Analysis of infections caused by carbapenemase-producing gram-negative bacteria in a hospital in the Campos Gerais region
DOI:
https://doi.org/10.33448/rsd-v10i17.24819Keywords:
Carbapenemases; Health-related infections; KPC; Risk factors.Abstract
Objective: To determine the profile and prevalence of hospital infections caused by carbapenem-resistant Gram-negative bacteria related to healthcare. Methodology: This retrospective cross-sectional descriptive study (Yin, 2015) analyzed the profile of infections in a single public hospital by collecting data from electronic medical records. The collection included demographic data and infection-related clinical and laboratory findings. Results: We analyzed 193 acquisitions of Gram negative bacteria, 25 of which were by carbapenem-resistant microorganisms. Of these, the most common species detected was Klebsiella pneumoniae (56%, 14/25). As for infections, the predominant hospital sector was the intensive care unit (56%, 14/25), mostly related to ventilator-associated pneumonia (40%, 10/25) and in patients submitted to some invasive procedure (72%, 18/25). About 50% of the patients had some adjacent health condition. Antimicrobial treatment prior to diagnosis was identified in 72% (19/25) of patients, with a predominance of betalactams (85.7%, 12/19) and after diagnosis, the majority used monotherapy (72%, 19/25). The impact of the infection was that 68% (17/25) were admitted to the intensive care unit, 40% (10/25) died, and 60% (15/25) were discharged. Conclusion: The results are in agreement with current literature and highlight the importance of prevention in combating the spread of these microorganisms in hospital environments.
References
Alvim, A. L. S., Couto, B. R. G. M., & Gazzinelli, A. (2020). Fatores de risco para infecções relacionadas à assistência à saúde causadas por Enterobacteriaceae produtoras de Klebsiella pneumoniae carbapenemase: um estudo de caso controle. Revista Eletrônica Trimestral de Enfermaria, 58, 267–276.
Anvisa. (2021). Prevenção de infecções por microrganismos multirresistentes em serviços de saúde. Boletim Informativo, 1, 1–12. https://pncq.org.br/wp-content/uploads/2021/03/manual-prevencao-de-multirresistentes7.pdf
ANVISA. (2017). Plano Nacional para a Prevenção e o Controle da Resistência Microbiana nos Serviços de Saúde. Agencia Nacional de Vigilância Sanitária - ANVISA, 1–81. http://portal.anvisa.gov.br/documents/33852/271855/Plano+Nacional+para+a+Prevenção+e+o+Controle+da+Resistência+Microbiana+nos+Serviços+de+Saúde/9d9f63f3-592b-4fe1-8ff2-e035fcc0f31d
Asai, N., Sakanashi, D., Suematsu, H., Kato, H., Hagihara, M., Nishiyama, N., Koizumi, Y., Yamagishi, Y., & Mikamo, H. (2018). The epidemiology and risk factor of carbapenem-resistant enterobacteriaceae colonization and infections: Case control study in a single institute in Japan. Journal of Infection and Chemotherapy, 24(7), 505–509. https://doi.org/10.1016/j.jiac.2018.02.005
BRASIL. (1998). Ministério da Saúde. Portaria nº 2616 de 12 de maio de 1998. Dispõe sobre diretrizes e normas para a prevenção e o controle das infecções hospitalares. Diário Oficial da União. Brasília, 1998.
Candevir Ulu, A., Kurtaran, B., Inal, A. S., Kömür, S., Kibar, F., Çiçekdemir, H. Y., Bozkurt, S., Gürel, D., Kılıç, F., Yaman, A., Aksu, H. S. Z., & Taşova, Y. (2015). Risk factors of carbapenem-resistant Klebsiella pneumoniae infection: A serious threat in ICUs. Medical Science Monitor, 21, 219–224. https://doi.org/10.12659/MSM.892516
Centers for Diasease Control and Prevention. CDC. (2015). Facility Guidance for Control of Carbapenem-resistant Enterobacteriaceae (CRE). National Center for Emerging and Zoonotic Infectious Diseases, November, 24. https://www.osha.gov/SLTC/ebola/control_prevention.html
Critérios Diagnósticos de Infecção Relacionada à Assistência à Saúde 2. (n.d.).
