RESUMEN

The reservoirs for NDM-producing Enterobacterales are increasing, not only in hospitals, but also in the environment and in the community, challenging the therapeutic efficacy of carbapenems. We aimed to characterize an isolate of Escherichia coli harboring the blaNDM-1 gene recovered from the bloodstream of a penguin (Spheniscus magellanicus) in Southern Brazil. A total of 74 bacterial isolates recovered from arterial blood samples from dead birds were submitted to species identification and antibiotic susceptibility evaluation. One isolate presented resistance to carbapenems (E. coli 89PenNDM) and proved to harbor the blaNDM-1 gene by multiplex high-resolution melting real-time PCR (PCR-HRM). Conjugation experiments indicated that the blaNDM-1 was transmissible to E. coli J53. Whole genome sequencing (WGS) confirmed the presence of the blaNDM-1 gene in a conjugative plasmid (IncA/C2 plasmid) in both the E. coli 89PenNDM and its transconjugants. The isolate was classified as ST 156 and many other resistance genes (e.g., sul1, sul,2, strA, floR, tet(A)) were identified, all carried in the same IncA/C2 plasmid. This is the first report of blaNDM-1-producing E. coli isolated from a penguin in the Brazilian seacoast. The presence of a carbapenemase gene in wildlife animals is of concern as they may become reservoirs of multidrug-resistant bacteria and disseminate them to the environment.

Asunto(s)

Infecciones por Escherichia coli , Spheniscidae , Animales , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Brasil , Farmacorresistencia Bacteriana Múltiple/genética , Escherichia coli , Infecciones por Escherichia coli/microbiología , Pruebas de Sensibilidad Microbiana , Plásmidos/genética , beta-Lactamasas/genética

RESUMEN

Resistance to carbapenems due to metallo-beta-lactamase NDM-1 was first described in Brazil in 2013. To date, only a few scattered reports of the prevalence of NDM-1 in the country have been reported, and most of them indicated a very low prevalence of this metalloenzyme. In the present study, we report a steady increase in the frequency of NDM among Enterobacterales resistant to carbapenems in a tertiary care hospital in southern Brazil. Carbapenemase genes were evaluated by multiplex real-time polymerase chain using high-resolution melting analysis among 3501 isolates of 8 different species of Enterobacterales recovered from January 2015 to May 2020. The blaKPC-like was identified in 3003 isolates (85.8%) and the blaNDM-like was the second most common gene (351 isolates-10%). There was a steady increase in frequency of blaNDM-like, from 4.2% in 2015 to 24% in 2020. The increase of blaNDM frequency raises an important matter as novel therapeutic options are currently very limited for the treatment of patients infected by bacteria carrying the blaNDM.

Asunto(s)

Proteínas Bacterianas/genética , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/clasificación , Enterobacteriaceae/genética , Centros de Atención Terciaria/estadística & datos numéricos , beta-Lactamasas/genética , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Proteínas Bacterianas/biosíntesis , Brasil , Carbapenémicos/farmacología , Carbapenémicos/uso terapéutico , Farmacorresistencia Bacteriana Múltiple , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Tipificación Molecular , beta-Lactamasas/biosíntesis

RESUMEN

Determination of polymyxins susceptibility by clinical laboratories is a nightmare, mainly because of physicochemical properties of the drug. Elution tests have already been proposed for colistin, but not for polymyxin B. We aimed to evaluate accuracy of Polymyxin B broth disk elution (PBDE) to determine the susceptibility to this drug. We evaluated 196 Enterobacterales (45.9% polymyxin B-resistant). PBDE was done in 15-mL cation-adjusted Mueller-Hinton broth where one polymyxin B disk (300 U) was eluted (2 µg/mL). BMD was performed as reference method. Categorical Agreement (CA), Major Error (ME) and Very Major Error (VME) were 99.5%, 0% and 1.11% (one false-negative K. pneumoniae MIC 4 µg/mL), respectively. As some institutions preferably use polymyxin B over colistin and in some countries colistin are not commercially available, to specifically evaluate polymyxin B is important. PBDE proved to be a cheap and easy to perform methodology to evaluate susceptibility to polymyxin B among Enterobacterales.

