Resumo

Resistance to the carbapenems in members of the Enterobacteriaceae (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 2010. 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 2011, was submitted to modified Hodge test (MHT) to check phenotypically the presence of carbapenemases. The research to blaKPC gene PCR was performed with specific primers. During 18 months studied, 804/5817 (13.8%) unique, consecutive Enterobacteriaceae isolates were identified as being carbapenem nonsusceptible. The MHT was positive in 89.7% (721/804) isolates producing CRE. However, the gene blaKPC was detected in 9.6% (561/5817) of the total species, 77.8% (561/721) of isolates MHT positive and 70.1% (561/804) of the CRE isolates. K. pneumoniae was the most common microorganism producing blaKPC gene 493/669 (73.7%), followed of Enterobacter cloacae 26/57 (45.6%), E. aerogenes 20/41 (48.8%), E. coli 11/11 (100.0%), Serratia marcescens 2/10 (20.0%), Citrobacter freundii 4/7 (57.1%), K.oxytoca 2/2 (100.0%) and Proteus mirabilis , Morganella morganni , Pantoea aglommerans 1/1 (100.0%). The baseline epidemiological information of KCP-positive isolates were analysed the vast majority of cultures were obtained from male 341/561 (60.8%). The distribution of the KCP-positive isolates by hospital area revealed that 306/561 (54.5%) in unit center intensive and 255/561 (45.5%) in the general wards and emergency room. 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. .