Dissemination of NDM-producing bacteria in Southern Brazil

Arend, Lavinia Nery Villa Stangler; Bergamo, Ricardo; Rocha, Fabiano Barreto; Bail, Larissa; Ito, Carmen Antônia Sanches; Baura, Valter A.; Balsanelli, Eduardo; Pothier, Joël F.; Rezzonico, Fabio; Pilonetto, Marcelo; Smits, Theo H. M.; Tuon, Felipe Francisco

doi:10.1016/j.diagmicrobio.2023.115930

Cited by 10 publications

(5 citation statements)

References 34 publications

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“…Finally, the increase in bla NDM detection, as demonstrated in the present analysis, could mean a possible replacement of carbapenemases in Brazil. This situation was also noted by Arend et al who showed that the increase in NDM-producing bacteria in southern Brazil was probably due to the presence of this gene in different plasmids [ 23 ]. Comparing the pre- and post-pandemic onset periods and considering the database for LACEN-PR and NRL only, an increase in the KPC DR of 5% was observed within the Enterobacterales order.…”

Section: Discussionsupporting

confidence: 66%

A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence

Kiffer,

Rezende,

Costa-Nobre

et al. 2023

Clinical Infectious Diseases

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Background Carbapenemase production is a global public health threat. Antimicrobial resistance (AMR) data analysis is critical to public health policy. Here we analyzed carbapenemase detection trends using the AMR Brazilian Surveillance Network. Methods Carbapenemase detection data from Brazilian hospitals included in the public laboratory information system dataset were evaluated. The detection rate (DR) was defined as carbapenemase detected by gene tested per isolate per year. The temporal trends were estimated using the Prais–Winsten regression model. The impact of COVID-19 on carbapenemase genes in Brazil was determined for the period 2015–2022. Detection pre- (October 2017 to March 2020) and post-pandemic onset (April 2020 to September 2022) was compared using the χ2 test. Analyses were performed with Stata 17.0 (StataCorp, College Station, TX). Results 83 282 blaKPC and 86 038 blaNDM were tested for all microorganisms. Enterobacterales DR for blaKPC and blaNDM was 68.6% (41 301/60 205) and 14.4% (8377/58 172), respectively. P. aeruginosa DR for blaNDM was 2.5% (313/12 528). An annual percent increase for blaNDM of 41.1% was observed, and a decrease for blaKPC of −4.0% in Enterobacterales, and an annual increase for blaNDM of 71.6% and for blaKPC of 22.2% in P. aeruginosa. From 2020 to 2022, overall increases of 65.2% for Enterobacterales, 77.7% for ABC, and 61.3% for P. aeruginosa were observed in the total isolates. Conclusions This study shows the strengths of the AMR Brazilian Surveillance Network with robust data related to carbapenemases in Brazil and the impact of COVID-19 with a change in carbapenemase profiles with blaNDM rising over the years.

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Section: Discussionsupporting

confidence: 66%

A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence

Kiffer,

Rezende,

Costa-Nobre

et al. 2023

Clinical Infectious Diseases

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“…(4,5,16) The PDR phenotype was in accordance with the Kp196 resistome, which was composed of genes associated with resistance to aminoglycosides (aadA1, aacA4, strAB, aph(3')-VI, aac(3)-IId), fluoroquinolones (qnrS1, qnrB1, oqxAB), trimethoprim (dfrA14), sulfonamides (sul2), tetracycline (tetD), fosfomycin ( fosA5), chloramphenicol (catB3) and β-lactams including carbapenems (bla SHV-11 , bla CTX-M-15 , bla OXA-9 , bla OXA-1, bla TEM-1, bla NDM-1 ). Although less prevalent than the carbapenemase-coding bla KPC-2 gene, several studies demonstrated the occurrence of bla NDM-1 among clinical K. pneumoniae in Brazil, (17) including the ST11 lineage, where this gene was found in the context of an IncC plasmid. (18) Interestingly, the bla NDM-1 occurrence in Brazil was not restricted to clinical settings since it had already been found in environmental K. pneumoniae isolates recovered from both surface waters, (19) and wastewater treatment plants (WWTPs).…”

