Showing papers by "Maria Virginia Villegas published in 2013"
University of Miami1, Jackson Memorial Hospital2, University of Paris-Sud3, Case Western Reserve University4, United States Department of Veterans Affairs5, Israel Ministry of Health6, National and Kapodistrian University of Athens7, National University of Ireland, Galway8, University of Verona9, University of Barcelona10, Rush University Medical Center11, University of Madras12, Public Health England13, University of East Anglia14, Centers for Disease Control and Prevention15, Royal Brisbane and Women's Hospital16, University of Calgary17, Peking University18, AstraZeneca19
TL;DR: The epidemiology of Klebsiella pneumoniae carbapenemases across continents is summarized, issues around detection, present antibiotic options and those in development, treatment outcome and mortality, and infection control are discussed.
Abstract: Klebsiella pneumoniae carbapenemases (KPCs) were originally identified in the USA in 1996. Since then, these versatile β-lactamases have spread internationally among Gram-negative bacteria, especially K pneumoniae, although their precise epidemiology is diverse across countries and regions. The mortality described among patients infected with organisms positive for KPC is high, perhaps as a result of the limited antibiotic options remaining (often colistin, tigecycline, or aminoglycosides). Triple drug combinations using colistin, tigecycline, and imipenem have recently been associated with improved survival among patients with bacteraemia. In this Review, we summarise the epidemiology of KPCs across continents, and discuss issues around detection, present antibiotic options and those in development, treatment outcome and mortality, and infection control. In view of the limitations of present treatments and the paucity of new drugs in the pipeline, infection control must be our primary defence for now.
1,314 citations
TL;DR: The emergence of the blaKPC-2 gene on unrelated plasmids, differing in size and in incompatibility group, and harbouring different genetic structures containing the blarneyPCP-2 genes in P. aeruginosa isolates suggests that this resistance trait may follow a dissemination scheme similar to that seen in Enterobacteriaceae.
Abstract: Methods: The two plasmids, pCOL-1 and pPA-2, were transferred to Escherichia coli recipient strain TOP10 and completely sequenced using high-throughput pyrosequencing for pCOL-1 and classical Sanger sequencing for pPA-2. Results: Both plasmids could be transferred to E. coli by transformation and displayed no other resistance marker besides KPC. Plasmid pCOL-1 was 31 529 bp in size, contained 31 open reading frames (ORFs) and belonged to the IncP-6 replicon group. It exhibited genes involved in replication, mobilization and partitioning, but none involved in conjugation. Plasmid pPA-2 was 7995 bp in size and contained seven ORFs. It exhibited a replicase gene of IncU, but was lacking genes involved in mobilization, partitioning and conjugation. Only 2072 bp matched Tn4401, including the blaKPC-2 gene, part of ISKpn6 and a 73 bp segment located upstream of the blaKPC-2 gene, containing the P1 promoter. Sequence identity was interrupted by a Tn3 transposon, itself interrupted by an IS26 element inserted within the b-lactamase blaTEM-1 gene. Conclusions: Here we present the genetic features of the very first plasmids carrying the blaKPC-2 gene from P. aeruginosa. The emergence of the blaKPC-2 gene on unrelated plasmids, differing in size and in incompatibility group, and harbouring different genetic structures containing the blaKPC-2 genes in P. aeruginosa isolates suggests that this resistance trait may follow a dissemination scheme in P. aeruginosa similar to that seen in Enterobacteriaceae.
55 citations
TL;DR: La articulacion of the biologia molecular with los sistemas de vigilancia permitio integrar el analisis del fenotipo con los mecanismos de resistencia involucrados en las bacterias estudiadas permitira the elaboracion of guias para el uso adecuado of antimicrobianos y contribuira a the contencion of estas bacterias multirresistentes en Colombia.
