@article{mbs:/content/journal/jmm/10.1099/jmm.0.000254, author = "da Silva, Kesia Esther and Maciel, Wirlaine Glauce and Sacchi, Flávia Patussi Correia and Carvalhaes, Cecilia Godoy and Rodrigues-Costa, Fernanda and da Silva, Ana Carolina Ramos and Croda, Mariana Garcia and Negrão, Fábio Juliano and Croda, Julio and Gales, Ana Cristina and Simionatto, Simone", title = "Risk factors for KPC-producing Klebsiella pneumoniae: watch out for surgery", journal= "Journal of Medical Microbiology", year = "2016", volume = "65", number = "6", pages = "547-553", doi = "https://doi.org/10.1099/jmm.0.000254", url = "https://www.microbiologyresearch.org/content/journal/jmm/10.1099/jmm.0.000254", publisher = "Microbiology Society", issn = "1473-5644", type = "Journal Article", keywords = "Antibiotic resistance", keywords = "carbapenemase", keywords = "Enterobacteriaceae.", abstract = "This study describes the molecular characteristics and risk factors associated with carbapenem-resistant Klebsiella pneumoniae strains. Risk factors associated with KPC-producing K. pneumoniae strains were investigated in this case-control study from May 2011 to May 2013. Bacterial identification was performed by matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Antimicrobial susceptibility was determined by broth microdilution. Carbapenemase production was assessed by both modified Hodge test (MHT) and ertapenem hydrolysis using MALDI-TOF MS. The presence of β-lactamase-encoding genes was evaluated by PCR and DNA sequencing. Alterations in genes encoding K. pneumoniae outer membrane proteins were analysed by PCR and DNA sequencing as well as SDS-PAGE. Genetic relatedness among strains was determined by pulsed-field gel electrophoresis. This study included 94 patients. Longer hospitalisation, mechanical ventilation, catheters, and previous surgery were associated with KPC-producing K. pneumoniae. Sixty-eight strains showed resistance to carbapenems. Carbapenemase production was detected by MHT in 67 K. pneumoniae strains and by MALDI-TOF MS in 57. The presence of the bla KPC-2 gene was identified in 57 strains. The bla KPC-2 gene was not found in 11 carbapenem-resistant K. pneumoniae; instead, the bla CTX–M-1-like, bla CTX–M-2-like, bla CTX-M-8 like, bla CTX-M-14-like and bla SHV- like genes associated with OmpK35 and OmpK36 alterations were observed. Thirty-three KPC-producing K. pneumoniae strains were clonally related, and patients infected with these strains had a higher mortality rate (78.78 %). Our results show that KPC-producing K. pneumoniae was associated with several healthcare‐related risk factors, including recent surgery.", }