Carbapenemase-Producing Klebsiella pneumoniae From Transplanted Patients in Brazil: Phylogeny, Resistome, Virulome and Mobile Genetic Elements Harboring blaKPC–2 or blaNDM–1

Abstract

Objectives Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) is a major cause of infections in transplanted patients and has been associated with high mortality rates in this group. There is a lack of information about the Brazilian structure population of CP-Kp isolated from transplanted patients. By whole-genome sequencing (WGS), we analyzed phylogeny, resistome, virulome of CP-Kp isolates, and the structure of plasmids encoding bla KPC– 2 and bla NDM– 1 genes. Methods One K. pneumoniae isolated from each selected transplanted patient colonized or infected by CP-Kp over a 16-month period in a hospital complex in Porto Alegre (Brazil) was submitted for WGS. The total number of strains sequenced was 80. The hospital complex in Porto Alegre comprised seven different hospitals. High-resolution SNP typing, core genome multilocus sequence typing (cgMLST), resistance and virulence genes inference, and plasmid reconstruction were performed in 80 CP-Kp. Results The mortality rate of CP-Kp colonized or infected transplanted inpatients was 21.3% (17/80). Four CP-Kp epidemic clones were described: ST11/KPC-2, ST16/KPC-2, and ST15/NDM-1, all responsible for interhospital outbreaks; and ST437/KPC-2 affecting a single hospital. The average number of acquired resistance and virulence genes was 9 (range = 2–14) and 27 (range = 6–36), respectively. Two plasmids carrying the bla KPC – 2 were constructed and belonged to IncN and IncM types. Additionally, an IncFIB plasmid carrying the bla NDM– 1 was described. Conclusion We detected intrahospital and interhospital spread of mobile structures and international K . pneumoniae clones as ST11, ST16, and ST15 among transplanted patients, which carry a significant range of acquired resistance and virulence genes and keep spreading across the world.

Prevalence of New Delhi Metallo-Beta Lactamase Gene among Klebsiella Species Isolates: An Egyptian Study

“…. But Raro et al found out only nine isolates (11.2%) out of 80 isolates collected carrying blaNDM-1[26]. While Devkota et al reported 30% frequency of blaNDM-1 carrying isolates in a study done in Nepal[27].…”

Genetic Basis of Antimicrobial Resistant Gram-Negative Bacteria Isolated From Bloodstream in Brazil

“…Here, the diversity and abundance of Inc groups found in K. pneumoniae strains contrast with P. aeruginosa and A. baumannii results. The majority of K. pneumoniae strains analyzed have the IncFIB plasmid, a group known for their MDR characteristic ( 39 , 40 ). In Brazil, the IncFIB plasmid has already been described as carrying bla KPC−2 and bla NDM−1 in K. pneumoniae ( 40 , 41 ).…”

“…The majority of K. pneumoniae strains analyzed have the IncFIB plasmid, a group known for their MDR characteristic ( 39 , 40 ). In Brazil, the IncFIB plasmid has already been described as carrying bla KPC−2 and bla NDM−1 in K. pneumoniae ( 40 , 41 ). A recent manuscript reported that plasmids with IncR, ColRNAI and IncF co-exists in KPC-2-producing K. pneumoniae strains from ST11 ( 42 ).…”

Phenotypic and molecular evaluation of biofilm formation in Klebsiella pneumoniae carbapenemase (KPC) isolates obtained from a hospital of Pelotas, RS, Brazil

“…The majority of K. pneumoniae strains have the IncFIB plasmid, a group known for their multi-drug resistance. In Brazil, the IncFIB plasmid has been described as a carrier of bla KPC in K. pneumoniae [27]. The spread of bla KPC is related to dispersion of Tn4401 transposon, carried by IncN plasmids mainly disseminated by the clonal complex [28].…”