Characteristics of dual carbapenemase-producing Klebsiella pneumoniae strains from an outbreak in Venezuela: a retrospective study

Abstract

Objective. To characterize carbapenemase-producing Klebsiella pneumoniae isolated from patients treated at a hospital in Cumaná, Sucre, Venezuela. Methods. This was a retrospective study conducted at the general hospital in Cumaná where 58 K. pneumoniae strains were analyzed for resistance to antimicrobials, specifically carbapenems, in January – June 2015. Production of metallo-β-lactamases and serine carbapenemases was determined by the double-disc synergy test, using EDTA-sodium mercaptoacetic acid and 3-aminophenyl boronic acid discs, respectively. Multiplex-PCR was used to detect genes coding for carbapenemases. Molecular typing using ERIC-PCR determined the presence of clones. Results. Four strains of K. pneumoniae resistant to carbapenems were identified. Phenotypic methods for detection of metallo-β-lactamases and serine carbapenemases were positive, and PCR demonstrated the co-presence of blaNDM and blaKPC genes in all four strains. ERIC-PCR identified two clones circulating in the hospital. Conclusions. Infection control strategies are needed at the central hospital in Cumaná and its surrounding areas to prevent the spread of these pathogens, especially given the high levels of migration from Venezuela to other countries in South America.

Escalating antimicrobial resistance among Enterobacteriaceae: focus on carbapenemases

“…In Brazil, KPC-2 is the most common CPase, carried on plasmids among K. pneumoniae belonging to different international lineages (e.g., sequence type (ST)258, ST101, and ST15) 64 . Clonal spread in Brazil 65,66 and certain South American countries has been extensive 64,67 . Reyes et al reviewed publications (in English or Spanish) until 2019; data from seven South American countries noted that K. pneumoniae belonging to clonal complex 258 was most common; the most prevalent CPase genes were KPC and NDM 68 .…”

“…In Venezuela, 19 isolates of CRKP co-expressing KPC-2 and VIM-2 were reported in a pediatric hospital in 2014 69 . In 2015, 4 strains of CR-Kp co-expressing KPC and NDM were described in a Venezuelan hospital 67 . In Europe, the first reports of outbreaks of infections due to KPC-2 were reported in Greece from 2007-08 70 .…”

Evaluate the Modified Carbapenem Inactivation Method for Phenotypic Detection of Carbapenemase Production Among Gram-Negative Bacteria

“…Carbapenem are extremely effective β-lactam antibiotics presented into clinicians subsequent the appearance of extended-spectrum β-lactamases (ESBL) producing bacteria (2)(3)(4). In recent years, gram-negative bacteria capable of producing enzymes that confer resistance to wide range β-lactam antibiotics, like carbapenems have observed (5)(6)(7)(8). It can lead appearance multi-drug resistance (MDR) or extensively drug-resistant (XDR) bacteria and it is a serious public health threat worldwide (2,3,(9)(10)(11).…”

“…It can lead appearance multi-drug resistance (MDR) or extensively drug-resistant (XDR) bacteria and it is a serious public health threat worldwide (2,3,(9)(10)(11). The limitation of therapeutic options in infections due to MDR or XDR bacteria have been labeled as an imminent threat to global public health (5). Moreover, longer duration of hospital stays and the consequently increased health-care costs and also, high rate of morbidity and mortality due to carbapenemresistant bacteria are posing serious challenges to the clinical management (12).…”