Multidrug-resistant Klebsiella aerogenes clinical isolates from Brazil carrying IncQ1 plasmids containing the blaKPC-2 gene associated with non-Tn4401 elements (NTEKPC-IId)

Beltrão, Elizabeth Maria Bispo; Oliveira, Érica Maria de; Vasconcelos, Crhisllane Rafaele dos Santos; Cabral, Adriane Borges; Rezende, Antônio Mauro; Lópes, Ana Catarina de Souza

doi:10.1016/j.jgar.2020.05.001

Cited by 10 publications

(13 citation statements)

References 5 publications

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“…Conjugative frequency was calculated as the ratio of transconjugant CFU per donor. Isolates were considered unable to transfer bla KPC-2 into the recipient species if the transfer frequency was 10 −9 or lower ( 46 – 48 ).…”

Section: Methodsmentioning

confidence: 99%

Clinical and Molecular Description of a High-Copy IncQ1 KPC-2 Plasmid Harbored by the International ST15 Klebsiella pneumoniae Clone

Martins

Nicolás

et al. 2020

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This study provides the genomic characterization and clinical description of bloodstream infections (BSI) cases due to ST15 KPC-2 producer Klebsiella pneumoniae. Six KPC-K. pneumoniae isolates were recovered in 2015 in a tertiary Brazilian hospital and were analyzed by whole-genome sequencing (WGS) (Illumina MiSeq short reads). Of these, two isolates were further analyzed by Nanopore MinION sequencing, allowing complete chromosome and plasmid circularization (hybrid assembly), using Unicycler software. The clinical analysis showed that the 30-day overall mortality for these BSI cases was high (83%). The isolates exhibited meropenem resistance (MICs, 32 to 128 mg/liter), with 3/6 isolates resistant to polymyxin B. The conjugative properties of the blaKPC-2 plasmid and its copy number were assessed by standard conjugation experiments and sequence copy number analysis. We identified in all six isolates a small (8.3-kb), high-copy-number (20 copies/cell) non-self-conjugative IncQ plasmid harboring blaKPC-2 in a non-Tn4401 transposon. This plasmid backbone was previously reported to harbor blaKPC-2 only in Brazil, and it could be comobilized at a high frequency (10−4) into Escherichia coli J53 and into several high-risk K. pneumoniae clones (ST258, ST15, and ST101) by a common IncL/M helper plasmid, suggesting the potential of international spread. This study thus identified the international K. pneumoniae ST15 clone as a carrier of blaKPC-2 in a high-copy-number IncQ1 plasmid that is easily transmissible among other common Klebsiella strains. This finding is of concern since IncQ1 plasmids are efficient antimicrobial resistance determinant carriers across Gram-negative species. The spread of such carbapenemase-encoding IncQ1 plasmids should therefore be closely monitored. IMPORTANCE In many parts of the world, carbapenem resistance is a serious public health concern. In Brazil, carbapenem resistance in Enterobacterales is mostly driven by the dissemination of KPC-2-producing K. pneumoniae clones. Despite being endemic in this country, only a few reports providing both clinical and genomic data are available in Brazil, which limit the understanding of the real clinical impact caused by the dissemination of different clones carrying blaKPC-2 in Brazilian hospitals. Although several of these KPC-2-producer K. pneumoniae isolates belong to the clonal complex 258 and carry Tn4401 transposons located on large plasmids, a concomitant emergence and silent dissemination of small high-copy-number blaKPC-2 plasmids are of importance, as described in this study. Our data identify a small high-copy-number IncQ1 KPC plasmid, its clinical relevance, and the potential for conjugative transfer into several K. pneumoniae isolates, belonging to different international lineages, such as ST258, ST101, and ST15.

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Section: Methodsmentioning

confidence: 99%

Clinical and Molecular Description of a High-Copy IncQ1 KPC-2 Plasmid Harbored by the International ST15 Klebsiella pneumoniae Clone

Martins

Nicolás

et al. 2020

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“…Since blaKPC is widely disseminated in our country (Almeida et al, 2012;Pereira et al, 2013Pereira et al, , 2015Dalmolin et al, 2018;Oliveira et al, 2020). In addition, NTEKPC-IId may decrease or enhance the spread of blaKPC (Beltrão et al, 2020). In addition, to our knowledge NTEKPC-IId has not yet been reported in P. mirabilis.…”

