Resistencia a antimicrobianos de bacilos Gram negativos aislados en unidades de cuidado intensivo en hospitales de Colombia, WHONET 2003, 2004 y 2005

An Analysis of the Epidemic of Klebsiella pneumoniae Carbapenemase-Producing K. pneumoniae: Convergence of Two Evolutionary Mechanisms Creates the "Perfect Storm"

Background

Carbapenem resistance is a critical healthcare challenge worldwide. Particularly concerning is the widespread dissemination of Klebsiella pneumoniae carbapenemase (KPC). Klebsiella pneumoniae harboring blaKPC (KPC-Kpn) is endemic in many areas including the United States, where the epidemic was primarily mediated by the clonal dissemination of Kpn ST258. We postulated that the spread of blaKPC in other regions occurs by different and more complex mechanisms. To test this, we investigated the evolution and dynamics of spread of KPC-Kpn in Colombia, where KPC became rapidly endemic after emerging in 2005.

Methods

We sequenced the genomes of 133 clinical isolates recovered from 24 tertiary care hospitals located in 10 cities throughout Colombia, between 2002 (before the emergence of KPC-Kpn) and 2014. Phylogenetic reconstructions and evolutionary mapping were performed to determine temporal and genetic associations between the isolates.

Results

Our results indicate that the start of the epidemic was driven by horizontal dissemination of mobile genetic elements carrying blaKPC-2, followed by the introduction and subsequent spread of clonal group 258 (CG258) isolates containing blaKPC-3.

Conclusions

The combination of 2 evolutionary mechanisms of KPC-Kpn within a challenged health system of a developing country created the "perfect storm" for sustained endemicity of these multidrug-resistant organisms in Colombia.

Draft Genome Sequences of Multidrug-Resistant Acinetobacter sp. Strains from Colombian Hospitals

The draft genome sequences of the strains Acinetobacter baumannii 107m, Acinetobacter nosocomialis 28F, and Acinetobacter pittii 42F, isolated from Colombian hospitals, are reported here. These isolates are causative of nosocomial infections and are classified as multidrug resistant, as they showed resistance to four different antibiotic groups.

Antimicrobial susceptibility of Listeria monocytogenes food isolates from different cities in Colombia

One hundred eight Listeria monocytogenes food isolates from four cities in Colombia and previously confirmed by multiplex polymerase chain reaction were characterized for antimicrobial susceptibility. Isolates were evaluated against 17 antimicrobials contained in the MICroSTREP plus(®)3 panel (MicroScan system). Susceptibility found for ampicillin, amoxicillin/clavulanic acid, and chloramphenicol was 100%, whereas it was 98% for other antimicrobials such as trimethoprim/sulfamethoxazole, 97% for azithromycin, 92% for vancomycin, 90% for erythromycin, 86% for tetracycline, 84% for penicillin, 70% for ciprofloxacin, 57% for rifampin, 56% for meropenem, and 32% for clindamycin. Natural resistance to cephalosporins was confirmed in all cases, and 16% of isolates were nonsusceptible to penicillin. Using Staphylococcus spp. or Enterococcus spp. breakpoints, 48% of isolates displayed multidrug resistances, and the major resistance phenotypes were against rifampin, clindamycin, ciprofloxacin, azithromycin, and erythromycin. Colombian food isolates displayed high resistance to clindamycin, meropenem, rifampin, and ciprofloxacin (30%-65%), and the primary drugs of choice against listeriosis remain effective for most of isolates (84%).

Management of antibiotic resistance in the intensive care unit setting

Over the past few decades, an alarming increase of infections caused by antibiotic-resistant pathogens, including methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus species, carbapenem-resistant Pseudomonas aeruginosa, extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella spp., and multidrug-resistant Acinetobacter spp., has been observed, particularly in intensive care units. For clinicians, the rising resistance rate observed in nosocomial pathogens, when coupled with the lack of effective antimicrobials, represents the real challenge in the therapeutic management of critically ill patients. The contribution of clinicians in minimizing the increasing trend of resistance is represented by reduction of the patients' exposure to antibiotics, which reduces the resistance-selecting pressure, and by avoiding unnecessary antibiotic treatments. Recent issues on strategies to minimize resistance development and to appropriately manage critically ill patients with infections caused by multidrug-resistant organisms in the intensive care unit setting are discussed in this article.

Dissemination of Acinetobacter baumannii clones with OXA-23 Carbapenemase in Colombian hospitals

During 2005, 66 carbapenem-resistant isolates of Acinetobacter baumannii were collected from seven tertiary-care hospitals participating in a nationwide surveillance network in Colombia. The isolates were multidrug resistant and produced the carbapenemases OXA-23 and OXA-51. Forty-five belonged to four clones while 21 were unique pulsotypes. One clone was present in two hospitals within one city, while another had spread between two hospitals in different cities. Blood, secretions, and abdominal fluids were the most frequent sites of isolation. This is the first description of widespread dissemination of OXA-23 in South America.