performance. Standards for antimicrobial Susceptibility Testing, 2010.
[22.]
X. Bertrand, D. Hocquet, K. Boisson, E. Siebor, P. Plésiat, D. Talon.
Molecular epidemiology of Enterobacteriaceae producing extended-spectrum beta-lactamase in a French university-affiliated hospital.
Int J Antimicrob Agents, 22 (2003), pp. 128-133
[23.]
G.D. Overturf.
Carbapenemase: a brief review for pediatric infectious disease specialists.
Pediatr Infect Dis J., 29 (2010), pp. 68-70
[24.]
L.S. Munoz-Price, M.K. Hayden, K. Lolans.
Successful control of an outbreak of Klebsiella pneumoniae carbapenemase-producing K. Pneumoniae at a long-term acute care hospital.
Infection Control and Hospital Epidemiology, 31 (2010), pp. 341-347
[25.]
Livermore DM, Paterson DL. Pocket Guide to Extended-Spectrum β-Lactamase in Resistance, 2005. Published by Current Medicine Group LTDA.
[26.]
Paterson DL, Bonomo RA. Extended-Spectrum β-Lactamase: a clinical update. Clinical Microbiology Reviews, 2005, pp. 657-686.
Copyright © 2011. Elsevier Editora Ltda.. All rights reserved
Download PDF
The Brazilian Journal of Infectious Diseases
Article options
Tools