Antimicrobial resistance in Enterobacteriaceae in Brazil: focus on β-lactams and polymyxins

Braz J Microbiol. 2016 Dec;47 Suppl 1(Suppl 1):31-37. doi: 10.1016/j.bjm.2016.10.002. Epub 2016 Oct 25.

Abstract

During the last 30 years there has been a dissemination of plasmid-mediated β-lactamases in Enterobacteriaceae in Brazil. Extended spectrum β-lactamases (ESBL) are widely disseminated in the hospital setting and are detected in a lower frequency in the community setting. Cefotaximases are the most frequently detected ESBL type and Klebsiella pneumoniae is the predominant species among ESBL producers. Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae became widely disseminated in Brazil during the last decade and KPC production is currently the most frequent resistance mechanism (96.2%) in carbapenem resistant K. pneumoniae. To date KPC-2 is the only variant reported in Brazil. Polymyxin B resistance in KPC-2-producing K. pneumoniae has come to an alarming rate of 27.1% in 2015 in São Paulo, the largest city in Brazil. New Delhi metallo-β-lactamase was detected in Brazil in 2013, has been reported in different Brazilian states but are not widely disseminated. Antimicrobial resistance in Enterobacteriaceae in Brazil is a very serious problem that needs urgent actions which includes both more strict adherence to infection control measures and more judicious use of antimicrobials.

Keywords: Antimicrobial resistance; Brazil; Carbapenemases; Colistin; ESBL; Enterobacteriaceae; Extended spectrum β-lactamases; KPC; Klebsiella pneumoniae carbapenemase; NDM; New Delhi metallo-β-lactamase; Polymyxin B.

Publication types

  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Anti-Infective Agents / pharmacology*
  • Anti-Infective Agents / therapeutic use
  • Bacterial Proteins / genetics
  • Bacterial Proteins / metabolism
  • Brazil / epidemiology
  • Drug Resistance, Bacterial*
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae / enzymology
  • Enterobacteriaceae / genetics
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / microbiology*
  • Humans
  • Plasmids / genetics
  • Polymyxins / pharmacology
  • Polymyxins / therapeutic use
  • beta-Lactamases / genetics
  • beta-Lactamases / metabolism
  • beta-Lactams / pharmacology
  • beta-Lactams / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Anti-Infective Agents
  • Bacterial Proteins
  • Polymyxins
  • beta-Lactams
  • AmpC beta-lactamases
  • beta-Lactamases
  • carbapenemase