ArticleRevista do Instituto de Medicina Tropical de Sao Paulo2019
Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil.
Article in Revista do Instituto de Medicina Tropical de Sao Paulo, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 20 papers, 3 of them syntheses that pooled it.
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Who cites it
20 citing papers in PubMed, 3 syntheses or guidelines pooled it, 48 citations in OpenAlex.
- Colistin monotherapy or combination for the treatment of bloodstream infection caused by Klebsiella pneumoniae: a systematic review and meta-analysis.BMC infectious diseases · 2024Pooled it
- Global prevalence of mutation in theFrontiers in microbiology · 2024Pooled it
- A meta-analysis for the role of aminoglycosides and tigecyclines in combined regimens against colistin- and carbapenem-resistant Klebsiella pneumoniae bloodstream infections.European journal of clinical microbiology & infectious diseases : official publication of the European Society of Clinical Microbiology · 2022Pooled it
- Colistin Resistance in Critically Ill Adults: A Systematic Review of Epidemiological, Clinical, Laboratory, and Molecular Evidence.Microorganisms · 2026Review
- Genetic Insights into Colistin Resistance in Carbapenem-ResistantInfection & chemotherapy · 2026Article
- A systematic analysis of various clonal lineages of colistin-resistant Klebsiella pneumoniae with mgrB mutations.Molecular biology reports · 2025Review
- High proportions of multidrug-resistant Klebsiella pneumoniae isolates in community-acquired infections, Brazil.Scientific reports · 2025Article
- Genetic diversity, drug resistance, and biofilm formation in Klebsiella pneumoniae associated with nosocomial infection in Pelotas, RS, Brazil.Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] · 2025Article
- Heteroresistance associated with the production of fosfomycin-resistant inner colonies during disk diffusion testing among a geographically diverse collection ofJAC-antimicrobial resistance · 2025Article
- NDM-5-carrying3 Biotech · 2023Article
- Global Prevalence of Colistin Resistance inPathogens (Basel, Switzerland) · 2022Review
- Prevalence of Efflux Pump and Porin-Related Antimicrobial Resistance in ClinicalArchives of Razi Institute · 2022Article
- Multidrug-resistant Klebsiella pneumoniae: a retrospective study in Manaus, Brazil.Archives of microbiology · 2022Article
- Microbiological quality analysis of inoculants based on Bradyrhizobium spp. and Azospirillum brasilense produced "on farm" reveals high contamination with non-target microorganisms.Brazilian journal of microbiology : [publication of the Brazilian Society for Microbiology] · 2022Article
- Global colistin use: a review of the emergence of resistant Enterobacterales and the impact on their genetic basis.FEMS microbiology reviews · 2022Review
- Prolonged Outbreak of Carbapenem and Colistin-ResistantFrontiers in microbiology · 2022Article
- Overview of polymyxin resistance in Enterobacteriaceae.Revista da Sociedade Brasileira de Medicina Tropical · 2022Review
- The Spread of NDM-1 and NDM-7-ProducingAntibiotics (Basel, Switzerland) · 2021Article
- Colistin Resistance Among Multiple Sequence Types ofFrontiers in microbiology · 2021Article
- Hypervirulent Klebsiella pneumoniae as Unexpected Cause of Fatal Outbreak in Captive Marmosets, Brazil.Emerging infectious diseases · 2020Article
Corrections and comments
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Authors and funding
10 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Increased resistance to polymyxin in Klebsiella pneumoniae (ColRKP) has been observed. Molecular epidemiology, as well as the clinical impact of these difficult to treat pathogens need to be better characterized. We present the clinical outcomes of 28 patients infected by ColRKP in a tertiary hospital. Isolates with MIC >2 by Vitek 2 were confirmed by the microdilution broth test. Polymerase chain reaction (PCR) was performed for blaKPC, blaNDM, blaOXA-48 and blamcr-1 genes in the isolates, and Whole Genome Sequencing (WGS) was performed in six isolates. Seventeen (61%) patients were female and the mean age was 50 years old. In-hospital and 30-day mortality were 64% (18/28) and 53% (15/28), respectively. Central line-associated bloodstream infection in addition to bacteremia episodes due to other sources were the most frequent (61%). Mean APACHE and Charlson comorbidity index were 16 and 5, respectively. Twenty patients (71%) received at least one active drug and ten (35%) received two drugs: tigecycline 46% (13/28); amikacin 21% (6/28) and fosfomycin 3% (1 case). Twenty-six out of 28 tested cases were positive for blaKPC. Eight different clusters were identified. Four STs were detected (ST11, ST23, ST340, and ST437). Mutations on pmrA, arnB, udg, and yciM genes were present in all six isolates submitted to WGS; lpxMand mgrB mutations were also detected in all but one isolate. In conclusion, we observed resistance to polymyxin in severely ill patients mostly from intensive care units and/or immunosuppressed patients with high mortality rates in whom a diversity of ColRKP clusters was identified and might indicate selective pressure.
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