Asunto(s)

Pruebas Antimicrobianas de Difusión por Disco , Enterobacteriaceae/efectos de los fármacos , Polimixina B/farmacología , Antibacterianos/farmacología , Antibacterianos/uso terapéutico , Pruebas Antimicrobianas de Difusión por Disco/métodos , Farmacorresistencia Bacteriana , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Polimixina B/uso terapéutico

RESUMEN

Carbapenem-resistant Enterobacterales (CREs) have been recognized as an important threat to global health. CRE cause the majority of the difficult-to-treat infections in health-care settings and are associated with high mortality. Klebsiella pneumoniae carbapenemase (KPC)-producing CREs, in particular Klebsiella pneumoniae, are globally disseminated and responsible for a large number of outbreaks. Development of rapid methods for KPC detection can provide great clinical and epidemiological benefits to prevent KPC dissemination. The aim of this study was to standardize and validate a LC-MS/MS method to detect KPC. This method was also tested against a broad variety of species, including CRE with other carbapenemase genes and the recently reported mcr-1. For validation, 111 isolates with reduced susceptibility to carbapenems were selected (49 KPC-positive and 62 KPC-negative). The presence of four tryptic peptides related to the KPC enzyme was evaluated, and the identification of at least two of them classified the isolate as "KPC-positive." The LTLGSALAAPQR and LALEGLGVNGQ peptides were both detected in 47 of 49 isolates with the blaKPC gene. The other two peptides, GFLAAAVLAR and APIVLAVYTR, were detected in 46 and 19 isolates with the blaKPC gene, respectively. The method correctly classified 47 of 49 KPC-positive and all KPC-negative isolates yielding 96.07% of sensitivity and 100% of specificity. In conclusion, our results demonstrate that the KPC peptide markers were robustly detected by the method which presented high sensitivity and full specificity and therefore can be used as a reliable method to identify this resistance mechanism.

Asunto(s)

Proteínas Bacterianas/metabolismo , Técnicas Bacteriológicas/métodos , Enterobacteriaceae Resistentes a los Carbapenémicos/enzimología , Klebsiella pneumoniae/enzimología , beta-Lactamasas/metabolismo , Proteínas Bacterianas/química , Proteínas Bacterianas/genética , Enterobacteriaceae Resistentes a los Carbapenémicos/genética , Enterobacteriaceae Resistentes a los Carbapenémicos/aislamiento & purificación , Cromatografía Liquida , Infecciones por Enterobacteriaceae/microbiología , Humanos , Klebsiella pneumoniae/genética , Klebsiella pneumoniae/aislamiento & purificación , Espectrometría de Masas en Tándem , beta-Lactamasas/química , beta-Lactamasas/genética

RESUMEN

We report 26 human isolates of mcr-1-positive Escherichia coli, most of them (65.4%) with a polymyxin B MIC of 2 mg/L. Seventeen out of the 24 mcr-1-positive E. coli proved to be nonclonal by rep-PCR which strengthens the hypothesis of environmental or animal origin of these strains and reinforces the one health context of antimicrobial resistance.

Asunto(s)

Farmacorresistencia Bacteriana/genética , Infecciones por Escherichia coli/microbiología , Proteínas de Escherichia coli/genética , Escherichia coli/efectos de los fármacos , Polimixinas/farmacología , Antibacterianos/farmacología , Estudios de Cohortes , Escherichia coli/genética , Humanos , Pruebas de Sensibilidad Microbiana

RESUMEN

In Enterobacteriaceae, the blaOXA-48-like genes have been identified on plasmids in different regions of the world. The OXA-370 is a plasmid-encoded OXA-48-like enzyme reported in two distinct regions of Brazil. Recently, we demonstrate that the blaOXA-370 gene is disseminated among several Enterobacteriaceae species and clones, indicating a high potential for dissemination. In this work, we described for the first time the complete nucleotide sequence of six plasmids harboring the blaOXA-370 gene. Complete DNA sequencing using the Illumina platform and annotation of the plasmids showed that they belonged to incompatibility groups IncX and had in average 70 kbp. The blaOXA-370 gene is located in a composite transposon containing four genes encoding transposases, named Tn6435. In this study, highly similar plasmids were detected in different Enterobacteriaceae genera.

