Molecular epidemiology and risk factors of bloodstream infections caused by extended-spectrum β-lactamase-producing Klebsiella pneumoniae
2008; Elsevier BV; Volume: 12; Issue: 6 Linguagem: Inglês
10.1016/j.ijid.2008.03.008
ISSN1878-3511
AutoresJuan Luis Mosqueda-Gómez, Aldo J. Montaño‐Loza, Ana Lilia Rolón, Carlos Cervantes, Miriam Bobadilla-del-Valle, Jesús Silva-Sánchez, Ulises Garza–Ramos, Angelina Villası́s-Keever, Arturo Galindo‐Fraga, Guillermo M. Ruiz Palacios, Alfredo Ponce‐de‐León, José Sifuentes‐Osornio,
Tópico(s)Antibiotics Pharmacokinetics and Efficacy
ResumoObjectivesTo study the prevalence, risk factors, outcome, and molecular epidemiology in patients with bacteremia caused by extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae (Kp) (cases), in comparison with patients with bacteremia caused by a susceptible Kp (controls).MethodsThis was a retrospective case–control study including all episodes of Kp bacteremia for the period 1993 to 2002 at a referral hospital for adults in Mexico. ESBL production was tested for by E-test. All isolates were typed by pulsed field gel electrophoresis (PFGE). A subset of isolates underwent plasmid analysis, conjugal transfer of cefotaxime resistance to Escherichia coli J53-2, isoelectric focusing bioassay, colony-blot hybridization, PCR, and sequencing.ResultsOf the 121 patients with bacteremia due to Kp included in the study, 17 (14.0%) had an ESBL-Kp isolate (cases). Multivariate analysis identified prior use of cephalosporins (OR 7.6, 95% CI 1.1–53.5; p = 0.039) and stay in the intensive care unit (ICU; OR 5.6, 95% CI 1.1–27.9; p = 0.033) as significant risk factors. No differences were observed in hospital stay or mortality after the event. Multi-drug resistance was more frequent in ESBL-Kp. There was no clonal predominance. A distinct β-lactamase profile was identified, which included a combination of TEM-1 (pI 5.4) and SHV-5 (pI 8.2) in 13/17 ESBL-Kp isolates. Cefotaxime resistance was transferred by conjugation in 14/17 isolates with a >120-kb plasmid encoding ESBL.ConclusionsThe prevalence of ESBL-Kp was found to be lower than that previously reported in Latin America. ESBL-Kp bacteremia was not associated with a worse clinical outcome. We were able to identify a plasmid-mediated horizontal dissemination over the 10-year period.
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