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Carbapenem-resistant  Klebsiella pneumoniae  infection lacks treatment options and is associated with prolonged hospital stays and high mortality rates. The production of carbapenemases is one of the most important factors responsible for this multi-resistance phenomenon.    METHODS:  In the present study, we analyzed the presence of genes encoding carbapenemases in  K. pneumoniae  isolates circulating in one of the public hospitals in the city of Aracaju, Sergipe, Brazil. We also determined the best combination of drugs that display  in vitro  antimicrobial synergy. First, 147 carbapenem-resistant  K. pneumoniae  isolates were validated for the presence of blaKPC,  bla  GES,  bla  NDM,  bla  SPM,  bla  IMP,  bla  VIM, and  bla  OXA-48 genes using multiplex polymerase chain reaction. Thereafter, using two isolates (97 and 102), the role of double and triple combinational drug therapy as a treatment option was analyzed.    RESULTS:  Seventy-four (50.3%) isolates were positive for  bla  NDM, eight (5.4%) for  bla  KPC, and one (1.2%) for both  bla  NDM and  bla  KPC. In the synergy tests, double combinations were better than triple combinations. Polymyxin B and amikacin for isolate 97 and polymyxin B coupled with meropenem for isolate 102 showed the best response.    CONCLUSIONS:  Clinicians in normal practice use multiple drugs to treat infections caused by multi-resistant microorganism; however, in most cases, the benefit of the combinations is unknown.  In vitro  synergistic tests, such as those described herein, are important as they might help select an appropriate multi-drug antibiotic therapy and a correct dosage, ultimately reducing toxicities and the development of antibiotic resistance.

revista da sociedade brasileira de medicina tropical

Prevalence of Klebsiella pneumoniae carbapenemase - and New Delhi metallo-beta-lactamase-positive K. pneumoniae in Sergipe, Brazil, and combination therapy as a potential treatment option