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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorBOSZCZOWSKI, Icaro
dc.contributor.authorSALOMAO, Matias Chiarastelli
dc.contributor.authorMOURA, Maria Luisa
dc.contributor.authorFREIRE, Maristela Pinheiro
dc.contributor.authorGUIMARAES, Thais
dc.contributor.authorCURY, Ana Paula
dc.contributor.authorROSSI, Flavia
dc.contributor.authorRIZEK, Camila Fonseca
dc.contributor.authorMARTINS, Roberta Cristina Ruedas
dc.contributor.authorCOSTA, Silvia Figueiredo
dc.date.accessioned2019-08-20T14:44:53Z
dc.date.available2019-08-20T14:44:53Z
dc.date.issued2019
dc.identifier.citationREVISTA DO INSTITUTO DE MEDICINA TROPICAL DE SAO PAULO, v.61, article ID UNSP e29, 9p, 2019
dc.identifier.issn0036-4665
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/33107
dc.description.abstractIncreased resistance to polymyxin in Klebsiella pneumoniae (ColRKP) has been observed. Molecular epidemiology, as well as the clinical impact of these difficult to treat pathogens need to be better characterized. We present the clinical outcomes of 28 patients infected by ColRKP in a tertiary hospital. Isolates with MIC >2 by Vitek 2 were confirmed by the microdilution broth test. Polymerase chain reaction (PCR) was performed for bla(KPC), bla(NDM), bla(OXA-48), and bla(mcr-1) genes in the isolates, and Whole Genome Sequencing (WGS) was performed in six isolates. Seventeen (61%) patients were female and the mean age was 50 years old. In-hospital and 30-day mortality were 64% (18/28) and 53% (15/28), respectively. Central line-associated bloodstream infection in addition to bacteremia episodes due to other sources were the most frequent (61%). Mean APACHE and Charlson comorbidity index were 16 and 5, respectively. Twenty patients (71%) received at least one active drug and ten (35%) received two drugs: tigecycline 46% (13/28); amikacin 21% (6/28) and fosfomycin 3% (1 case). Twenty-six out of 28 tested cases were positive for bla(KPC) Eight different clusters were identified. Four STs were detected (ST1, ST23, ST340, and ST437). Mutations on pmrA, arnB udg, and yciM genes were present in all six isolates submitted to WGS; /pxMand mgrB mutations were also detected in all but one isolate. In conclusion, we observed resistance to polymyxin in severely ill patients mostly from intensive care units and/or immunosuppressed patients with high mortality rates in whom a diversity of ColRKP clusters was identified and might indicate selective pressure.eng
dc.language.isoeng
dc.publisherINST MEDICINA TROPICAL SAO PAULOeng
dc.relation.ispartofRevista do Instituto de Medicina Tropical de Sao Paulo
dc.rightsopenAccesseng
dc.subjectColistin resistanceeng
dc.subjectHospital epidemiologyeng
dc.subjectAntibiotic therapyeng
dc.subjectGenome sequencingeng
dc.subjectPolymyxinseng
dc.subject.othercolistin resistanceeng
dc.subject.otherantimicrobial resistanceeng
dc.subject.otherenterobacteriaceaeeng
dc.subject.otherdisseminationeng
dc.subject.otherinfectionseng
dc.subject.otheremergenceeng
dc.subject.otherpmrbeng
dc.titleMultidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazileng
dc.typearticleeng
dc.rights.holderCopyright INST MEDICINA TROPICAL SAO PAULOeng
dc.identifier.doi10.1590/S1678-9946201961029
dc.identifier.pmid31241658
dc.subject.wosTropical Medicineeng
dc.type.categoryoriginal articleeng
dc.type.versionpublishedVersioneng
hcfmusp.description.articlenumberUNSP e29
hcfmusp.description.volume61
hcfmusp.origemWOS
hcfmusp.origem.idWOS:000472473200002
hcfmusp.origem.idSCIELO:S0036-46652019005000213
hcfmusp.origem.id2-s2.0-85068860207
hcfmusp.publisher.citySAO PAULOeng
hcfmusp.publisher.countryBRAZILeng
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dc.description.indexMEDLINEeng
dc.identifier.eissn1678-9946
hcfmusp.citation.scopus18
hcfmusp.scopus.lastupdate2022-12-02-
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Artigos e Materiais de Revistas Científicas - FM/MIP
Departamento de Moléstias Infecciosas e Parasitárias - FM/MIP

Artigos e Materiais de Revistas Científicas - HC/ICESP
Instituto do Câncer do Estado de São Paulo - HC/ICESP

Artigos e Materiais de Revistas Científicas - HC/ICHC
Instituto Central - HC/ICHC

Artigos e Materiais de Revistas Científicas - LIM/03
LIM/03 - Laboratório de Medicina Laboratorial

Artigos e Materiais de Revistas Científicas - LIM/49
LIM/49 - Laboratório de Protozoologia


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