Codjoe, F. S., & Donkor, E. S. (2017). Carbapenem Resistance: A Review. Medical sciences (Basel, Switzerland), 6(1), 1. https://doi.org/10.3390/medsci6010001
De Figueiredo, D. Q., Castro, L. F. S., Santos, K. R. N., Teixeira, L. M., & De Mondlno, S. S. B. (2009). Detecção de metalo-beta-lactamases em amostras hospitalares de Pseudomonas aeruginosa e Acínetobacter baumonnii. Jornal Brasileiro de Patologia e Medicina Laboratorial, 45(3), 177–184. https://doi.org/10.1590/s1676-24442009000300002
Dias, V. C., Resende, J. A., Bastos, A. N., De Andrade Bastos, L. Q., De Andrade Bastos, V. Q., Bastos, R. V., Diniz, C. G., & Da Silva, V. L. (2017). Epidemiological, Physiological, and Molecular Characteristics of a Brazilian Collection of Carbapenem-Resistant Acinetobacter baumannii and Pseudomonas aeruginosa. Microbial Drug Resistance, 23(7), 852–863. https://doi.org/10.1089/mdr.2016.0219
Doi, Y., & Paterson, D. L. (2015). Carbapenemase-producing Enterobacteriaceae. Seminars in respiratory and critical care medicine, 36(1), 74–84. https://doi.org/10.1055/s-0035-1544208
Elshamy, A. A., & Aboshanab, K. M. (2020). A review on bacterial resistance to carbapenems: Epidemiology, detection and treatment options. Future Science OA, 6(3). https://doi.org/10.2144/fsoa-2019-0098
Fang, L., Lu, X., Xu, H., Ma, X., Chen, Y., Liu, Y., Hong, G., & Liang, X. (2019). Epidemiology and risk factors for carbapenem-resistant Enterobacteriaceae colonisation and infections: Case-controlled study from an academic medical center in a southern area of China. Pathogens and Disease, 77(4), 1–8. https://doi.org/10.1093/femspd/ftz034
Gomes, S. M. (2013). Nota técnica no 01/2013. 1–22.
Jabalameli, F., Taki, E., Emaneini, M., & Beigverdi, R. (2018). Prevalence of metallo-β-lactamase-encoding genes among carbapenem-resistant Pseudomonas aeruginosa strains isolated from burn patients in Iran. Revista Da Sociedade Brasileira de Medicina Tropical, 51(3), 270–276. https://doi.org/10.1590/0037-8682-0044-2018
Jacoby, G. A. (2009). AmpC Β-Lactamases. Clinical Microbiology Reviews, 22(1), 161–182. https://doi.org/10.1128/CMR.00036-08
Jiao, Y., Qin, Y., Liu, J., Li, Q., Dong, Y., Shang, Y., Huang, Y., & Liu, R. (2015). Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization and predictors of mortality: A retrospective study. Pathogens and Global Health, 109(2), 68–74. https://doi.org/10.1179/2047773215Y.0000000004
Kindu, M., Derseh, L., Gelaw, B., & Moges, F. (2020). Carbapenemase-Producing Non-Glucose-Fermenting Gram-Negative Bacilli in Africa, Pseudomonas aeruginosa and Acinetobacter baumannii: A Systematic Review and Meta-Analysis. International Journal of Microbiology, 2020. https://doi.org/10.1155/2020/9461901
Kofteridis, D. P., Valachis, A., Dimopoulou, D., Maraki, S., Christidou, A., Mantadakis, E., & Samonis, G. (2014). Risk factors for carbapenem-resistant Klebsiella pneumoniae infection/colonization: A case-case-control study. Journal of Infection and Chemotherapy, 20(5), 293–297. https://doi.org/10.1016/j.jiac.2013.11.007
Kritsotakis, E. I., Tsioutis, C., Roumbelaki, M., Christidou, A., & Gikas, A. (2011). Antibiotic use and the risk of carbapenem-resistant extended-spectrum-β-lactamase-producing Klebsiella pneumoniae infection in hospitalized patients: Results of a double case-control study. Journal of Antimicrobial Chemotherapy, 66(6), 1383–1391. https://doi.org/10.1093/jac/dkr116
Labaste, F., Grossac, J., Bounes, F. V., Conil, J. M., Ruiz, S., Seguin, T., Grare, M., Fourcade, O., Minville, V., & Georges, B. (2019). Risk factors for acquisition of carbapenem-resistance during treatment with carbapenem in the intensive care unit: a prospective study. European Journal of Clinical Microbiology and Infectious Diseases, 38(11), 2077–2085. https://doi.org/10.1007/s10096-019-03644-6
