Carbepenem Resistant Klebsiella Pneumoniae
-
Upload
diana-sofia-serna-corredor -
Category
Health & Medicine
-
view
225 -
download
1
Transcript of Carbepenem Resistant Klebsiella Pneumoniae
By
Ximena Vazart Hernández
Diana Sofía Serna Corredor
INTRODUCTION
-Klebsiella microorganisms belong to Enterobacteriaceae family -They are non motile gram-negative bacilli -The outermost layer of Klebsiella it's formed by a polysaccharide capsule that differentiates these microorganisms from other genders -Edwin Klebs, a German microbiologist
KLEBSIELLA
INTRODUCTION
-They make lactose and acetone fermentation -Belongs to bacterias gender Klebsiella -Causes about 1% of bacterial pneumonias, sepsis, soft tissue infections, UTI and surgical wound infections.
K.PNEUMONIAE
TYPES OF RESISTANCE
1. Natural Resistance: innate ability of bacteria to
resist the activity of an antimicrobial agent
2. Acquired Resistance: Obtention of the ability to
resist to the activity of an antimicrobial agent to
which was previously susceptible.
BACTERIAL RESISTANCE
INTRODUCTION
RESISTANCE
OBTENTION
✓SPONTANEOUS MUTATION
✓GENES TRANSFER
RESISTANCE
MECHANISMS
✓ INACTIVATION ENZYMES
✓TARGET MOLECULES
ALTERATIONS
✓DECREASE OF DRUG UPTAKE
✓INCREASED IN DRUG
ELIMINATION
ST258 strain is the most representative carrier
of bla-kpc gen, responsible of klebsiella
pneumoniae carbepenem resistance.
NON ST258
ST514
ST11
ST13
KLEBSIELLA
PNEUMONIAE
STRAINS
General Objetive
To compare the characteristics and outcomes Carbapenem-Resistant Klebsiella pneumoniae ST258 carriers to carriers of other STs defined using MLST
Materiales y Métodos
Se incluyeron los pacientes que asistieron al Detroit Medical Center en septiembre de 2008 a septiembre de 2009 en los cuales se aisló la bacteria, tanto colonizados como infectados Pacientes en los que se aisló Klebsiella
pneumoniae más de una vez, solo se tuvo en cuenta el primer aislamiento
Variables: comorbilidades, exposición reciente
a antimicrobianos, procedimientos médicos,
índice de severidad de la enfermedad,
regímenes terapéuticos y desenlaces
Prueba exacta de Fisher
CONCENTRACIÓN
ESTANDAR DE LA CEPA DISEMINACIÓN EN PLATO CON
AGAR
DISCOS CON ANTIBIOTICO
SOBRE LA SUPERFICIE DEL
MEDIO.
FORMACION DE GRADIENTE DE
FARMACO EN TORNO A DISCOS
ZONA DE INHIBICIÓN
SI? NO? TAMAÑO?
DIFUSIÓN EN DISCO
DIFUSIÓN EN DISCO
Determinación de la susceptibilidad de una
cepa bacteriana a un antimicrobiano.
Determinación de concentración mínima
inhibitoria
✓K Pneumoniae resistentes a cefalosporinas
✓Concentración mínima inhibitoria ≥2 mg/dl
Test de Hodge Modificado (MHT)
PCR
DESNATURALIZACIÓN
ALINEAMIENTO
AMPLIFICACIÓN
PCR
Amplificación directa de un gen o fragmento de DNA
CARBAPENEM RESISTANT KLEPSIELLA PNEUMONIAE
blaKPC
blaIMP
blaVIM
blaOXA
blaNDM
CARBEPENEMASAS
rep- PCR
MULTILOCUS SEQUENCE
TYPING
PCR SECUENCIACIÓN DE
GENES
NÚMERO ALÉLICO A
CADA SECUENCIA
ÚNICA DENTRO DEL
GEN
CARACTERIZACIÓN DE
CEPAS
DENDROGRAMA
RESULTADOS
RESULTADOS
RESULTADOS
group 1: 6-17
RESULTADOS
group 2: 21-62
DISCUSSION AUTHOR WHAT HE SAID
YES/NO
Chen L, Mathema B, Pitout JD
«2 of the non ST258 were
identified as ST11, which
are a single locus variants
of ST258 and are though
to be precursors of blakpc
producing k pneumoniae
ST258»
NO
Addler A, Paikin S, Sterlin Y, et al
«Other mechanisms (eg,
ESLBLs such as blaCTX-M
coupled with porin loss
mutations) might be
involved in current CRKP
epidemiology»
YES
DISCUSSION AUTHOR WHAT HE SAID YES/NO
Munoz-Price LS, Poirel L,
Bonomo RA, et al.
A negative MHT, which might represent false-negative tests due
to the presence of carbapene-mases other than KPC. This
observation suggests increased diversity in the current molecular
epidemiology of CRKP at DMC
YES
Katz S, Ford AB, Moskowitz
RW, et al.
Poor outcomes and high prevalence of resistance was
identified among the small sample of non-ST258 cases as well,
including in-hospital mortality among 3 of 7 non-ST258 cases
This underscores the fact that the epidemiological significance and
clinical impact of non-ST258 strains cannot be dismissed
YES
CONCLUSIONS
MLST allows to determinate similarity between
gen sequences of bacteria strains and its relation
with expression of b lactamases.
Non ST258 strains have a representative influence
in Carbapenem resistant Klebsiella pneumonie and
its dissemination around the world.
CONCLUSIONS
Bla kpc is not determinant for the diagnosis of
Klebsiella pneumoniae but could be determinant
for knowing if it is resistant or not
Negative MHT could be false negative because
carbapenemases can be produced by other thing
different from Klebsiella.
MLST
69 patients
This patient
was excluded
70 CRKP (plus one from the same person
who had 2)
62 patients with
CRKP ST 258
7 patients with
other
3 ST 514 2 ST 11 1 ST 13 1 ST 248
MHT + except
1
56 analyzed
55 with bla kpc
68 patients
rep-PCR
1 ST 514 was ST 258 42 clone 1 12 clone 2
5 non
ST258 were
bla kpc
1 clone 1 3 clone 4 3 clone 4
GRACIAS