Resumo

Resistance to the carbapenems in members of the Enterobacteriaceae (CRE) infections are most commonly seen in people with exposure to healthcare settings like hospitals and long-term care facilities, such as skilled nursing facilities, and long-term acute care hospitals. CRE can be caused by a variety of mechanisms, including serine-based or metallo-β-lactamases alone or in combination with porin protein reduction. Since the beginning of the last decade, Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacteriaceae have been increasingly detected in many countries worldwide The aim of this study was to describe the dissemination of the KPC enzyme between Enterobacteriaceae members, in University Hospital, between july 2009 and december 2012. The samples were previously identified by the MicroScan Walkaway automated system (BD), and those that were resistant to carbapenems evaluate (ertapenem, meropenem, and imipenem), as described by CLSI 2012. After they were submitted to modified Hodge test (MHT) to check phenotypically the presence of carbapenemases and the research to blaKPC gene PCR was performed with specific primers. During 42 months studied, 2080/15671(13.3%) , consecutive Enterobacteriaceae isolates were identified as being carbapenem nonsusceptible. The MHT was positive in 89.9% (1870/2080) isolates producing CRE. However, the gene blaKPC was detected in 10.5% (1641/15671) of the total species, 82.2% (1710/2080) of isolates MHT positive and 78.9% (1641/2080) of the CRE isolates. K. pneumoniae was the most common microorganism producing blaKPC gene 1332/1493 (89,2%), followed of Enterobacter cloacae 154/234 (65,86%), E. aerogenes 31/75 (41,.3%), E. coli 44/56 (78,6%), Serratia marcescens 11/25 (44%), Citrobacter freundii 35/36 (97,2%), K.oxytoca 12/14 (85,7%) and others microorganism 22/25 (88%). The distribution of the KCP-positive showed the clinical material isolated CRE were: swab culture of surveillance 1112/2080 (53,5%), respiratory tract 379/2080 (18,2%) , urinary tract 362/2080 (17,4%), blood 106/2080 (5,1%), skin and soft tissue 98/2080 (4,7%) and liquid 23/2080 (1,1%) This study shows the rapid spread of blaKPC gene among isolates of Enterobacteriaceae in the Hospital University. However, K. pneumoniae is still the most common organism producing this mechanism of resistance. Our findings highlight the urgent need to develop strategies for prevention and infection control. Limiting use of certain antimicrobials may be an effective strategy.