Asunto(s)

Elementos Transponibles de ADN , Plásmidos/genética , beta-Lactamasas/genética , Antibacterianos/farmacología , Biología Computacional/métodos , Conjugación Genética , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/enzimología , Enterobacteriaceae/genética , Infecciones por Enterobacteriaceae/microbiología , Humanos , Pruebas de Sensibilidad Microbiana , Transformación Bacteriana

RESUMEN

BACKGROUND: Between November 2013 and June 2014, 56 cases of bacteremia (15 deaths) associated with the use of Total Parenteral Nutrition (TPN) and/or calcium gluconate (CG) were reported in four Brazilian states. METHODS: We analyzed 73 bacterial isolates from four states: 45 from blood, 25 from TPN and three from CG, originally identified as Acinetobacter baumannii, Rhizobium radiobacter, Pantoea sp. or Enterobacteriaceae using molecular methods. RESULTS: The first two bacterial species were confirmed while the third group of species could not be identified using standard identification protocols. These isolates were subsequently identified by Multi-Locus Sequence Analysis as Phytobacter diazotrophicus, a species related to strains from similar outbreaks in the United States in the 1970's. Within each species, TPN and blood isolates proved to be clonal, whereas the R. radiobacter isolates retrieved from CG were found to be unrelated. CONCLUSION: This is the first report of a three-species outbreak caused by TPN contaminated with A. baumannii, R. radiobacter and P. diazotrophicus. The concomitant presence of clonal A. baumannii and P. diazotrophicus isolates in several TPN and blood samples, as well as the case of one patient, where all three different species were isolated simultaneously, suggest that the outbreak may be ascribed to a discrete contamination of TPN. In addition, this study highlights the clinical relevance of P. diazotrophicus, which has been involved in outbreaks in the past, but was often misidentified as P. agglomerans.

Asunto(s)

Infecciones por Acinetobacter/etiología , Acinetobacter baumannii/aislamiento & purificación , Agrobacterium tumefaciens/aislamiento & purificación , Infecciones por Enterobacteriaceae/etiología , Infecciones por Bacterias Gramnegativas/etiología , Pantoea/aislamiento & purificación , Nutrición Parenteral Total/efectos adversos , Infecciones por Acinetobacter/epidemiología , Adolescente , Adulto , Anciano , Bacteriemia/etiología , Bacteriemia/microbiología , Brasil/epidemiología , Niño , Preescolar , Brotes de Enfermedades , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Infecciones por Bacterias Gramnegativas/epidemiología , Infecciones por Bacterias Gramnegativas/microbiología , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Tipificación Molecular , Adulto Joven

RESUMEN

OBJECTIVES: This study assessed susceptibility to polymyxin B (PMB) and alternative antimicrobials, with focus on aminoglycosides and tigecycline, according to different breakpoints in KPC-producing Klebsiella pneumoniae (KPC-Kp) bloodstream isolates from Brazilian hospitals. METHODS: Bloodstream K. pneumoniae isolates non-susceptible to any of the three carbapenems (meropenem, imipenem or ertapenem) from four Brazilian tertiary-care hospitals were selected. Antimicrobial susceptibility was determined and interpreted according to distinct breakpoints. Twenty-nine PMB-resistant KPC-Kp isolates were selected for molecular typing. RESULTS: A total of 158 KPC-Kp were analysed. MIC50/90 values for PMB were 0.25/16mg/L; 40 isolates (25.3%) were resistant to PMB. MIC50/90 values for meropenem were 32/≥256mg/L; no isolates were susceptible to meropenem according to CLSI, but 10 isolates were intermediate using EUCAST breakpoints (1, MIC=4mg/L; 9, MIC=8mg/L). MIC50/90 values for tigecycline were 2/8mg/L; 53 (33.5%) and 94 (59.5%) isolates were susceptible according to EUCAST and FDA breakpoints, respectively. MIC50/90 values were 32/≥64mg/L for amikacin and ≥16/≥16mg/L for gentamicin; 48 (30.4%), 28 (17.7%) and 16 (10.1%) were susceptible to amikacin according to CLSI, EUCAST and USCAST, respectively, but susceptibility rates to gentamicin were <7.0%. Eighteen distinct clonal profiles were identified among 29 PMB-resistant isolates by DNA macrorestriction. Most clones belonged to CC11. CONCLUSION: Elevated rates of PMB-resistant KPC-Kp bloodstream infections were found in four Brazilian hospitals, mostly of polyclonal origin. Alternative antimicrobials with the highest in vitro activity were tigecycline and amikacin, although susceptibility rates significantly decreased using criteria with stricter breakpoints (e.g. EUCAST, USCAST).

