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dc.rights.licenseAtribución-NoComercial 4.0 Internacional
dc.contributor.advisorCortes Luna, Jorge Alberto
dc.contributor.advisorLeal Castro, Aura Lucía
dc.contributor.advisorEscobar Pérez, Javier Antonio
dc.contributor.authorVergara Vela, Erika Paola
dc.date.accessioned2020-07-21T14:33:49Z
dc.date.available2020-07-21T14:33:49Z
dc.date.issued2020-07-01
dc.identifier.urihttps://repositorio.unal.edu.co/handle/unal/77808
dc.description.abstractIntroducción: K. pneumoniae resistente a carbapenémicos está implicada en procesos infecciosos principalmente en pacientes inmunosuprimidos y en eventos por atención en salud. La producción de enzimas que hidrolizan estos antibióticos es el principal mecanismo de resistencia, siendo KPC la de mayor distribución mundial y el clon CC 258 el más frecuentemente reportado. Recientemente se han informado otros clones; no se conocen comportamientos clínicos diferenciales por tipo de clado y tampoco el comportamiento en eventos procedentes de un mismo individuo. Métodos: Estudio tipo serie de casos. En 3 años se tomaron aislamientos con K. pneumoniae resistentes a carbapenémicos con el gen bla KPC (Kp-KPC) en pacientes adultos de una institución de tercer nivel de Bogotá; se incluyeron todos los eventos de un mismo paciente. Se analizaron características clínicas de los individuos y moleculares en los aislamientos con identificación de tipo de KPC y otras Betalactamasas por reacción en cadena de la polimerasa (PCR ) , relación clonal por electroforesis de campo pulsado (PFGE ) y tipo de ST . Se realizó secuenciación genómica en 4 de los clones más frecuentes identificados en el período de estudio. Resultados: Se analizaron 143 eventos (aislamientos por Kp-KPC) de 69 pacientes quienes tenían alta comorbilidad. KPC 2 se encontró con más frecuencia; se documentó co- expresión con otras betalactamasas como CTX-M (27%) y TEM ( 37%), no se detectó OXA-48, VIM ni NDM. Se identificaron 46 pulsotipos, los más frecuentes el 4 ( correspondiente con ST 258), 19 (ST 485) y 37 ( ST111) en el 22%, 6% y 5,5% respectivamente. El pulsotipo 4 se presentó con mayor frecuencia en personas mayores y se asocio a mayor resistencia a ciprofloxacina, amikacina y gentamicina. Se documentó multiclonalidad y cambios genómicos generados tanto a nivel cromosomal bacteriano como mediados por elementos genéticos móviles en eventos procedentes de un mismo paciente Conclusiones: Existe circulación de múltiples clones de Kp-KPC en una misma institución y en eventos procedentes de un paciente; el ST 258 continua siendo el más reportado y se asocia a resistencia a otros grupos antibióticos. Palabras claves: Klebsiella pneumoniae, carbapenemasa, KPC, Resistencia antibiótica
dc.description.abstractIntroduction: K. pneumoniae resistant to carbapenems, is implicated in infectious processes primarily in immunosuppressed patients and in events for health care. The enzyme production that hydrolyzes these antibiotics is the main resistance mechanism, KPC being the one with the largest world distribution and clone CC 258 the one reported most frequently. Recently, other clones have been reported; there is no knowledge of differential clinical behaviors by clade type or the behavior of preceding events of a same individual. Methodology: Case series study. In 3 years there were preventive isolations with K. pneumoniae resistant to carbapenems with the bla KPC (Kp-KPC) gen in adult patients in a third level institution in Bogota; all events of a same patient were included. The clinical characteristics of the individuals were analyzed as well as the molecular characteristics in the isolation with identification of KPC type and other Betalactamases on chain reaction (PCR), clonal relation for electrophoresis of pulsed field (PFGE), and ST type. A genome sequence was performed in 4 of the most frequent cones identified in the research period. Results: 143 events (isolations for Kp-KPC) out of 69 patients who had high comorbidity. KPC 2 was encountered with a higher frequency; co-expression was documented with other betalactamases like CTX-M (27%) and TEM ( 37%), OXA-48, VIM and NDM were not detected. 46 pulse types were identified, the most frequent ones were el 4 ( correspondent to ST 258), 19 (ST 485) y 37 ( ST111) in the 22%, 6% and 5,5% respectively. The 4th pulse type was presented with a higher frequency in third age people and was associated to higher resistance to ciprofloxacin, amikacin, and gentamicin. The multiclonality was documented and genome changes both at a bacterial chromosomal and at the ones mediated by mobile genetic elements in preceding events in the same patient. Conclusions: there is circulation of multiple clones of Kp-KPC in a same institution and in preceding events in patients; the ST 258 continues to be the one reported the most and it is associated to resistance to other antibiotic groups. Keywords: Klebsiella pneumonia, KPC, antibiotic resistance
dc.format.extent79
dc.format.mimetypeapplication/pdf
dc.language.isospa
dc.rightsDerechos reservados - Universidad Nacional de Colombia
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/
dc.subject.ddc610 - Medicina y salud
dc.titleComportamiento clínico - microbiológico y dinámicas moleculares en infecciones por clones de Klebsiella pneumoniae resistentes a carbapenémicos portadores del gen blaKPC en el período post-endémico en pacientes atendidos en una institución de salud de cuarto nivel en Bogotá, período 2014-2016
dc.typeOtro
dc.rights.spaAcceso abierto
dc.description.projectDeterminación del impacto del efecto post-endémico de los clones de Klebsiella pneumoniae resistentes a carbapenémicos en la presentación clínica de una institución de salud de tercer nivel en Bogotá.
dc.description.additionalEsta tesis hace parte del proyecto: Determinación del impacto del efecto post-endémico de los clones de Klebsiella pneumoniae resistentes a carbapenémicos en la presentación clínica de una institución de salud de tercer nivel en Bogotá. Colciencias código 130877758007
dc.type.driverinfo:eu-repo/semantics/other
dc.type.versioninfo:eu-repo/semantics/acceptedVersion
dc.publisher.programBogotá - Medicina - Especialidad en Infectología
dc.description.degreelevelEspecialidades Médicas
dc.publisher.branchUniversidad Nacional de Colombia - Sede Bogotá
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dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.subject.proposalKlebsiella pneumoniae
dc.subject.proposalKlebsiella pneumoniae
dc.subject.proposalCarbapenemasa
dc.subject.proposalKPC
dc.subject.proposalKPC
dc.subject.proposalAntibiotic resistance
dc.subject.proposalResistencia antibiótica
dc.type.coarhttp://purl.org/coar/resource_type/c_1843
dc.type.coarversionhttp://purl.org/coar/version/c_ab4af688f83e57aa
dc.type.contentText
oaire.accessrightshttp://purl.org/coar/access_right/c_abf2


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Atribución-NoComercial 4.0 InternacionalThis work is licensed under a Creative Commons Reconocimiento-NoComercial 4.0.This document has been deposited by the author (s) under the following certificate of deposit