Detecção de resistência aos carbapenêmicos e avaliação da produção de klebsiella pnemoniae carbapenemase (kpc) em isolados clínicos da família enterobacteriaceae

摘要: Detection of carbapenem resistance and evaluation Klebsiella pneumoniae Carbapenemase (KPC) production in clinical isolates from Enterobacteriaceae family The includes important community nosocomial pathogens frequently associated to multirresistance. Multidrug-resistant strains represent an concern among hospitals healthcare institutions around the world, due limited therapeutic options. In recent decades, overall increase producing inducible βlactamases extended spectrum β-lactamases (ESBL) has lead use carbapenems as first option for treatment serious infections. However, been considered a public health problem many countries enzyme carbapenemase described major mechanism this family. Whereas only sporadic reports KPCproducing have reported Rio Grande do Sul (RS), contrast situation Brazilian states, study aimed establish prevalence KPC with reduced susceptibility 11 disctinct RS, promote molecular characterization these isolates, well evaluate main phenotypic methods used detection. Significant differences were observed profiles imipenem (IPM) meropenem (MEM), when compared ertapenem (ERT): less than 10% classified susceptible ERT over 73% IPM MEM. Our results demonstrated that carbapenems, was mainly AmpC ESBL, instead true carbapenemases. Regarding carbapenemases found Enterobacteriaceae, detected studied, at 4%. producers included species E. cloacae, K. pneumoniae, S. marcescens georgiana, four different hospitals. sequencing analysis all them KPC-2 producers. According profile, most highly resistant β-lactams quinolones, whereas polymyxin amikacin effective drugs vitro. Two clonal groups cloacae by PFGE analysis. Only partial genetic context involves blaKPC-2 gene possible indicating altered platform classic environment (Tn4401). plasmid indicated plasmids variable sizes, higher those ~ 20Kb involved gene. also showed non-typable PBRT technique. With respect detection, proved present better performance MEM combined-disc test boronic acid (AB), resulting 100% sensitivity (SN) 96.1% specificity (SP). quantification Modified Hodge Test (MHT), proposed study, eliminated subjectivity leading considerable SP conventional methodology. conclusion, our confirmed high plasticity distinct phenotypes family; contributed knowledge local epidemiology KPC-producing isolates; reinforced useful tool able discriminate mechanisms resistance.