Asunto(s)

Farmacorresistencia Bacteriana , Infecciones por Klebsiella/sangre , Klebsiella pneumoniae/enzimología , beta-Lactamasas/biosíntesis , Antibacterianos/farmacología , Brasil , Humanos , Klebsiella pneumoniae/efectos de los fármacos , Klebsiella pneumoniae/aislamiento & purificación , Pruebas de Sensibilidad Microbiana , Polimixinas/farmacología

Asunto(s)

Proteínas Bacterianas/genética , Enterobacteriaceae/genética , Enterobacteriaceae/aislamiento & purificación , beta-Lactamasas/genética , Antibacterianos/farmacología , Enterobacteriaceae/enzimología , Infecciones por Enterobacteriaceae/tratamiento farmacológico , Humanos , Pruebas de Sensibilidad Microbiana

Asunto(s)

Enterobacteriaceae Resistentes a los Carbapenémicos/genética , beta-Lactamasas/genética , Brasil , Bases de Datos de Ácidos Nucleicos , Enterobacteriaceae , Infecciones por Enterobacteriaceae , Humanos , Klebsiella pneumoniae , Plásmidos , Reacción en Cadena de la Polimerasa

Asunto(s)

Infecciones por Acinetobacter/tratamiento farmacológico , Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/aislamiento & purificación , Proteínas Bacterianas/genética , beta-Lactamasas/genética , Acinetobacter baumannii/efectos de los fármacos , Acinetobacter baumannii/genética , Antibacterianos/uso terapéutico , Brasil , Farmacorresistencia Bacteriana Múltiple/genética , Humanos , Pruebas de Sensibilidad Microbiana

RESUMEN

BACKGROUND: The genus Acinetobacter sp. comprises more than 50 species, and four are closely related and difficult to be distinguished by either phenotypic or genotypic methods: the Acinetobacter calcoaceticus-baumannii complex (ABC). The correct identification at species level is necessary mainly due to the epidemiological aspects. METHODS: We evaluated a multiplex PCR for gyrB gene to identify the species of the ABC using the sequencing of the ITS 16S-23S fragment as a gold standard. Isolates identified as Acinetobacter calcoaceticus-baumannii from three hospitals at southern Brazil in 2011 were included in this study. RESULTS: A total of 117 isolates were obtained and 106 (90.6%) were confirmed as A. baumannii, 6 (5.1%) as A. nosocomialis and 4 (3.4%) as A. pittii by PCR for gyrB gene. Only one isolate did not present a product of the PCR for the gyrB gene; this isolate was identified as Acinetobacter genospecie 10 by sequencing of ITS. We also noted that the non-A. baumannii isolates were recovered from respiratory tract (8/72.7%), blood (2/18.2%) and urine (1/9.1%), suggesting that these species can cause serious infection. CONCLUSION: These findings evidenced that the multiplex PCR of the gyrB is a feasible and simple method to identify isolates of the ABC at the species level.

Asunto(s)

Infecciones por Acinetobacter , Acinetobacter baumannii/genética , Girasa de ADN/genética , ADN Bacteriano/análisis , Reacción en Cadena de la Polimerasa Multiplex/métodos , Infecciones por Acinetobacter/diagnóstico , Infecciones por Acinetobacter/microbiología , Acinetobacter baumannii/clasificación , ADN Bacteriano/química , ADN Bacteriano/genética , Humanos

RESUMEN

Over the last decade, Acinetobacter baumannii resistant to carbapenems has emerged in many medical centres and has been commonly associated with high morbimortality. In Brazil, this resistance is mainly attributed to the spread of OXA-23-producing clones and, to a lesser extent, to OXA-143-producing clones. Here, we describe, for the first time, two OXA-72-producing A. baumannii isolates in southern Brazil to a broad spectrum of antibiotics, except polymyxin B and tigecycline. Molecular typing by multilocus sequence typing (MLST) demonstrated that both OXA-72-producing isolates belong to a new sequence type (ST), ST730, which was recently identified in OXA-23-producing A. baumannii isolates in São Paulo, Brazil. We demonstrate that the two A. baumannii ST730 isolates carrying blaOXA-72share a common ancestral origin with the blaOXA-23producers in Brazil. This observation reinforces the importance of strain-typing methods in order to clarify the dynamics of the emergence of new clones in a geographic region.

