Carbapenemase-producing Enterobacteriaceae in Mexico: report of seven non-clonal cases in a pediatric hospital

Abstract

BackgroundCarbapenemases-producing Enterobacteriaceae (CPE) are a worldwide public health emergency. In Mexico, reports of CPE are limited, particularly in the pediatric population. Here, we describe the clinical, epidemiological, and molecular characteristics of seven consecutive cases in a third-level pediatric hospital in Mexico City over a four-month period during 2016.ResultsThe Enterobacteriaceae identified were three Escherichia coli strains (producing OXA-232, NDM-1 and KPC-2), two Klebsiella pneumoniae strains (producing KPC-2 and NDM-1), one Klebsiella oxytoca strain producing OXA-48 and one Enterobacter cloacae strain producing NDM-1. The majority of patients had underlying disesases, three were immunocompromised, and three had infections involved the skin and soft tissues. Half patients died as a result of CPE infection.ConclusionsThis study represents the first report of E. coli ST131-O25b clone producing NDM-1 in Latin America. In addition, this study is the first finding of K. oxytoca producing OXA-48 and E. coli producing OXA-232 in Mexican pediatric patients.

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“…These two highly virulent Gram-negative bacterial strains can cause life-threatening infections including severe bacteremia, cholecystitis, pneumonia, complicated skin infections, urinary tract infections (UTIs), severe gastritis, infections of the upper and lower respiratory tract, wound infections, meningitis and osteomyelitis. 11,12 Thus far, synthetic and semi-synthetic drugs have not exhibited any signicant control of these lethal bacterial strains.…”

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“…Subsequently OXA-48 was reported from several members of the Enterobacterales, especially E. coli (108), the E. cloacae complex (109), Citrobacter freundii (98), Serratia marcescens (74), Proteus mirabilis (110), Kluyvera spp. (111), Klebsiella oxytoca (112), and Salmonella spp. (113).…”

“…Sporadic global appearances of E. coli with bla OXA-232 on pOXA-232-like plasmids have been reported, and the isolates belonged to the following clones: ST131, ST167, ST448, ST457, ST2003, and ST2968 (26,112,158,190,193).…”

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“…Furthermore, some fungi, for example, Candida species, are also showing resistance to various antifungal drugs, such as azole [ 3 ]. These pathogenic microbes are causing life-threatening diseases, such as aspergillosis, candidiasis, pneumocystis pneumonia, sepsis, osteomyelitis, meningitis, cholecystitis, severe bacteremia, diarrhea, tuberculosis [ 4 , 5 ]. Numerous antimicrobial drugs have been developed; however, because of the emergence of MDR in pathogens, clinical efficiency of existing drugs is vulnerable.…”