Abstract: Introduccion. La evolucion de la resistencia bacteriana constituye una amenaza para la salud publica mundial. Los sistemas de vigilancia epidemiologica han integrado tecnicas de biologia molecular para mejorar las estrategias de control. Objetivo. Describir los perfiles moleculares y fenotipicos de los bacilos Gram negativos en unidades de cuidados intensivos de 23 hospitales de Colombia entre 2009 y 2012. Materiales y metodos. Se diseno un estudio descriptivo en 23 hospitales del Grupo para el Estudio de la Resistencia Nosocomial (sic.) en Colombia. Se analizaron 38.048 aislamientos usando WHONET durante el periodo descrito. Se describieron perfiles de resistencia para Escherichia coli , Klebsiella pneumoniae , Pseudomonas aeruginosa y Acinetobacter baumannii . En 1.248 cepas se realizo reaccion en cadena de la polimerasa (PCR) para detectar las carbapenemasas clinicamente mas relevantes. Resultados. Escherichia coli fue el microorganismo mas frecuente (promedio=14,8 %); la frecuencia de aislamientos de K. pneumoniae aumento de 11 % en 2009 a 15 % en 2012 (p<0,001). La tendencia de los perfiles de multirresistencia aumento en todas las especies estudiadas. De los aislamientos de K. pneumoniae evaluados, 68,4 % fue positivo para KPC ( Klebsiella pneumoniae Carbapenemase), mientras que la VIM (Verona Integron-encoded Metallo-betalactamase) en P. aeruginosa se observo en 46,5 %. Conclusiones. Se observo un incremento en la tendencia de los microorganismos hacia la multirresistencia y una amplia distribucion de las carbapenemasas. La articulacion de la biologia molecular con los sistemas de vigilancia permitio integrar el analisis del fenotipo con los mecanismos de resistencia involucrados en las bacterias estudiadas. Este analisis permitira la elaboracion de guias para el uso adecuado de antimicrobianos y contribuira a la contencion de estas bacterias multirresistentes en Colombia.
47 citations
TL;DR: La infeccion no complicada del tracto urinario bajo and the bacteriuria asintomatica son causas frecuentes de consulta medica ambulatoria y en el servicio de urgencias en Colombia y el mundo.
35 citations
TL;DR: Klebsiella pneumoniae strains coharboring KPC and VIM carbapenemases poses a major threat to antibiotic utility worldwide.
Abstract: Klebsiella pneumoniae strains coharboring KPC and VIM carbapenemases have been reported, to the best of our knowledge, only in Greece ([1][1][–][2][5][3]) and Germany ([6][4]). The coexpression of these two resistance determinants poses a major threat to antibiotic utility worldwide. Herein we
32 citations
TL;DR: The presence of KPC-2 in different enterobacterial species from different cities within Colombia underlines the spread of K PC beyond K. pneumoniae.
23 citations
TL;DR: A high prevalence of bla KPC gene in microorganisms isolated from different hospitals in Colombia revealed the urgent need to strengthen epidemiological surveillance systems, and to timely adjust institutional policies for rational use of antibiotics in order to limit its dissemination to other institutions in the country.
Abstract: Introduccion Las enzimas carbapenemasas de tipo KPC tienen gran capacidad de diseminacion, son causantes de epidemias y se asocian a mayor mortalidad y estancia hospitalaria En Colombia se han venido reportando cada vez mas desde 2007, pero se desconoce la prevalencia hospitalaria Objetivo Estimar la prevalencia hospitalaria del gen blaKPC Materiales y metodos Se evaluo la presencia del gen blaKPC y su ‘clonalidad’ en aislamientos de enterobacterias y Pseudomonas aeruginosa de pacientes hospitalizados Resultados De los 424 aislamientos evaluados durante el periodo de estudio, 273 cumplieron con criterios de elegibilidad, 31,1 % fue positivo para el gen blaKPC y, al ajustar por ‘clonalidad’, la positividad fue de 12,8 % El gen blaKPC se encontro con mayor frecuencia en Klebsiella pneumoniae seguido de P aeruginosa y otras enterobacterias A pesar de que la unidad de cuidados intensivos aporto el mayor numero de aislamientos, no se encontro un patron mas prevalente del gen blaKPC en las ellas que en las otras salas El aparato respiratorio fue el sitio anatomico de origen con la mayor prevalencia No se presento estacionalidad en la frecuencia de los aislamientos portadores del gen blaKPC Conclusion Este estudio revelo la alta prevalencia del gen blaKPC en diferentes microorganismos aislados en varias instituciones hospitalarias del pais La extraordinaria capacidad de propagacion del gen blaKPC , las dificultades del diagnostico y la limitada disponibilidad de antibioticos plantean la apremiante necesidad de fortalecer los sistemas de vigilancia epidemiologica y ajustar oportunamente las politicas institucionales de uso racional de antibioticos con el fin de contener su diseminacion a otras instituciones de salud del pais
16 citations
TL;DR: Nonmetallocarbapenemase class A (NMC-A) was identified in 1990 from a clinical isolate of Enterobacter cloacae, and since its first report in France, this research has focused on its threats to the efficacy of carbapenems.
Abstract: Carbapenemases are a growing concern worldwide since they threaten the efficacy of carbapenems, the most potent β-lactam antibiotics. Nonmetallocarbapenemase class A (NMC-A) was identified in 1990 from a clinical isolate of Enterobacter cloacae, and since its first report in France ([1][1]), this
9 citations
TL;DR: Clinical laboratories are recommended to standardize the criteria for reports on antibiograms in Gram-negative bacilli, including the current CLSI breakpoints and applying phenotypic confirmatory testing to detect ESBLs and Carbapenemases.
5 citations