Outbreak of KPC-2 producing Serratia marcescens MDR in a tertiary hospital in the Midwest region, Brazil
DOI:
https://doi.org/10.33448/rsd-v10i9.18078Keywords:
S. marcescens; Health-related infection; Outbreak; BlaKPC.Abstract
About 700,000 deaths per year worldwide are caused of Healthcare-related infections (HAI). Result in significant patient morbidity and mortality, being is ranked the fourth leading cause of death in Brazil. Usually, HAI are caused by multidrug-resistance microorganisms (MDR), as well as Serratia marcescens, that is associated with healthcare-related infections causing high patient mortality and morbidity. This paper describes an outbreak of S. marcescens MDR carrier gene blaKPC-2 in a university hospital, with the need to broadly combat horizontal transmission of this bacterium between patients, as well as the need to optimize treatment with other antimicrobial classes due to resistance of this microorganism to polymyxins. Ten isolates were analyzed for the presence of carbapenemic resistance gene blaKPC-2. This gene was detected in all isolates, with a corresponding high patient mortality rate, highlighting the importance of its molecular detection, which corroborates the resistance of S. marcescens to carbapenem antibiotics. The detection of this gene is necessary due to the importance to broadly combat horizontal transmission of this bacterium between patients, as well as the need to optimize treatment with other antimicrobial agents due to its resistance to polymyxins.
References
Allegranzi, B., Bagheri Nejad, S., Combescure, C., Graafmans, W., Attar, H., Donaldson, L.,& Pittet, D. (2011). Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet, 377 (9761), 228-241. doi 10.1016 / S0140-6736 (10) 61458-4
Arslan, U., Erayman, I., Kirdar, S., Yuksekkaya, S., Cimen, O., Tuncer, I., & Bozdogan, B. (2010). Serratia marcescens sepsis outbreak in a neonatal intensive care unit. Pediatrics International, 52, 208-212. doi:10.1111/j1442-200X.2009.02934.x
Cayô, R., Leme, R.C., Streling, A.P., Matos, A.P., Nodari, C.S., Chaves, J.R., Brandão, J.L., De Almeida, M.F., Carrareto, V., De Castro Pereira, M.A., De Almeida, J.P., Ferreira, D.C., & Gales, A.C. (2017). Serratia marcescens harboring SME-4 in Brazil: a silent threat. Diagnostic Microbiology and Infectious Disease, 87, 357-358. doi:10.1016/j.diagmicrobio.2017.01.00
Clinical & Laboratory Standards Institute (CLSI) (2017). “Performance Standards for Antimicrobial Susceptibility Testing: 27th informational supplement M100.” Wayne, PA: Clinical and Laboratory Standards Institute, pp. 46–48.
Cristina, M.L., Sartini, M., & Spagnolo, A.M. (2019). Serratia marcescens infections in neonatal intensive care units (NICUs). International Journal of Environmental Research and Public Health, 16, (610), 1-10. doi:10.3390/ijerph16040610
Denervaud-Tendon ,V., Poirel, L., Connolly, L.E., Krause, K.M., & Nordmann, P. (2017). Plazomicin activity against polymyxin-resistant Enterobacteriaceae, including MCR-1-producing isolates. Journal of Antimicrobial Chemotherapy, 72 (10), 2787-2791. doi:10.1093/jac /dkx239
Interagency Coordination Group on Antimicrobial Resistance (IACG) (2019). No time to wait: securing the future from drug-resistant infections. Report to the Secretary-General of the United Nations. https://www.who.int/docs/default-source/documents/no-time-to-wait-securing-the-future-from-drug-resistant-infections-en.pdf?sfvrsn=5b424d7_6
Hejazi, A., & Falkiner, F.R. (1997). Serratia marcescens. Journal of Medical Microbiology, 46, 903–912. doi.org/10.1099/00222615-46-11-903
Hornsey, M., Ellington, M.J., Doumith, M., Hudson, S., Livermore, D.M., & Woodford, N. (2010). Tigecycline resistance in Serratia marcescens associated with up-regulation of the SdeXY-HasF efflux system also active against ciprofloxacin and cefpirome. Journal of Antimicrobial Chemotherapy, 65, 479-482. doi:10.1093/jac/dkp475
Jones, R.N. (1998) Important and emerging beta-lactamase-mediated resistances in hospital-based pathogens: the Amp C enzymes. Diagnostic Microbiology and Infectious Disease, 31, 461–466. doi:10.1016/s0732-8893(98)00029-715
