Distribución de genes codificadores de β-lactamasas de espectro extendido en aislamientos de Klebsiella pneumoniae de hospitales de Bogotá, D.C., Colombia
Palabras clave:
Klebsiella pneumoniae, beta-lactamasas, farmacorresistencia bacteriana, análisis de secuencia de ADN, epidemiología molecular, Colombia
Resumen
Introducción. Las beta-lactamasas de espectro extendido son las enzimas de Enterobacteriaceae de mayor distribución en Latinoamérica. No obstante, en Colombia existe poca información sobre la identidad de los genes codificadores de estas enzimas en Klebsiella pneumoniae.Objetivo. Identificar genes bla presentes en K. pneumoniae procedentes de hospitales de Bogotá, D.C., Colombia.
Materiales y métodos. Se recolectaron 177 aislamientos productores de beta-lactamasas de espectro extendido de 10 hospitales de Bogotá, entre 2003 y 2005. Se determinó su sensibilidad antibiótica por difusión en disco y el número de beta-lactamasas presentes por isoelectroenfoque. Se identificaron los genes blaCTX-M, blaSHV y blaTEM, mediante PCR y posterior secuenciación.
Resultados. Además de la resistencia a las cefalosporinas de tercera generación, el 44,7 % y el 49,7 % fueron resistentes a la gentamicina y al trimetoprim-sulfametoxazol, respectivamente. Se observaron porcentaje de resistencia más bajos con otros antibióticos. En promedio, se detectaron por aislamiento tres beta-lactamasas, y los genes blaCTX-M-12 (56%) y blaSHV-12 (33,3%) fueron los más prevalentes. Además, se identificaron blaSHV-5 (11,8%), blaCTX-M-1 (4%), blaSHV-27 (2,8%), blaSHV-2 (2,8%), blaCTX-M-2 (1,7%) y blaCTX-M-15 (0,6%). Además, en nuestros aislamientos se identificaron tres genes codificadores de beta-lactamasas de espectro ampliado.
Conclusión. Se identificaron once genes bla, de los cuales, ocho eran codificadores de beta-lactamasas de espectro extendido. La diversidad encontrada de los genes bla sugiere la continua exposición de K. pneumoniae a fuertes presiones antibióticas, como las observadas en nuestros hospitales.
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Referencias bibliográficas
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12. Villegas M, Correa A, Pérez F, Miranda MC, Zuluaga T, Quinn JP, et al. Prevalence and characterization of extended-spectrum β-lactamases in Klebsiella pneumoniae and Escherichia coli isolates from Colombian hospitals. Diagn Microbiol Infect Dis. 2004;49:217-22.
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21. Bouza E, San Juan R, Muñoz P, Voss A, Kluytmans J. A European perspective on nosocomial urinary tract infections II. Report on incidence, clinical characteristics and outcome (ESGNI-004study). Clin Microbiol Infect. 2001;7:532-42.
22. Kil K, Darouiche RO, Hull RA, Mansouri MD, Musher DM. Identification of a Klebsiella pneumoniae strain associated with nosocomial urinary tract infection. J Clin Microbiol. 1997;35:2370-4.
23. Suljagic V, Cobeljic M, Jankovic S, Mirovic V, Markovic-Denic L, Romic P, et al. Nosocomial bloodstream infections in ICU and non-ICU patients. Am J Infect Control. 2005;33:333-40.
24. Biedenbach DJ, Moet GJ, Jones RN. Ocurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997- 2002). Diag Microbiol Infect Dis. 2004;50:59-69.
25. Kariuki S, Corkill J, Revathi G, Musoke R, Hart CA. Molecular characterization of a novel plasmid-encoded-cefotaximase (CTX-M-12) found in clinical Klebsiella pneumoniae isolates from Kenya, Antimicrob Agents Chemother. 2001;45:2141-3.
26. Villegas MV, Correa A, Pérez F, Zuluaga T, Radice M, Gutkind G, et al. CTX-M-12 β-lactamase in a Klebsiella pneumoniae isolate in Colombia. Antimicrob Agents Chemother. 2004;48:629-31.
27. Corkill JE, Cuevas LE, Gurgel RQ, Greensill J, Hart CA. SHV-27, a novel cefotaxime-hydrolyzing ß-lactamase, identified in Klebsiella pneumoniae isolates from a Brazilian hospital. J Antimicrob Chemother. 2001;47:463-5.
28. Segatore B, Setacci D, Perilli M, Franchino L, Franceschini N, Agnifili A, et al. Antimicrobial susceptibility of clinical isolates of Enterobacteriaceae producing complex β-lactamase patterns including extended-spectrum enzymes. Int J Antimicrob Agents. 2004;23:480-6.
