{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,6]],"date-time":"2026-10-06T17:24:05Z","timestamp":1791307445427,"version":"4.3.1"},"reference-count":38,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2011,8,1]],"date-time":"2011-08-01T00:00:00Z","timestamp":1312156800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Microbial Drug Resistance"],"published-print":{"date-parts":[[2011,8]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>\n                      Infections with carbapenem-resistant enterobacteria are an emerging threat. This study reports the microbiologic, clinical, and epidemiologic features and the therapeutic outcomes of the infections caused by carbapenem- and pandrug-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      emerged in our hospital. Fingerprinting analyses by automated repetitive extragenic palindromic-polymerase chain reaction (rep-PCR) and matrix-assisted laser desorption\/ionization-time of flight (MALDI-TOF) mass spectrometry are also compared.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods:<\/jats:title>\n                    <jats:p>\n                      Carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      spp. affecting 13 patients were investigated using automated rep-PCR (DiversiLab System) and MALDI-TOF. Species identification was performed by Vitek 2 System and MALDI-TOF. Antimicrobial susceptibility testing was made using Vitek 2 System and Etest. Screening for extended spectrum beta-lactamase (ESBL) and carbapenemase production was made by double disk synergy and Hodge tests, respectively. Synergy studies were performed using Etest. DNA array was used for detection of KPC and ESBLs.\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>VIM-1<\/jats:sub>\n                      gene was amplified by PCR and sequencing. Use of carbapenems in the hospital was studied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 13 patients were found to be colonized\/infected with carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      . All patients were previously submitted to surgery and\/or presented with severe underlying disease. After carbapenem-resistant\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      isolation, the majority of the patients were treated with amikacin plus carbapenem, tigecycline, or fosfomycin. All\n                      <jats:italic toggle=\"yes\">Klebsiella<\/jats:italic>\n                      isolates (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      \u2009=\u200914), except two, had the\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>VIM-1<\/jats:sub>\n                      gene and all\n                      <jats:italic toggle=\"yes\">Klebsiella pneumoniae<\/jats:italic>\n                      also had\n                      <jats:italic toggle=\"yes\">bla<\/jats:italic>\n                      <jats:sub>SHV<\/jats:sub>\n                      gene associated with ESBL production. DiversiLab system showed higher discriminatory power than MALDI-TOF for strain typing.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The risk of a rapid dissemination and the persistence of these multidrug-resistant strains through the time determine the need to implement routine procedures for metallo-beta-lactamase detection and measures for prevention of the spread of these microorganisms. The combined use of MALDI-TOF for species identification and DiversiLab System for clonal strain typing may be a useful tool for fast and accurate management of nosocomial outbreaks. The potential clinical utility of fosfomycin in this matter should be considered in future studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1089\/mdr.2010.0182","type":"journal-article","created":{"date-parts":[[2011,5,13]],"date-time":"2011-05-13T20:35:28Z","timestamp":1305318928000},"page":"433-442","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":18,"title":["Molecular and Epidemiological Analysis of Nosocomial Carbapenem-Resistant\n                    <i>Klebsiella<\/i>\n                    spp. Using Repetitive Extragenic Palindromic-Polymerase Chain Reaction and Matrix-Assisted Laser Desorption\/Ionization-Time of Flight"],"prefix":"10.1177","volume":"17","author":[{"given":"Mercedes","family":"Trevi\u00f1o","sequence":"first","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Navarro","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gema","family":"Barbeito","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Garc\u00eda-Riestra","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos","family":"Crespo","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benito J.","family":"Regueiro","sequence":"additional","affiliation":[{"name":"Complejo Hospitalario Universitario de Santiago de Compostela","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2011,8]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1086\/527513","article-title":"Molecular and descriptive epidemiology of multidrug-resistant Enterobacteriaceae in hospitalized infants","volume":"29","author":"Anderson B.","year":"2008","unstructured":"Anderson B., , Nicholas S., , Sprague B., , Campos J., , Short M.D., , Singh N. 2008. 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