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Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization

2014; Elsevier BV; Volume: 2; Issue: 3 Linguagem: Inglês

10.1002/nmi2.40

2052-2975

Carolina Márquez, Ana Ingold, Natalia Echeverría, Ashley Acevedo, Rafael Vignoli, Virginia García-Fulgueiras, J. Viroga, O. Gonzalez, V. Odizzio, K. Etulain, Eduardo J. Núñez, Henry Albornoz, Graciela Borthagaray, Antonio Galiana,

Antibiotics Pharmacokinetics and Efficacy

We describe the first outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP), the infection control measures adopted and the shift in resistance patterns of isolates during antibiotic treatment. The ST258 KPC-KP strain exhibited a multiresistant antibiotic phenotype including co-resistance to gentamycin, colistin and tigecycline intermediate susceptibility. Isolates before and after treatment had different behaviour concerning their antibiotic susceptibility and the population analysis profile study. A progressive increase in the aminoglycosides (acquiring amicacin resistance) and β-lactam MICs, and a decreased susceptibility to fosfomycin was observed throughout the administration of combined antimicrobial regimens including meropenem. A high meropenem resistance KPC-KP homogeneous population (MIC 256 Jg/mL), could arise from the meropenem heterogeneous low-level resistance KPC-KP population (MIC 8 Jg/mL), by the selective pressure of the prolonged meropenem therapy. The kpc gene was inserted in a Tn4401 isoform a, and no transconjugants were detected. The core measures adopted were successful to prevent evolution towards resistance dissemination.