29. Xiong Z, Zhu D, Wang F, Zhang Y, Okamoto R, Inoue M. A Klebsiella pneumoniae producing three kinds of class A β-lactamases encoded by one single plasmid isolated from a patient in Huashan Hospital, Shanghai, China. Int J Antimicrob Agents. 2004;23:262-7.
30. Bradford PA. Extended-spectrum β-lactamases in the 21st century: Characterization, epidemiology and detection of this important resistance threat. Clin Microbiol Rev. 2001;14:933-51.
31. Siu LK, Lu P, Hsueh P, Lin FM, Chang S, Luh K, et al. Bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric oncology ward: Clinical features and identification of different plasmids carrying both SHV-5 and TEM-1 genes. J Clin Microbiol. 1999;37:4020-7.
2. Bonnet R. Growing group of extended-spectrum β-lactamases: The CTX-M enzymes. Antimicrob Agents Chemother. 2004;48:1-14.
3. Pagani L, Dell´Amico E, Migliavacca R, D'Andrea MM, Giacobone E, Amicosante G, et al. Multiple CTX-M-type extended-spectrum β-lactamases in nosocomial isolates of Enterobacteriaceae from a hospital in Northern Italy. J Clin Microbiol. 2003;41:4264-9.
4. Van't veen A, van der Zee A, Nelson J, Speelberg B, Kluytmans JA, Buiting AG. Outbreak of infection with a multiresistant Klebsiella pneumoniae strain associated with contaminated roll boards in operating rooms. J Clin Microbiol. 2005;43:4961-7.
5. Ben-Hamouda T, Foulon T, Ben-Cheikn-Masmoudi A, Fendri C, Belhadj O, Ben Mahrez K. Molecular epidemiology of an outbreak of multiresistant Klebsiella pneumoniae in a Tunisian neonatal ward. J Med Microbiol. 2003;52:427-33.
6. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: Epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev. 1998;11:589-603.
7. Winokur PL, Canton R, Casellas JM, Legakis N. Variations in the prevalence of strains expressing an extended-spectrum β-lactamase phenotype and characterization of isolates from Europe, the Americas, and the Western Pacific region. Clin Infect Dis. 2001;32(Suppl. 2):S94-103.
8. The Colombian Resistance Antimicrobial Group, Jones RN, Salazar JC, Pfaller MA, Doern GV. Multicenter evaluation of antimicrobial resistance to six broad-spectrum β-lactams in Colombia using the Etest method. Diagn Microbiol Infect Dis. 1997;29:265-72.
9. The Colombian Antimicrobial Resistance Study Group, Pfaller MA, Jones RN, Doern GV, Salazar JC. Multicenter evaluation of antimicrobial resistance to six broad-spectrum beta-lactams in Colombia: Comparison of data from 1997 and 1998 using the Etest method. Diagn Microbiol Infect Dis. 1999;35:235-41.
10. Valenzuela E, Mantilla J, Reguero M, González E, Pulido I, Llerena I, et al. Detection of CTX-M-1, CTX-M-15, and CTX-M-2 in clinical isolates of Enterobacteriaceae in Bogotá, Colombia. J Clin Microbiol. 2005;44:1919-20.
11. Espinal P, Mantilla J, Saavedra C, Leal A, Alpuche C, Valenzuela E. Epidemiología molecular de la infección nosocomial por Klebsiella pneumoniae productora de beta-lactamasas de espectro extendido. Biomédica. 2004;24:252-61.
12. Villegas M, Correa A, Pérez F, Miranda MC, Zuluaga T, Quinn JP, et al. Prevalence and characterization of extended-spectrum β-lactamases in Klebsiella pneumoniae and Escherichia coli isolates from Colombian hospitals. Diagn Microbiol Infect Dis. 2004;49:217-22.
13. Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibillity testing. Sixteenth Informational supplement. CLSI document M-100-S16 (ISBN 1-56238-588-7). Wayne: Clinical and Laboratory Standards Institute; 2006.
14. Jarlier V, Nicolas MH, Fournier G, Philippon A. Extended broad-spectrum β-lactamases conferring transferable resistance to newer β-lactams agents in Enterobacteriaceae: Hospital prevalence and susceptibility patterns. Rev Infect Dis. 1988;10:867-78.
15. Cao V, Lambert T, Quynh Nhu D, Loan HK, Hoang N, Arlet G, et al. Distribution of extended-spectrun β-lactamases in clinical isolates of Enterobacteriaceae in Vietnam. Antimicrob Agents Chemother. 2002;46:3739-43.
16. Neuwirth C, Madec S, Siebor E. TEM-89 β-lactamase produced by Proteus mirabilis clinical isolate: New complex mutant (CMT 3) with mutations in both TEM-59 (IRT-17) and TEM-3. Antimicrob Agents Chemother. 2001;45:3591-4.