Asunto(s)

Acinetobacter baumannii/genética , Genes Bacterianos/genética , beta-Lactamasas/genética , Acinetobacter baumannii/enzimología , Anciano , Proteínas Bacterianas/genética , Brasil , Farmacorresistencia Bacteriana/genética , Humanos , Masculino , Tipificación de Secuencias Multilocus

RESUMEN

Over the last decade, Acinetobacter baumannii resistant to carbapenems has emerged in many medical centres and has been commonly associated with high morbimortality. In Brazil, this resistance is mainly attributed to the spread of OXA-23-producing clones and, to a lesser extent, to OXA-143-producing clones. Here, we describe, for the first time, two OXA-72-producing A. baumannii isolates in southern Brazil to a broad spectrum of antibiotics, except polymyxin B and tigecycline. Molecular typing by multilocus sequence typing (MLST) demonstrated that both OXA-72-producing isolates belong to a new sequence type (ST), ST730, which was recently identified in OXA-23-producing A. baumannii isolates in São Paulo, Brazil. We demonstrate that the two A. baumannii ST730 isolates carrying blaOXA-72share a common ancestral origin with the blaOXA-23producers in Brazil. This observation reinforces the importance of strain-typing methods in order to clarify the dynamics of the emergence of new clones in a geographic region.

Asunto(s)

Humanos , Masculino , Anciano , Acinetobacter baumannii/genética , beta-Lactamasas/genética , Genes Bacterianos/genética , Acinetobacter baumannii/enzimología , Proteínas Bacterianas/genética , Brasil , Farmacorresistencia Bacteriana/genética , Tipificación de Secuencias Multilocus

Asunto(s)

Escherichia coli/genética , Polimixinas , Animales , Brasil , Infecciones por Escherichia coli , Humanos , Aves de Corral

RESUMEN

We evaluated the epidemiology of Acinetobacter spp. recovered from patients diagnosed with bloodstream infections in 9 tertiary hospitals located in all Brazilian geographic regions between April and August 2014. Although OXA-23-producing Acinetobacter baumannii clones were disseminated in most hospitals, it was observed for the first time the spread of OXA-72 among clonally related A. baumannii isolated from distinct hospitals. Interestingly, Acinetobacter pittii was the most frequent species found in a Northern region hospital. Contrasting with the multisusceptible profile displayed by A. pittii isolates, the tetracyclines and polymyxins were the only antimicrobials active against all A. baumannii isolates.

Asunto(s)

Infecciones por Acinetobacter/epidemiología , Infecciones por Acinetobacter/microbiología , Acinetobacter/enzimología , Bacteriemia/epidemiología , Bacteriemia/microbiología , Proteínas Bacterianas/metabolismo , beta-Lactamasas/metabolismo , Acinetobacter/clasificación , Acinetobacter/genética , Acinetobacter/aislamiento & purificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Brasil/epidemiología , Niño , Preescolar , Análisis por Conglomerados , Farmacorresistencia Bacteriana Múltiple , Femenino , Genotipo , Humanos , Lactante , Recién Nacido , Masculino , Pruebas de Sensibilidad Microbiana , Persona de Mediana Edad , Tipificación Molecular , Reacción en Cadena de la Polimerasa , Centros de Atención Terciaria , Adulto Joven , beta-Lactamasas/genética

RESUMEN

Outbreaks associated with rapidly growing mycobacteria (RGM) have been increasingly reported worldwide, including in Brazil. Among the RGM, the Mycobacterium abscessus complex is the most pathogenic and related to multidrug resistance. The aim of this study was to evaluate the antimicrobial susceptibility and molecular profile of RGM isolates involved in new postsurgical infection outbreaks in Brazil since 2007. Of the 109 cases reported in the state of Rio Grande do Sul between 2007 and 2011, 43 (39 %) had confirmed mycobacterial growth in culture. Clinical isolates were obtained from biopsy specimens or abscess aspirates. PRA-hsp65 restriction pattern identified the isolates as M. abscessus type 2, and partial rpoB sequencing confirmed the identification as M. abscessus subsp. bolletii. All isolates were susceptible to amikacin and resistant to ciprofloxacin, doxycycline, sulfamethoxazole, moxifloxacin and tobramycin. Most isolates (72 %) were fully susceptible to cefoxitin but six isolates (14 %) were fully resistant to clarithromycin. The latter differed from the susceptibility profiles of the previously described BRA100 clone from other Brazilian regions. Nevertheless, pulsed-field gel electrophoresis analysis revealed that these isolates belonged to a single BRA100 clone. In conclusion, our study reports the persistence of an emergent single and highly resistant clone of M. abscessus subsp. bolletii for several years even after national implementation of infection control measures.

