Determinantes genéticos relacionados con la resistencia a betalactámicos en aislados clínicos de klebsiella pneumoniae resistentes a carbapenémicos
Archivos
Fecha
2015
Autores
Título de la revista
ISSN de la revista
Título del volumen
Editor
Universidad de Guayaquil. Facultad de Ciencias Médicas. Escuela de Graduados
Resumen
Klebsiella pneumoniae productora de enzimas KPC es un patógeno oportunista y uno de los principales responsables de infecciones nosocomiales. Este tipo de bacterias son resistentes a la mayoría de los antibióticos empleados en su tratamiento. Su resistencia se extiende a los carbapenemes, antibióticos betalactámicos que no son hidrolizados por betalactamasas de espectro extendido. En este estudio se analizó la variante del gen blaKPC, la presencia de genes blaCTX-M, blaTEM, blaSHV, blaPER, blaIMP, blaVIM, blaSPM, blaNDM y se secuenció la región variable de integrones clase 1, en 30 aislados clínicos multirresistentes de Klebsiella pneumoniae resistentes a carbapenémicos. La producción de la enzima KPC fue detectada fenotípicamente con el test modificado de Hodge y confirmada genotípicamente. Mediante secuenciamiento se identificó la variante blaKPC-2 en todos los aislados. Se realizaron ensayos de susceptibilidad antibiótica por medio de pruebas de difusión en disco y se observó que los 30 aislados fueron resistentes a los tres carbapenémicos probados (imipenem, meropenem, ertapenem) y a 20 antibióticos adicionales. La susceptibilidad a la tigeciclina y colistina se determinó a partir de la Concentración Inhibitoria Mínima (CIM). Se observó que 7/30 aislados fueron resistentes a la tigeciclina y 1/30 resistente a la colistina. 20/30 aislados portaron el gen blaCTX-M, 30/30 el gen blaSHV, 28/30 el gen blaTEM y 2/30 el gen blaOXA. La amplificación del gen int1 se registró en los 30 aislados. La amplificación de la Región Variable fue positiva en 26/30 aislados, cuyos productos amplificados y secuenciados correspondieron a los genes dfrA12-orfF-aadA. La clonalidad se analizó por electroforesis en campo pulsado y fueron identificaron 7 pulsotipos: PT1 (5 aislados), PT2 (20 aislados) PT3 al PT7 (con un aislado cada uno). Estos resultados muestran una diseminación clonal de los aislados y su frecuente relación con otros genes de resistencia.
Klebsiella pneumoniae producing KPC is an opportunistic pathogen enzymes and one of the main causes of nosocomial infections. Such resistant bacteria are one treatment the majority of antibiotics used in its. Its resistance extends to carbapenems, -lactam antibiotics that no child hydrolyzed by extended spectrum beta-lactamase. In this study blaKPC variant gene was analyzed, the presence of genes blaCTX-M, blaTEM, blaSHV, blaPER, blaIMP, blaVIM, blaSPM, blaNDM and integrons variable region was sequenced for class 1, 30 multiresistant Isolated clíncos Klebsiella pneumoniae carbapenem resisitentes. Production of KPC enzyme was detected phenotypically with the Modified Hodge test and confirmed genotypically. By sequencing the blaKPC-2 variant with bathroom All isolates were identified. Antibiotic susceptibility tests were performed by means of diffusion tests in the disco and found that the 30 Isolated Were resistant to all three tested carbapenems (imipenem, meropenem, ertapenem) and 18 additional antibiotics. Susceptibility to tigecycline and colistin was determined one after the minimum inhibitory concentration (MIC). That 7/30 was observed Resistant Isolated Were the 1/30 tigecilcina and resistant to colistin. Isolated 20/30 carried the blaCTX-M, the blaSHV gene gene 30/30, 28/30 02.30 the blaTEM gene and the gene blaOXA. Int1 generation amplification itself 30 aislados log in. Amplification of the region was positive in 26/30 Variable Isolated, Whose Products amplified and sequenced corresponded to dfrA12-Orff-aadA genes. Clonality was analyzed by pulsed field electrophoresis, seven pulsotypes PT1 (5 isolates), PT2 (20 isolates) PT3 7 (Isolated des) were identified. These results show a clonal spread of Isolated and frequent contact with other resistance genes.
Klebsiella pneumoniae producing KPC is an opportunistic pathogen enzymes and one of the main causes of nosocomial infections. Such resistant bacteria are one treatment the majority of antibiotics used in its. Its resistance extends to carbapenems, -lactam antibiotics that no child hydrolyzed by extended spectrum beta-lactamase. In this study blaKPC variant gene was analyzed, the presence of genes blaCTX-M, blaTEM, blaSHV, blaPER, blaIMP, blaVIM, blaSPM, blaNDM and integrons variable region was sequenced for class 1, 30 multiresistant Isolated clíncos Klebsiella pneumoniae carbapenem resisitentes. Production of KPC enzyme was detected phenotypically with the Modified Hodge test and confirmed genotypically. By sequencing the blaKPC-2 variant with bathroom All isolates were identified. Antibiotic susceptibility tests were performed by means of diffusion tests in the disco and found that the 30 Isolated Were resistant to all three tested carbapenems (imipenem, meropenem, ertapenem) and 18 additional antibiotics. Susceptibility to tigecycline and colistin was determined one after the minimum inhibitory concentration (MIC). That 7/30 was observed Resistant Isolated Were the 1/30 tigecilcina and resistant to colistin. Isolated 20/30 carried the blaCTX-M, the blaSHV gene gene 30/30, 28/30 02.30 the blaTEM gene and the gene blaOXA. Int1 generation amplification itself 30 aislados log in. Amplification of the region was positive in 26/30 Variable Isolated, Whose Products amplified and sequenced corresponded to dfrA12-Orff-aadA genes. Clonality was analyzed by pulsed field electrophoresis, seven pulsotypes PT1 (5 isolates), PT2 (20 isolates) PT3 7 (Isolated des) were identified. These results show a clonal spread of Isolated and frequent contact with other resistance genes.
Descripción
PDF
Palabras clave
Carbapenémicos, Infección hospitalaria, Resistencia betalactámica, Pontificia Universidad Católica del Ecuador. Laboratorio de Microbiología, Cantón Quito, Ecuador, Klebsiella pneumoniae