17. Bonnet R, Dutour J, Sampaio M, Chanal C, Sirot D, Labia R, et al. Novel cefotaxime (CTX-M-16) with increase catalytic efficiency due to substitution Asp-240-Gli. Antimicrob Agents Chemother. 2001;45:2269-75.
18. Nagano N, Shibata N, Saitou Y, Nagano Y, Arakawa Y. Nosocomial outbreak infections by Proteus mirabilis that produces extended-spectrum CTX-M-2 type β-lactamase. J Clin Microbiol. 2003;41:5530-6.
19. Chanawong A, M'Zali FH, Heritage J, Xiong J, Hawkey PM. Three cefotaximases, CTX-M-9, CTX-M-13, and CTX-M-14, among Enterobacteriaceae in the People's Republic of China. Antimicrob Agents Chemother. 2002;46:630-7.
20. Shibata N, Kurokawa H, Doi Y, Yagi T, Yamane K, Wachino J, et al. PCR classification of CTX-M-type β-lactamase genes identified in clinically isolated gram-negative bacilli in Japan. Antimicrob Agents Chemother. 2006;50:791-5.
21. Bouza E, San Juan R, Muñoz P, Voss A, Kluytmans J. A European perspective on nosocomial urinary tract infections II. Report on incidence, clinical characteristics and outcome (ESGNI-004study). Clin Microbiol Infect. 2001;7:532-42.
22. Kil K, Darouiche RO, Hull RA, Mansouri MD, Musher DM. Identification of a Klebsiella pneumoniae strain associated with nosocomial urinary tract infection. J Clin Microbiol. 1997;35:2370-4.
23. Suljagic V, Cobeljic M, Jankovic S, Mirovic V, Markovic-Denic L, Romic P, et al. Nosocomial bloodstream infections in ICU and non-ICU patients. Am J Infect Control. 2005;33:333-40.
24. Biedenbach DJ, Moet GJ, Jones RN. Ocurrence and antimicrobial resistance pattern comparisons among bloodstream infection isolates from the SENTRY Antimicrobial Surveillance Program (1997- 2002). Diag Microbiol Infect Dis. 2004;50:59-69.
25. Kariuki S, Corkill J, Revathi G, Musoke R, Hart CA. Molecular characterization of a novel plasmid-encoded-cefotaximase (CTX-M-12) found in clinical Klebsiella pneumoniae isolates from Kenya, Antimicrob Agents Chemother. 2001;45:2141-3.
26. Villegas MV, Correa A, Pérez F, Zuluaga T, Radice M, Gutkind G, et al. CTX-M-12 β-lactamase in a Klebsiella pneumoniae isolate in Colombia. Antimicrob Agents Chemother. 2004;48:629-31.
27. Corkill JE, Cuevas LE, Gurgel RQ, Greensill J, Hart CA. SHV-27, a novel cefotaxime-hydrolyzing ß-lactamase, identified in Klebsiella pneumoniae isolates from a Brazilian hospital. J Antimicrob Chemother. 2001;47:463-5.
28. Segatore B, Setacci D, Perilli M, Franchino L, Franceschini N, Agnifili A, et al. Antimicrobial susceptibility of clinical isolates of Enterobacteriaceae producing complex β-lactamase patterns including extended-spectrum enzymes. Int J Antimicrob Agents. 2004;23:480-6.
29. Xiong Z, Zhu D, Wang F, Zhang Y, Okamoto R, Inoue M. A Klebsiella pneumoniae producing three kinds of class A β-lactamases encoded by one single plasmid isolated from a patient in Huashan Hospital, Shanghai, China. Int J Antimicrob Agents. 2004;23:262-7.
30. Bradford PA. Extended-spectrum β-lactamases in the 21st century: Characterization, epidemiology and detection of this important resistance threat. Clin Microbiol Rev. 2001;14:933-51.
31. Siu LK, Lu P, Hsueh P, Lin FM, Chang S, Luh K, et al. Bacteremia due to extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric oncology ward: Clinical features and identification of different plasmids carrying both SHV-5 and TEM-1 genes. J Clin Microbiol. 1999;37:4020-7.
Cómo citar
1.
Pulido IY, Mantilla JR, Valenzuela EM, Reguero MT, González EB. Distribución de genes codificadores de β-lactamasas de espectro extendido en aislamientos de Klebsiella pneumoniae de hospitales de Bogotá, D.C., Colombia. Biomed. [Internet]. 16 de abril de 2011 [citado 16 de agosto de 2024];31(1):15-20. Disponible en: https://revistabiomedica.org/index.php/biomedica/article/view/331
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