Abstract
INTRODUCTION:Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon.METHODS:In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display in vitro antimicrobial synergy. First, 147 carbapenem-resistant K. pneumoniae isolates were validated for the presence of blaKPC, bla GES, bla NDM, bla SPM, bla IMP, bla VIM, and bla OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed.RESULTS:Seventy-four (50.3%) isolates were positive for bla NDM, eight (5.4%) for bla KPC, and one (1.2%) for both bla NDM and bla KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response.CONCLUSIONS:Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown. In vitro synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.
Highlights
Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates
The main aims of this study were to identify the genes coding for carbapenemases in multi-resistant K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil, and elucidate the best combination of drugs that display in vitro antimicrobial synergy
One hundred and forty-seven isolates identified as K. pneumoniae and presenting varied resistance to carbapenems were tested for the presence of genes coding carbapenemases
Summary
Carbapenem-resistant Klebsiella pneumoniae infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. Methods: In the present study, we analyzed the presence of genes encoding carbapenemases in K. pneumoniae isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed. Conclusions: Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; in most cases, the benefit of the combinations is unknown. The rate of mortality associated with infections caused by Carbapenem-resistant Klebsiella pneumoniae may reach up to 75%, depending on the age and disease profile of the population analyzed[5]. Several types of carbapenemases have been described; from an epidemiological viewpoint, class A carbapenemases of the type Klebsiella pneumoniae
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More From: Revista da Sociedade Brasileira de Medicina Tropical
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