Lima, E. M., Cid, P. A., Beck, D. S., Pinheiro, L. H. Z., Tonhá, J. P. S., Alves, M. Z. O., Lourenço, N. D., Santos, R. Q., Asensi, M. D., Marques, J. A., Bandeira, C. S., Rodrigues, C. A. S., Gomes Junior, S. C. S., Gomes, M. Z. R., Magalhães, G. R. A. A., Silva, P. P., Reis Di Chiara, S. M. S. A. S., Machado, A. A. S., Tozo, T. M., … Assef, A. P. D. C. (2020). Predictive factors for sepsis by carbapenem resistant Gram-negative bacilli in adult critical patients in Rio de Janeiro: A case-case-control design in a prospective cohort study. Antimicrobial Resistance and Infection Control, 9(1), 1–13. https://doi.org/10.1186/s13756-020-00791-w
Ling, M. L., Tee, Y. M., Tan, S. G., Amin, I. M., How, K. B., Tan, K. Y., & Lee, L. C. (2015). Risk factors for acquisition of carbapenem resistant Enterobacteriaceae in an acute tertiary care hospital in Singapore. Antimicrobial Resistance and Infection Control, 4(1), 3–9. https://doi.org/10.1186/s13756-015-0066-3
Liu, P., Li, X., Luo, M., Xu, X., Su, K., Chen, S., Qing, Y., Li, Y., & Qiu, J. (2018). Risk Factors for Carbapenem-Resistant Klebsiella pneumoniae Infection: A Meta-Analysis. Microbial Drug Resistance, 24(2), 190–198. https://doi.org/10.1089/mdr.2017.0061
Loon van, K., Voor in ‘t holt, A. F., & Vos, M. C. (2018). A Systematic Review and Meta-analyses of the Clinical. Antimicrobial Agents and Chemotherapy, 62(e01730-17), 1–18.
Magiorakos, A. P., Burns, K., Rodríguez Baño, J., Borg, M., Daikos, G., Dumpis, U., Lucet, J. C., Moro, M. L., Tacconelli, E., Simonsen, G. S., Szilágyi, E., Voss, A., & Weber, J. T. (2017). Infection prevention and control measures and tools for the prevention of entry of carbapenem-resistant Enterobacteriaceae into healthcare settings: Guidance from the European Centre for Disease Prevention and Control. Antimicrobial Resistance and Infection Control, 6(1), 1–17. https://doi.org/10.1186/s13756-017-0259-z
Marston, H. D., Dixon, D. M., Knisely, J. M., Palmore, T. N., & Fauci, A. S. (2016). Antimicrobial Resistance. JAMA, 316(11), 1193–1204. https://doi.org/10.1001/jama.2016.11764
Mehrad, B., Clark, N. M., Zhanel, G. G., & Lynch, J. P. (2015). Antimicrobial resistance in hospital-acquired gram-negative bacterial infections. Chest, 147(5), 1413–1421. https://doi.org/10.1378/chest.14-2171
Miller, B. M., & Johnson, S. W. (2016). Demographic and infection characteristics of patients with carbapenem-resistant Enterobacteriaceae in a community hospital: Development of a bedside clinical score for risk assessment. American Journal of Infection Control, 44(2), 134–137. https://doi.org/10.1016/j.ajic.2015.09.006
Miller, S., & Humphries, R. M. (2016). Clinical laboratory detection of carbapenem-resistant and carbapenemase-producing Enterobacteriaceae. Expert Review of Anti-Infective Therapy, 14(8), 705–717. https://doi.org/10.1080/14787210.2016.1206815
Miranda, I. F., Dos Santos, M. L., Oliveira, C. W. S., & Oliveira, M. C. (2018). Klebsiella pneumoniae producer of carbapenemase of the kpc type: worldwide dissemination and current aspect in Brazil. Brazilian Journal of Surgery and Clinical Research, 25(2), 113–119. http://www.mastereditora.com.br/bjscr
Miriagou, V., Cornaglia, G., Edelstein, M., Galani, I., Giske, C. G., Gniadkowski, M., Malamou-Lada, E., Martinez-Martinez, L., Navarro, F., Nordmann, P., Peixe, L., Pournaras, S., Rossolini, G. M., Tsakris, A., Vatopoulos, A., & Cantón, R. (2010). Acquired carbapenemases in Gram-negative bacterial pathogens: Detection and surveillance issues. Clinical Microbiology and Infection, 16(2), 112–122. https://doi.org/10.1111/j.1469-0691.2009.03116.x