Section: Resultsmentioning

confidence: 99%

Unveiling the genome of a high-risk pandrug-resistant Klebsiella pneumoniae emerging in the Brazilian Amazon Region, 2022

Fonseca,

Morgado,

Freitas

et al. 2023

Mem. Inst. Oswaldo Cruz

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BACKGROUND Pandrug-resistant (PDR) Klebsiella pneumoniae has been reported sporadically in many countries and remains rare in Brazil. OBJECTIVES This study unravelled the genetic determinants involved with the PDR background of a clinical ST11 K. pneumoniae recovered in the Brazilian Amazon Region, where K. pneumoniae genomic and epidemiological information is scarce. METHODS Kp196 was submitted to the antimicrobial susceptibility test by the disk-diffusion method and minimum inhibitory concentration (MIC) determination. The whole genome sequencing was obtained and the sequence type was determined by core genome multilocus sequence typing (cgMLST). Its intrinsic and acquired resistome was assessed by Comprehensive Antibiotic Resistance Database (CARD) and comparison with wild-type genes. FINDINGS The analyses revealed that Kp196 belonged to the pandemic ST11 and presented the PDR phenotype. Its acquired resistome was composed of a huge set of clinically relevant resistance determinants, including bla CTX-M-15 and bla NDM-1 , all found in the vicinity of mobile platforms. Considering its intrinsic resistome, the multidrug resistance, especially to colistin, tigecycline and fluoroquinolones, was multifactorial and attributed to modifications (indels, missense mutations, and gene disruption) in several housekeeping genes ( arnT / phoQ/mgrB/ramR/acrB/gyrA/parC/ompK35-36-37 ). The Kp196 intrinsic resistome was also observed in a ST11 environmental strain, although harbouring distinct acquired resistomes. CONCLUSIONS An accumulation of different resistance mechanisms regarding the intrinsic resistome accounts for a more stable resistome, strongly contributing to the Kp196 PDR phenotype.

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“…The preservation of the bla NDM-1 -containing cluster was probably favored by the presence of last-line antimicrobials like ceftazidime/avibactam and the versatility of this carbapenemase-encoding gene to incorporate with different types of conjugative plasmid backbones. Indeed, the spread of bla NDM-1 through IncFIA plasmids is well documented in the literature [16][17][18][19].…”

Section: Discussionmentioning

confidence: 98%

Probable Three-Species In Vivo Transfer of blaNDM-1 in a Single Patient in Greece: Occurrence of NDM-1-Producing Klebsiella pneumoniae, Proteus mirabilis, and Morganella morganii

et al. 2023

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NDM carbapenemase-encoding genes disseminate commonly among Enterobacterales through transferable plasmids carrying additional resistance determinants. Apart from the intra-species dissemination, the inter-species exchange of plasmids seems to play an additional important role in the spread of blaNDM. We here present the genetics related to the isolation of three species (Klebsiella pneumoniae, Proteus mirabilis, and Morganella morganii) harboring the blaNDM-1 gene from a single patient in Greece. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek2. Whole genome sequencing and bioinformatic tools were used to identify resistance genes and plasmids. BlaNDM-1 harboring plasmids were found in all three isolates. Moreover, the plasmid constructs of the respective incomplete or circular contigs showed that the blaNDM-1 and its neighboring genes form a cluster that was found in all isolates. Our microbiological findings, together with the patient’s history, suggest the in vivo transfer of the blaNDM-1-containing cluster through three different species in a single patient.

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Dissemination of NDM-producing bacteria in Southern Brazil

Cited by 10 publications

References 34 publications

A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence

A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence

Unveiling the genome of a high-risk pandrug-resistant Klebsiella pneumoniae emerging in the Brazilian Amazon Region, 2022

Probable Three-Species In Vivo Transfer of blaNDM-1 in a Single Patient in Greece: Occurrence of NDM-1-Producing Klebsiella pneumoniae, Proteus mirabilis, and Morganella morganii

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