title: [Carbapenem resistance in Klebsiella pneumoniae clinical isolates from urinary tract infections].
abstract: Resistance to carbapenems by KPC (Klebsiella pneumoniae carbapenemase) production in Klebsiella pneumoniae clinical isolates was first described ten years ago in the U.S.A. and recently reported in other countries. This enzyme inactivates all beta-lactam antibiotics and is associated with fluoroquinolone and aminoglycoside resistance.
  
  
  METHODS
  We investigated the carbapenem resistance in 498 Escherichia coli and Klebsiella pneumoniae strains isolated from urinary tract infections during 2009 in the lasi "Dr. C. I. Parhon" Clinical Hospital. Antimicrobial susceptibility testing was performed according to CLSI guidelines. To detect ESBL (extended spectrum beta-lactamase) and KPC production we used phenotypic tests and molecular biology methods (PCR).
  
  
  RESULTS
  From all tested strains, only two K. pneumoniae strains showed modified susceptibility to carbapenems. The modified Hodge test was positive for the strain resistant to ertapenem, meropenem, imipenem (KA) and negative for the strain resistant only to ertapenem (K(B)). Both KA and K(B) isolates were negative for blaKPC and blaTEM genes, but harbored blaSHV and bla(CTX-M) genes, respectively.
  
  
  CONCLUSIONS
  We report the first carbapenem resistant K. pneumoniae strains from Northeast Romania. The resistance is not mediated by KPC-carbapenemase; the possibility of dual mechanisms through cefalosporinases production and porins loss is suggested.
authors.affiliation: Universitatea de Medicină şi Farmacie Gr. T. Popa Iaşi, Facultatea de Medicină, Disciplina de Microbiologie.
authors.forename: Ana Irina
authors.initials: AI
authors.lastname: Mereuţă
authors.forename: Ecaterina Mariana
authors.initials: EM
authors.lastname: Enache
authors.forename: Adina
authors.initials: A
authors.lastname: Dumitraşcu
authors.forename: Teodora
authors.initials: T
authors.lastname: Vremeră
authors.forename: Gabriela
authors.initials: G
authors.lastname: Coman
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015780:Carbapenems / Q000494:pharmacology* / Q000627:therapeutic use; D000077727:Ertapenem; D004926:Escherichia coli / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007711:Klebsiella pneumoniae / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D000077731:Meropenem; D008826:Microbial Sensitivity Tests; D010641:Phenotype; D016133:Polymerase Chain Reaction; D018272:Porins / Q000235:genetics; D013845:Thienamycins / Q000494:pharmacology; D014552:Urinary Tract Infections / Q000188:drug therapy* / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis*; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D018272:Porins; D013845:Thienamycins; D047090:beta-Lactams; D015378:Imipenem; D001618:beta-Lactamases; C063912:carbapenemase; D000077731:Meropenem; D000077727:Ertapenem