1587. Colistin and carbapenen resistants isolates of Klebsiella pneumoniae emerging in Brazil: report of ten cases
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Poster_IDweek_2013_Guimaraes.pdf (4.2 MB)
  • Background: In Brazil, carbapenemase-producing K. pneumoniae emerged in 2009, has increased significantly and colistin is one of the therapeutic options. However, there have been sporadic reports of colistin-resistant worldwide, no one described in Brazil. We describe epidemiology and risk factors for mortality associated with the colistin and carbapenem resistants K. pneumoniae (CCRKP).

    Methods: Retrospective cohort study was conducted at Instituto Central (HC-FMUSP- 933 beds), during the period from Dec-2010 to Dec-2012. Adults patients were included if they had infections due to CCRKP, using diagnostic criteria by CDC. Death was evaluated within 14 and 28 days after the positive culture. The microbiologic identification and the MIC were assessed by Vitek2®. For colisitin the MIC was confirmed by Etest. Resistance to colistin and tigecycline was defined as MIC >2 mg/L (EUCAST). The presence of blaKPC and blaCTX-M genes was determined by PCR.

    Results: Total of 10 KPCCR infections (6 male; mean age 44, 5 ± 21 years), 7/10 were allocated at ICU. BSI was documented in 5 patients (2 recurrences), VAP in 3 patients and peritonitis in 2 patients. All patients required CVC and had comorbidities. Cutoffs for scores systems were Charlson ≥ 5, APACHE II ≥ 21 and Pitt ≥ 4 points and were present in 2, 5 and 6 patients, respectively.  The mean length of hospital stay was 54 days and before infection acquisition was 20 days.  9/10 received previous antimicrobial therapy. 8 patients received active antibiotic therapy: monotherapy for 4 patients (1 survived) and 4 patients received combined therapy (3 survived). The length of therapy ranged 6-75 days. Mortality rate was 30 and 60% in 14 and 28 days, respectively. The isolates were coresistant to almost all antimicrobials, sparing susceptibility to tigecycline (90%), aminoglycoside (70%) and ciprofloxacin (20%).The genes blaKPC and blaCTX-M were present in 70%. No risk factors for mortality were identified in a univariate analysis.

    Conclusion: KPCCR infections affect severe patients admitted in ICU with prolonged stay and exposed to previous antibiotics. Although combined therapy seems to be best, the mortality was high and the appearance of this superbug is worrisome and requires attention of local and public authorities.

    Lucy Nagm, MD1, Naíma Mortari, MD1, Ícaro Boszczowski, MD, MSc2, Maristela Freire, MD, MSc3, Andre Doi, MD4, Flavia Rossi, MD PhD5 and Thaís Guimarães, MD, PhD1, (1)Sccih, Instituto Central - Hospital Das Clínicas, São Paulo, Brazil, (2)Infection Control, Instituto Central - Hospital Das Clínicas, Sao Paulo, Brazil, (3)Instituto Central - Hospital Das Clínicas, São Paulo, Brazil, (4)Laboratório De Microbiologia, Instituto Central - Hospital Das Clínicas, São Paulo, Brazil, (5)Laboratório De Microbiologia, Hospital Das Clínicas, SAO PAULO, Brazil

    Disclosures:

    L. Nagm, None

    N. Mortari, None

    Boszczowski, None

    M. Freire, None

    A. Doi, None

    F. Rossi, None

    T. Guimarães, None

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