Asunto(s)

Brotes de Enfermedades , Tipificación Molecular , Infecciones por Mycobacterium no Tuberculosas/epidemiología , Mycobacterium/clasificación , Mycobacterium/genética , Infección de la Herida Quirúrgica/epidemiología , Antibacterianos/farmacología , Proteínas Bacterianas/genética , Brasil/epidemiología , Chaperonina 60/genética , ARN Polimerasas Dirigidas por ADN/genética , Electroforesis en Gel de Campo Pulsado , Genotipo , Humanos , Pruebas de Sensibilidad Microbiana , Epidemiología Molecular , Mycobacterium/efectos de los fármacos , Mycobacterium/aislamiento & purificación , Infecciones por Mycobacterium no Tuberculosas/microbiología , Polimorfismo de Longitud del Fragmento de Restricción , Análisis de Secuencia de ADN , Infección de la Herida Quirúrgica/microbiología

RESUMEN

OBJECTIVES: To evaluate the emergence of New Delhi metallo-ß-lactamase 1 (NDM-1)-producing Enterobacteriaceae isolates in Brazil. METHODS: From April to October 2013, following the detection of the first NDM-1-producing isolate, a surveillance study was performed for the detection of blaNDM-1 among Enterobacteriaceae isolates with reduced susceptibility to carbapenems in 17 hospitals of Porto Alegre, Brazil. Real-time PCR was used to determine the presence of carbapenemase genes, which were further sequenced. Clonal relatedness was assessed by pulsed-field gel electrophoresis (PFGE). RESULTS: A total of 1134 isolates were evaluated. blaNDM-1 was detected in 11 (0.97%) isolates: nine Enterobacter cloacae complex (eight belonging to a single clone recovered from two distinct hospitals and the other strain from a third hospital) and two Morganella morganii (belonging to a single clone recovered from one hospital). Most isolates presented high-level resistance to carbapenems. CONCLUSIONS: NDM-1-producing Enterobacteriaceae have emerged rapidly in the hospitals of the Brazilian city where they were first detected. The emergence of NDM-1 in Brazil is of great concern, since it is a severe threat to antimicrobial therapy against Enterobacteriaceae in this country.

Asunto(s)

Enfermedades Transmisibles Emergentes , Infecciones por Enterobacteriaceae/epidemiología , Infecciones por Enterobacteriaceae/microbiología , Enterobacteriaceae/genética , beta-Lactamasas/genética , Antibacterianos/farmacología , Brasil/epidemiología , Infección Hospitalaria , Enterobacteriaceae/efectos de los fármacos , Enterobacteriaceae/aislamiento & purificación , Humanos , Pruebas de Sensibilidad Microbiana , beta-Lactamasas/biosíntesis

Asunto(s)

Carbapenémicos/farmacología , Resistencia a Múltiples Medicamentos , Infecciones por Enterobacteriaceae/enzimología , Providencia/efectos de los fármacos , Providencia/enzimología , beta-Lactamasas/efectos de los fármacos , Antibacterianos/farmacología , Susceptibilidad a Enfermedades , Ertapenem , Humanos , Meropenem , Tienamicinas/farmacología , beta-Lactamasas/biosíntesis , beta-Lactamas/farmacología

Asunto(s)

Adulto , Humanos , Masculino , Antibacterianos/farmacología , Resistencia betalactámica , Carbapenémicos/farmacología , Klebsiella pneumoniae/enzimología , beta-Lactamasas/biosíntesis , Brasil , Infecciones por Klebsiella/microbiología , Klebsiella pneumoniae/efectos de los fármacos , Pruebas de Sensibilidad Microbiana , Fenotipo