Section: Discussionmentioning

confidence: 86%

“…In addition to the Tn4401 transposon, other transposons may harbor the blaKPC-2 gene, such as the Tn3000 transposon and the non-Tn4401 mobile element (NTE). NTEKPC-IId has been reported in Brazil in K. pneumoniae and Klebsiella aerogenes, including in hospitals in Recife-PE, Brazil (Cerdeira et al, 2017;Beltrão et al, 2020;Fuga et al, 2020;. There is evidence that NTEKPC-IId is the variant circulating in Recife harboring the blaKPC gene in K. pneumoniae and K. aerogenes, together with the plasmid IncQ (Beltrão et al, 2020b;Oliveira et al, 2020).…”

Section: Discussionmentioning

confidence: 99%

“…Plasmid IncQ1 found in isolate P20-A2 is a small, promiscuous, non-conjugative plasmid. However, this plasmid has the ability to bind to conjugative plasmids at the time of conjugation, which can facilitate its dissemination in pathogenic bacteria of the same species and different species (Beltrão et al, 2020;Oliveira et al, 2020). In addition to plasmid IncQ1, a small plasmid belonging to the Col3M family was found harboring the qnrD1 gene, which confers resistance to quinolones, in isolate P20-A2.…”

Section: Discussionmentioning

confidence: 99%

“…This pathogen is frequently reported to cause Urinary Tract Infections (UTI), especially in patients with prolonged use of indwelling catheters and urinary catheters. In addition, P. mirabilis has intrinsic resistance to tigecycline, nitrofurantoin, polymyxins and tetracycline (Cunha et al, 2017;Beltrão et al, 2020). And has reduced susceptibility to imipenem (Bontron et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

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Proteus mirabilis carrying NTEKPC-IId, blaNDM-1, blaOXA-10, aph(3')-VI, qnrD1 and IncQ and Col3M plasmids from a hospital in Recife-PE, Brazil

Beltrão

Oliveira

Vasconcelos

et al. 2021

RSD

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The present study objective to characterize the clinical aspects of a patient infected with two strains of P. mirabilis and the presence of resistance determinants in the two isolates from a patient at a public hospital in Recife-PE, Brazil. The total DNA of the isolates was extracted and submitted to PCR and amplicon sequencing for the investigation of resistance genes, blaKPC, blaOXA-10, blaOXA-23, blaOXA-48, blaOXA-58, blaVIM, blaIMP, blaSPM, blaGES, blaNDM, qnrD and aac(6')-Ib). Isolate P21-A2 harbored the aac(6')-Ib, blaOXA-10 and qnrD genes. One of the isolates, P20-A2, was selected for plasmid DNA sequencing. The results showed that the patient developed multiple infections with various pathogens including two strains of P. mirabilis. The patient was hospitalized for 103 days, had septic shock of skin, abdominal, pulmonary and ulcer focus, and died. Isolate P20-A2 harbored the genes blaNDM, qnrD, aph(3')-VI, blaKPC and blaOXA-10, and plasmids IncQ and Col3M, together with NTEKPC-IId. To our knowledge, this is the first report of P. mirabilis harboring NTEKPC-IId. Although P. mirabilis is standing out as a cause of nosocomial infections and a resistant multidrug pathogen, this species is still neglected, the emergence of these P. mirabilis isolates harboring aforementioned resistance determinants and the plasmids IncQ and Col3M demonstrate the potential for dissemination of important resistance genes, mainly in the case of P. mirabilis.

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Occurrence of blaNDM-7 and association with blaKPC-2, blaCTX-M15, aac, aph, mph(A), catB3 and virulence genes in a clinical isolate of Klebsiella pneumoniae with different plasmids in Brazil

et al. 2022

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Multidrug-resistant Klebsiella aerogenes clinical isolates from Brazil carrying IncQ1 plasmids containing the blaKPC-2 gene associated with non-Tn4401 elements (NTEKPC-IId)

Cited by 10 publications

References 5 publications

Clinical and Molecular Description of a High-Copy IncQ1 KPC-2 Plasmid Harbored by the International ST15 Klebsiella pneumoniae Clone

Clinical and Molecular Description of a High-Copy IncQ1 KPC-2 Plasmid Harbored by the International ST15 Klebsiella pneumoniae Clone

Proteus mirabilis carrying NTEKPC-IId, blaNDM-1, blaOXA-10, aph(3')-VI, qnrD1 and IncQ and Col3M plasmids from a hospital in Recife-PE, Brazil

Occurrence of blaNDM-7 and association with blaKPC-2, blaCTX-M15, aac, aph, mph(A), catB3 and virulence genes in a clinical isolate of Klebsiella pneumoniae with different plasmids in Brazil

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