Morrill, H. J., Pogue, J. M., Kaye, K. S., & LaPlante, K. L. (2015). Treatment Options for Carbapenem-Resistant Enterobacteriaceae Infections. Open forum infectious diseases, 2(2), ofv050. https://doi.org/10.1093/ofid/ofv050
Nordmann, P., & Mammeri, H. (2007). Extended-spectrum cephalosporinases: Structure, detection and epidemiology. Future Microbiology, 2(3), 297–307. https://doi.org/10.2217/17460913.2.3.297
Nordmann, P., Naas, T., & Poirel, L. (2011). Global spread of carbapenemase producing Enterobacteriaceae. Emerging Infectious Diseases, 17(10), 1791–1798. https://doi.org/10.3201/eid1710.110655
Nour, I., Eldegla, H. E., Nasef, N., Shouman, B., Abdel-Hady, H., & Shabaan, A. E. (2017). Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit. Journal of Hospital Infection, 97(1), 52–58. https://doi.org/10.1016/j.jhin.2017.05.025
Palacios-Baena, Z. R., Giannella, M., Manissero, D., Rodríguez-Baño, J., Viale, P., Lopes, S., Wilson, K., McCool, R., & Longshaw, C. (2021). Risk factors for carbapenem-resistant Gram-negative bacterial infections: a systematic review. Clinical Microbiology and Infection, 27(2), 228–235. https://doi.org/10.1016/j.cmi.2020.10.016
Poirel, L., & Nordmann, P. (2006). Carbapenem resistance in Acinetobacter baumannii: Mechanisms and epidemiology. Clinical Microbiology and Infection, 12(9), 826–836. https://doi.org/10.1111/j.1469-0691.2006.01456.x
Potter, R. F., D'Souza, A. W., & Dantas, G. (2016). The rapid spread of carbapenem-resistant Enterobacteriaceae. Drug resistance updates : reviews and commentaries in antimicrobial and anticancer chemotherapy, 29, 30–46. https://doi.org/10.1016/j.drup.2016.09.002
Raman, G., Avendano, E. E., Chan, J., Merchant, S., & Puzniak, L. (2018). Risk factors for hospitalized patients with resistant or multidrug-resistant Pseudomonas aeruginosa infections: A systematic review and meta-analysis. Antimicrobial Resistance and Infection Control, 7(1), 1–14. https://doi.org/10.1186/s13756-018-0370-9
Saeed, N. K., Alkhawaja, S., Azam, N. F. A. E. M., Alaradi, K., & Al-Biltagi, M. (2019). Epidemiology of carbapenem-resistant Enterobacteriaceae in a Tertiary Care Center in the Kingdom of Bahrain. Journal of Laboratory Physicians, 11(02), 111–117. https://doi.org/10.4103/jlp.jlp_101_18
Schwartz-Neiderman, A., Braun, T., Fallach, N., Schwartz, D., Carmeli, Y., & Schechner, V. (2016). Risk factors for Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae (CP-CRE) acquisition among contacts of newly diagnosed CP-CRE patients. Infection Control and Hospital Epidemiology, 37(10), 1219–1225. https://doi.org/10.1017/ice.2016.153
Segagni Lusignani, L., Presterl, E., Zatorska, B., Van Den Nest, M., & Diab-Elschahawi, M. (2020). Infection control and risk factors for acquisition of carbapenemase-producing enterobacteriaceae. A 5 year (2011-2016) case-control study. Antimicrobial Resistance and Infection Control, 9(1), 1–10. https://doi.org/10.1186/s13756-019-0668-2
Tacconelli, E., Cataldo, M. A., Dancer, S. J., De Angelis, G., Falcone, M., Frank, U., Kahlmeter, G., Pan, A., Petrosillo, N., Rodríguez-Baño, J., Singh, N., Venditti, M., Yokoe, D. S., & Cookson, B. (2014). ESCMID guidelines for the management of the infection control measures to reduce transmission of multidrug-resistant Gram-negative bacteria in hospitalized patients. In Clinical Microbiology and Infection (Vol. 20, Issue S1). https://doi.org/10.1111/1469-0691.12427
Tamma, P. D., Goodman, K. E., Harris, A. D., Tekle, T., Roberts, A., Taiwo, A., & Simner, P. J. (2017). Comparing the outcomes of patients with carbapenemase-producing and non-carbapenemase- producing carbapenem-resistant enterobacteriaceae bacteremia. Clinical Infectious Diseases, 64(3), 257–264. https://doi.org/10.1093/cid/ciw741
Teresa, M., & Almeida, G. De. (n.d.). Carbapenemases: um problema em evolução.