Kaleem. F., Usman, J., Hassan, A., & Khan, A. (2010). Frequency and susceptibility pattern of metallo-beta-lactamase producers in a hospital in Pakistan. The Journal of Infection in Developing Countries, 4 (12), 810–813. doi: 10.3855 / jidc.1050
Margate, E., Magalhães, V., Fehlberg, L.C.C., Gales, A.C., & Lopes, A.C.S. (2015). KPC-producing Serratia marcescens in a home-care patient from Recife, Brazil. Revista do Instituto de Medicina Tropical de São Paulo, 57 (4), 359-360. doi: 10.1590/S0036-46652015000400016
Mendes, R.E., Toleman, M.A., Ribeiro, J., Sader, H.S., Jones, R.N., & Walsh, T.R. (2004). Integron carrying a novel metallo-β-lactamase gene, blaIMP-16, and a fused form of aminoglycoside-resistant gene aac(6′)-30/aac(6′)-Ib′: report from the SENTRY Antimicrobial Surveillance Program. Antimicrobial Agents and Chemotherapy Journal, 48, 4693-4702. doi:10.1128/AAC.48.12.4693-4702.2004
Milisavljevic, V., Wu, F., Larson, E., Rubenstein, D., Ross, B., Drusin, L.M., Della-Latta, P., & Saiman, L. (2004). Molecular epidemiology of Serratia marcescens outbreaks in two neonatal intensive care units. Infection Control & Hospital Epidemiology., 25, 719-721. doi 10.1086/502466
Peleg, A.Y., & Hooper, D.C. (2010). Hospital-acquired infections due to gram-negative bacteria. The New England Journal of Medicine, 362, 1804-1813. doi: 10.1056/ NEJMra0904124
Polilli , E., Parruti, G., Fazii, P., D'Antonio, D., Palmieri, D., D'Incecco, C., Mangifesta, A., Garofalo, G., Del Duca, L., D'Amario, C., Scimia , M, Cortesi, V., & Fortunato, V. (2011). Rapidly controlled outbreak of Serratia marcescens infection/colonisations in a neonatal intensive care unit, Pescara General Hospital, Pescara, Italy. Euro Surveill 16 (24), 1-3. doi:10.2807/ese.16.24.19892-pt
Quezada-Aguiluz., M., Lincopan, N., Cerdeira, L., Fuga, B., Silva, F., Barrera, B., Cifuentes,M., Bello-Toledo, H., Opazo-Capurro, A., & González-Rocha, G. (2020). Draft genome sequence of a multidrug-resistant KPC-2 and SRT-2 co-producing Serratia marcescens strain isolated from a hospitalised patient in Chile. Journal of Global Antimicrobial Resistanc, 21, 1-2. doi.org/10.1016/j.jgar.2020.02.004
Sambrook,. J, & Russel, D.W. (2004). Molecular cloning: a laboratory manual. 3 ed. New York; Cold Spring Harbor Laboratory Press pp 5.65-5.67.
Sandner-Miranda, L., Vinuesa, P., Soberón-Chávez, G., & Morales-Espinosa, R. (2016). Complete genome sequence of Serratia marcescens SmUNAM836, a nonpigmented multidrug-resistant strain isolated from a Mexican patient with obstructive pulmonar y disease. Genome Announcements, 4 (1), e01417-15. doi: 10.1128/genomeA.01417-15.
Silva, K.C., & Lincopan, N. (2012) Epidemiology of extended-spectrum beta-lactamases in Brazil: Clinical impact and implications for agribusiness. Jornal Brasileiro de Patologia e Medicina Laboratorial, 48 (2), 91-99. doi:10.1590/S1676-24442012000200004
Silva, K.E., Cayô, R., Carvalhaes, C.G, Sacchi, F.P.C., Rodrigues-Costa, F., Silva, A.C.R., Croda, J., Gales, A.C., & Simionatto, S. (2015). Coproduction of KPC-2 and IMP-10 in Carbapenem-Resistant Serratia marcescens Isolates from an Outbreak in a Brazilian Teaching Hospital. Journal of Clinical Microbiology, 53 (7), 2324-2328. doi:10.1128/JCM.00727-15.
Tacconelli, E., Carrara, E., Savoldi, A., Harbarth, S., Mendelson, M., Monnet, D.L., Pulcini, C., Kahlmeter, G., Kluytmans, J., Carmeli, Y., Ouellette, M., Outterson, K., Patel, J., Cavaleri, M., Cox, E.M., Houchens, C.R., Grayson, M.L., Hansen, P., Singh, N., Theuretzbacher, U., & Magrini, N. (2018) Discovery, research, and development of new antibiotics: the WHO priority list of antibiotic-resistant bacteria and tuberculosis. The Lancet Infectious Diseases, 18 (3), 318-327. doi:10.1016/S1473-3099(17)30753-3
Yigiti, H., Queenan, A.M., Anderson, G.J., Domenech-Sanchez, A., Biddle, J.W., & Steward, C.D. (2001). Novel carbapenem-hydrolyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrobial agents and chemotherapy, 45 (4), 1151-1161. doi:10.1128/AAC.45.4.1151-1161.2001
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Copyright (c) 2021 Thalita Priscila Peres Seabra da Cruz; Francisco Kennedy Scofoni Faleiros de Azevedo ; Marco Andrey Pepato ; Alessandra Tammy Hayakawa Ito de Sousa ; Paula Sossai Rizzo; Francisco José Dutra Souto; Luciano Nakazato; Valéria Dutra

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