1189. A Comprehensive Characterization of the Emerging Carbapenem-Resistant Klebsiella pneumoniae Clinical Isolates From a Public Hospital in Lima, Peru

Abstract

BackgroundIn contrast with other countries in Latin America, Peru had been notoriously spared by the global dissemination of carbapenem-resistant Klebsiella pneumoniae (CR-Kp), until recently. Even though, isolated cases of KPC-producing K. pneumoniae had been reported since 2013, it was not until 2016 that the first outbreak of NDM- producing K. pneumoniae was described in Peru. By 2017, rapid emergence of CR-Kp took place in Hospital Cayetano Heredia (HCH), a tertiary care hospital in Lima. Here, we provide a description of clinical, microbiological and molecular characteristics of CR-Kp isolates recovered at HCH.MethodsRetrospective review of all CR-Kp clinical isolates recovered at HCH until December 2017. Antibiotic susceptibility data were obtained during routine care (Vitek or disc diffusion) and was assessed using CLSI breakpoints. DNA extraction was performed by heat shock, and PCR was performed to assess carriage of blaNDM gene. String test was performed to detect hypermucoviscosity.ResultsThe first case of CR-Kp in HCH dated from July 2015. Since then, a total of 69 CR-Kp clinical isolates, from 60 patients have been recovered until December 2017. A significant increase in the number of cases was observed during 2017 (Figure 1). The average age of patients was 55. Urinary, and respiratory sources of infection or colonization were the most common ones (35% and 30%, respectively), followed by blood stream (17%) and intraabdominal (10%) infections. Isolate recovery and DNA extraction was achieved in 40 cases. Of these, 15 (38%) had a positive PCR for blaNDM carbapenemase gene (Figure 2). Antibiotic susceptibility testing revealed that amikacin was the most effective antimicrobial with the rest of antimicrobials having extremely high rates of resistance (Figure 3). String test was positive in two of these isolates, suggesting that hypervirulent CR-KP might be emerging in this region.ConclusionAn epidemic of CR-Kp has established in our hospital, representing the first one reported in Peru. The different mechanisms of carbapenem resistance found suggest a polyclonal expansion. Amikacin remains the only active antimicrobial within the routinely tested antibiotics, highlighting the need to add other antimicrobials to the routine panel. Disclosures All authors: No reported disclosures.

Panorama de las carbapenemasas en Perú

“… a Fueron 8 los casos reportados, 3 se repitieron del estudio anterior Gonzales-Escalante E. et al ( 11 ) b Fueron 83 los casos reportados, 9 se incluyeron del estudio Resurrección-Degado C. et al ( 13 ), 11 del estudio Krapp F. et al ( 19 ) y 1 de Velázquez J.et al ( 9 ). …”

“… b Fueron 83 los casos reportados, 9 se incluyeron del estudio Resurrección-Degado C. et al ( 13 ), 11 del estudio Krapp F. et al ( 19 ) y 1 de Velázquez J.et al ( 9 ). …”

“…Las carbapenemasas reportadas en el presente estudio corresponden a las tres clases de la clasificación de Ambler, lo que indica que en el Perú circulan todas las clases de carbapenemasas. El incremento de reportes sugiere que se ha extendido incluyeron 14 trabajos que caracterizaron 313 carbapenemasas mediante estudios moleculares (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22).…”

Antibiotic Consumption and Its Relationship with Bacterial Resistance Profiles in ESKAPE Pathogens in a Peruvian Hospital

“…In contrast, the carbapenem-resistant Klebsiella pneumoniae rate in Peru was 8% compared to 16% in Colombia and 24% in Ecuador the same year. The increasing carbapenem-resistant Klebsiella pneumoniae (CRE) outbreaks in Peru [17,18] were associated with higher mortality rates than the infections caused by non-carbapenem-resistant strains, thus necessitating the establishment of multidisciplinary and multilevel strategies to control this threat [19].…”

Caracterización molecular de carbapenemasas en el Perú durante el 2019

“…En relación con la clase A de carbapenemasas, el tipo blaKPC identificado en este estudio es el tercer más frecuente reportado (12,4%) y presente en 23 cepas de Enterobacteriaceae (22 en K. pneumoniae y 1 en E. coli) en cuatro regiones del país (Arequipa, Lima, Lambayeque y Callao). Este gen fue reportado por primera vez en el 2005 en Colombia (8) y fue el primer blaKPC reportado en el Perú (Lima) (14)(15)(16) . Su presencia aumentada y distribuida en IPRESS de regiones altamente pobladas es un hallazgo importante, ya que su presencia en la sangre está asociada a elevadas tasas de letalidad en pacientes hospitalizados y que reciben tratamiento antibiótico efectivo (17) .…”