Secular trends in Klebsiella pneumoniae isolated in a tertiary-care hospital: increasing prevalence and accelerated decline in antimicrobial susceptibility.

Rodrigo De Carvalho Santana,Gilberto Gambero Gaspar,Roberto Martinez,Fernando Crivelenti Vilar,Fernando Bellissimo-Rodrigues

doi:10.1590/0037-8682-0072-2016

Rodrigo De Carvalho Santana, Gilberto Gambero Gaspar + Show 3 more

Open Access

https://doi.org/10.1590/0037-8682-0072-2016

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Abstract

INTRODUCTION Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. METHODS This retrospective study examines data obtained from the microbiology laboratory of a Brazilian tertiary-care hospital. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. The relative frequencies of K. pneumoniae isolation were calculated among all Gram-negative bacilli isolated in each period analyzed. Susceptibility tests were performed using automated systems. From 2000-2006, K. pneumonia isolates comprised 10.7% of isolated Gram-negative bacilli (455/4260). From 2007-2013, this percentage was 18.1% (965/5331). Strictly considering isolates from bloodstream infections, the relative annual prevalence of K. pneumoniae increased from 14-17% to 27-32% during the same periods. A progressive decrease in K. pneumoniae susceptibility to all antimicrobial agents assessed was detected. Partial resistance was also observed to antimicrobial drugs that have been used more recently, such as colistin and tigecycline. CONCLUSIONS Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance.

Highlights

Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years
This study aimed to describe secular trends of antimicrobial susceptibility among K. pneumoniae isolates over a 14-year period in a Brazilian tertiary-care hospital
The results of this study indicate a recent increase in K. pneumoniae colonization and infection of hospitalized patients, as well as a progressive reduction in the in vitro susceptibility of this Enterobacteriaceae to several antimicrobials(8)

Summary

Introduction

Klebsiella pneumoniae has become an increasingly important etiologic agent of nosocomial infections in recent years. This is mainly due to the expression of virulence factors and development of resistance to several antimicrobial drugs. To assess temporal trends in prevalence and antimicrobial susceptibility, K. pneumoniae isolates were analyzed from 2000 to 2013. Conclusions: Our study indicates that K. pneumoniae has become a major pathogen among hospitalized patients and confirms its recent trend of increasing antimicrobial resistance. Klebsiella pneumoniae has become an increasingly important nosocomial infectious agent, which is partly attributed to its increased expression of virulence factors that promote intra-hospital transmission and challenge infection control practices(1). Development of resistances to alternative drugs used to treat hospital-acquired K. pneumoniae infections, such as polymixins and tigecycline, is currently being observed(6).

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