1099-1Detection of KPC-2-Producing Klebsiella pneumoniae during an outbreak with high mortality in intensive care unit.
Autores:Willames Marcos Brasileiro da Silva Martins (CPQAM - Centro de Pesquisa Aggeu Magalhães) ; Anna Carolina Soares Almeida (UFPE - Universidade Federal de Pernambuco) ; Fábio André Brayner dos Santos (CPQAM - Centro de Pesquisa Aggeu Magalhães) ; Luis Carlos Alves (CPQAM - Centro de Pesquisa Aggeu Magalhães) ; Marinalda Anselmo Vilela (UPE - Universidade de Pernambuco) ; Márcia Maria Camargo de Morais (UPE - Universidade de Pernambuco)


The spread of strains of KPC producing K. pneumoniae in hospitals is a serious risk for the patients and outbreaks of KPC-producing bacteria are reported worldwide. In this study, we described an outbreak of isolates of K. pneumoniae producing KPC in an intensive care unit, which showed a high mortality due to septicemia. In order to characterize those isolates, the profile of antibiotic susceptibility, the presence of resistance genes and the clonal relationship were analyzed. The six isolates were obtained from surveillance cultures performed in five patients during the first two days of December 2011, in the general ICU of the hospital. Isolates were identified by biochemical tests and then were stored in 15% glycerol at -80°C. The antimicrobial susceptibility was performed by broth microdilution. Detection of resistance genes, mobile genetic elements was performed by PCR using primers and conditions described previously. Determination of the clonal relationship among isolates was performed by PFGE. Four patients died due to septic shock, however, the causative bacterial agent was not confirmed, despite three of the five patients developed infections by KPC producing K. pneumoniae. The susceptibility profiles of the isolates indicated resistance to all β-lactams and susceptibility to amikacin (<8mg/mL) and tigecycline (<0.5 mg/mL). The isolates carried the gene blaKPC-2 and other genes such as β-lactamase blaCTX-M, blaTEM and blaSHV. Class 1 integrons were detected and their variable regions were amplified, generating a 2kb fragment in all the isolates. Further analysis will allow us to detect the alleles of β-lactamase genes and those located at the integron variable region. The PFGE indicated the presence of three different profiles (A, A1, A2), which were related to the plasmid content. The isolates showed 3-6 plasmids of different sizes, and the plasmid of 133Kb was detected in all the isolates. The presence of genetically related multiresistant isolates with various β-lactamase genes and within a single ICU in a short period of time emphasizes the importance of establishing measures to contain the spread of these isolates.

Palavras-chave:  bacterial resistance, Carbapenemase, Micro-organisms, outbreak