Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications
Background: Gram-negative bacilli (GNB), notably Acinetobacter spp., Pseudomonas spp., and Klebsiella spp., are becoming increasingly resistant to carbapenems and are associated with high health care costs and mortality, becoming a global concern. Objective: To determine the prevalence rates of carb...
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| Format: | Article |
| Language: | English |
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Elsevier
2020-09-01
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| Series: | Brazilian Journal of Infectious Diseases |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1413867020301057 |
| _version_ | 1818217769625190400 |
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| author | Jéssica Endy Scariot Costa Keite da Silva Nogueira Clóvis Arns da Cunha |
| author_facet | Jéssica Endy Scariot Costa Keite da Silva Nogueira Clóvis Arns da Cunha |
| author_sort | Jéssica Endy Scariot Costa |
| collection | DOAJ |
| description | Background: Gram-negative bacilli (GNB), notably Acinetobacter spp., Pseudomonas spp., and Klebsiella spp., are becoming increasingly resistant to carbapenems and are associated with high health care costs and mortality, becoming a global concern. Objective: To determine the prevalence rates of carbapenem resistance among Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. in the main sites of nosocomial infection at a tertiary care hospital in southern Brazil and the consequent therapeutic implications. Methods: Cultures processed at the institution’s laboratory in 2017 were analyzed, and those positive for Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. were identified. Antibiograms were evaluated for meropenem sensitivity following the Clinical Laboratory Standards Institute guidelines. Results: Acinetobacter spp. had the lowest prevalence among the three GNB, and resistance of this pathogen to meropenem at different sites of infection ranged from 36% (blood) to 82% (respiratory tract). Pseudomonas spp. was highly prevalent at the respiratory tract (31%) and had a high resistance rate to meropenem in rectal swab samples (71%), but a relatively low frequency at infection sites (skin/soft tissue, 13%; blood, 25%). Klebsiella spp. was identified in 7.5% of the blood cultures and 15% of the urine cultures and was the chief colonizer among all pathogens, representing 54% of all rectal swab samples, of which 53% were meropenem resistant. At sites of infection, rates of Klebsiella spp. resistant to meropenem ranged from 19% (skin) to 55% (vascular catheter). Conclusions: The prevalence of carbapenem-resistant GNB at our hospital was relatively low compared to national and international data; thus, meropenem remains a good therapeutic option against these bacteria. Other antibiotics effective against GNB, such as ceftazidime, cefepime, and piperacillin-tazobactam, can be used in most cases, while meropenem should be reserved for patients with sepsis. Strict contact precaution measures are still needed, given the high resistance rate observed at the colonizing site. |
| first_indexed | 2024-12-12T07:13:08Z |
| format | Article |
| id | doaj.art-effefd1c458f4e74b8c37f392ae1ce1a |
| institution | Directory Open Access Journal |
| issn | 1413-8670 |
| language | English |
| last_indexed | 2024-12-12T07:13:08Z |
| publishDate | 2020-09-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Brazilian Journal of Infectious Diseases |
| spelling | doaj.art-effefd1c458f4e74b8c37f392ae1ce1a2022-12-22T00:33:35ZengElsevierBrazilian Journal of Infectious Diseases1413-86702020-09-01245380385Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implicationsJéssica Endy Scariot Costa0Keite da Silva Nogueira1Clóvis Arns da Cunha2Universidade Federal do Paraná, Faculdade de Medicina, Curitiba, PR, Brazil; Corresponding author at: Jéssica Endy Scariot Costa, Universidade Federal do Paraná, Faculdade de Medicina, 240, 1804A, Amintas de Barros, Curitiba, PR, 80060-205, Brazil.Universidade Federal do Paraná, Complexo Hospital de Clínicas da Universidade Federal do Paraná, Laboratório de Microbiologia, Curitiba, PR, BrazilUniversidade Federal do Paraná, Faculdade de Medicina, Departamento de Saúde Coletiva, Curitiba, PR, BrazilBackground: Gram-negative bacilli (GNB), notably Acinetobacter spp., Pseudomonas spp., and Klebsiella spp., are becoming increasingly resistant to carbapenems and are associated with high health care costs and mortality, becoming a global concern. Objective: To determine the prevalence rates of carbapenem resistance among Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. in the main sites of nosocomial infection at a tertiary care hospital in southern Brazil and the consequent therapeutic implications. Methods: Cultures processed at the institution’s laboratory in 2017 were analyzed, and those positive for Acinetobacter spp., Pseudomonas spp., and Klebsiella spp. were identified. Antibiograms were evaluated for meropenem sensitivity following the Clinical Laboratory Standards Institute guidelines. Results: Acinetobacter spp. had the lowest prevalence among the three GNB, and resistance of this pathogen to meropenem at different sites of infection ranged from 36% (blood) to 82% (respiratory tract). Pseudomonas spp. was highly prevalent at the respiratory tract (31%) and had a high resistance rate to meropenem in rectal swab samples (71%), but a relatively low frequency at infection sites (skin/soft tissue, 13%; blood, 25%). Klebsiella spp. was identified in 7.5% of the blood cultures and 15% of the urine cultures and was the chief colonizer among all pathogens, representing 54% of all rectal swab samples, of which 53% were meropenem resistant. At sites of infection, rates of Klebsiella spp. resistant to meropenem ranged from 19% (skin) to 55% (vascular catheter). Conclusions: The prevalence of carbapenem-resistant GNB at our hospital was relatively low compared to national and international data; thus, meropenem remains a good therapeutic option against these bacteria. Other antibiotics effective against GNB, such as ceftazidime, cefepime, and piperacillin-tazobactam, can be used in most cases, while meropenem should be reserved for patients with sepsis. Strict contact precaution measures are still needed, given the high resistance rate observed at the colonizing site.http://www.sciencedirect.com/science/article/pii/S1413867020301057MDR GNBSusceptibility profilePrevalenceCarbapenems |
| spellingShingle | Jéssica Endy Scariot Costa Keite da Silva Nogueira Clóvis Arns da Cunha Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications Brazilian Journal of Infectious Diseases MDR GNB Susceptibility profile Prevalence Carbapenems |
| title | Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications |
| title_full | Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications |
| title_fullStr | Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications |
| title_full_unstemmed | Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications |
| title_short | Carbapenem-resistant bacilli in a hospital in southern Brazil: prevalence and therapeutic implications |
| title_sort | carbapenem resistant bacilli in a hospital in southern brazil prevalence and therapeutic implications |
| topic | MDR GNB Susceptibility profile Prevalence Carbapenems |
| url | http://www.sciencedirect.com/science/article/pii/S1413867020301057 |
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