Torres-Gonzalez, P., Cervera-Hernandez, M. E., Niembro-Ortega, M. D., Leal-Vega, F., Cruz-Hervert, L. P., García-García, L., Galindo-Fraga, A., Martinez-Gamboa, A., Bobadilla-Del Valle, M., Sifuentes-Osornio, J., & Ponce-De-Leon, A. (2015). Factors associated to prevalence and incidence of carbapenem-resistant enterobacteriaceae fecal carriage: A cohort study in a Mexican tertiary care hospital. PLoS ONE, 10(10), 1–13. https://doi.org/10.1371/journal.pone.0139883
Wang, Q., Zhang, Y., Yao, X., Xian, H., Liu, Y., Li, H., Chen, H., Wang, X., Wang, R., Zhao, C., Cao, B., & Wang, H. (2016). Risk factors and clinical outcomes for carbapenem-resistant Enterobacteriaceae nosocomial infections. European Journal of Clinical Microbiology and Infectious Diseases, 35(10), 1679–1689. https://doi.org/10.1007/s10096-016-2710-0
WHO. (2012). GLOBAL report on AM resistance. Who, 33, 3–8.
Wilson, G. M., Suda, K. J., Fitzpatrick, M. A., Bartle, B., Pfeiffer, C. D., Jones, M., Rubin, M. A., Perencevich, E., Evans, M., & Evans, C. T. (2021). Risk Factors Associated With Carbapenemase-Producing Carbapenem-Resistant Enterobacteriaceae Positive Cultures in a Cohort of US Veterans. Clinical Infectious Diseases, 73(8), 1370–1378. https://doi.org/10.1093/cid/ciab415
Yin, R.K. (2015). O estudo de caso. Porto Alegre: Bookman.
Yong, D., Toleman, M. A., Giske, C. G., Cho, H. S., Sundman, K., Lee, K., & Walsh, T. R. (2009). Characterization of a new metallo-β-lactamase gene, bla NDM-1, and a novel erythromycin esterase gene carried on a unique genetic structure in Klebsiella pneumoniae sequence type 14 from India. Antimicrobial Agents and Chemotherapy, 53(12), 5046–5054. https://doi.org/10.1128/AAC.00774-09
Zarkotou, O., Pournaras, S., Tselioti, P., Dragoumanos, V., Pitiriga, V., Ranellou, K., Prekates, A., Themeli-Digalaki, K., & Tsakris, A. (2011). Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clinical Microbiology and Infection, 17(12), 1798–1803. https://doi.org/10.1111/j.1469-0691.2011.03514.x
Zhao, S., Kennedy, S., Perry, M. R., Wilson, J., Chase-Topping, M., Anderson, E., Woolhouse, M. E. J., & Lockhart, M. (2021). Epidemiology of and risk factors for mortality due to carbapenemase-producing organisms (CPO) in healthcare facilities. Journal of Hospital Infection, 110, 184–193. https://doi.org/10.1016/j.jhin.2021.01.028
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