High plasmid variability, and the presence of IncFIB, IncQ, IncA/C, IncHI1B, and IncL/M in clinical isolates of Klebsiella pneumoniae with bla KPC and bla NDM from patients at a public hospital in Brazil.

Abstract

Introduction: Antibiotic resistance in carbapenemase-producing Klebsiella pneumoniae is acquired and disseminated mainly by plasmids. Therefore, we aimed to investigate the occurrence of carbapenemase genes, analyze the genetic diversity by ERIC-PCR, and examine the most common plasmid incompatibility groups (Incs) in clinical isolates of K. pneumoniae from colonization and infection in patients from a hospital in Brazil. Methods: Twenty-seven isolates of carbapenem-resistant K. pneumoniae were selected and screened for the presence of carbapenemase genes and Incs by PCR, followed by amplicon sequencing. Results: The bla KPC and bla NDM genes were detected in 24 (88.8 %) and 16 (59.2 %) of the isolates, respectively. Thirteen isolates (48.1 %) were positive for both genes. The IncFIB (92.6 %) and IncQ (88.8 %) were the most frequent plasmids, followed by IncA/C, IncHI1B, and IncL/M, indicating that plasmid variability existed in these isolates. To our knowledge, this is the first report of IncHI1B in Brazil. We found eight isolates with clonal relationship distributed in different sectors of the hospital. Conclusions: The accumulation of resistance determinants, the variability of plasmid Incs, and the clonal dissemination detected in K. pneumoniae isolates demonstrate their potential for infection, colonization, and the dissemination of different resistance genes and plasmids.

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 .…”

“…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 . A recent study in a hospital in Brazil reported 27 isolates of CP-resistant K. pneumoniae (CR-Kp); 24 (88.8%) produced KPC; 16 (59.2%) produced NDM; 13 (48.1%) expressed both genes 65 . In Venezuela, 19 isolates of CRKP co-expressing KPC-2 and VIM-2 were reported in a pediatric hospital in 2014 69 .…”

“…Efficacy endpoints included clinical cure, day-28 all-cause mortality, microbiologic cure, and overall success (clinical cure + microbiologic eradication). Clinical cure rates were65.6% (21/32) with MEV vs 33.3% (5/15) with BAT [p = 0.03)] at end of treatment and 59.4% (19/32) and 26.7% (4/15) [p = 0.02] at test of cure. All-cause mortality at 28 days was 15.6% (5/32) with MEV vs 33.3% (5/15) with BAT, respectively.…”

Whole Genome Sequencing of Pediatric Klebsiella pneumoniae Strains Reveals Important Insights Into Their Virulence-Associated Traits

“…IncFIB plasmid was present in 36 of 37 of the bacterial isolates. This conjugative plasmid has been associated with the dissemination of the bla NDM–1 , bla SHV–12 , bla CTXM–15 , and bla OXA–1 genes in K. pneumoniae ( Oliveira et al, 2020 ). Methods of circularization and annotation of the plasmid DNA using sequencing techniques that generate long-read sequences will offer insights into the content of those plasmids and its evolution and spread ( Ramsamy et al, 2020 ).…”

Detection of a New Resistance-Mediating Plasmid Chimera in a blaOXA-48-Positive Klebsiella pneumoniae Strain at a German University Hospital

“…Thereby, the bla OXA-48 gene has been reported to be specifically encoded on the IncL sequence [ 10 , 20 ]. Although IncL/M plasmids are predominantly prevalent in the Mediterranean region and Western Europe [ 21 ], their global spread has been confirmed by identifications even in tropical Brazil [ 22 ]. Moreover, IncN-plasmids have also been described to be widely distributed in K. pneumoniae [ 16 , 23 , 24 ] and to harbor resistance genes, such as bla CTX-M-1 [ 25 ], bla KPC [ 26 ] and bla IMP-6 [ 27 ], respectively.…”