Spread of ST348 Klebsiella pneumoniae Producing NDM-1 in a Peruvian Hospital

Abstract

The aim of this study was to characterize carbapenem-resistant Klebsiella pneumoniae (CR-Kp) isolates recovered from adults and children with severe bacteremia in a Peruvian Hospital in June 2018. Antimicrobial susceptibility was determined by disc/gradient diffusion and broth microdilution when necessary. Antibiotic resistance mechanisms were evaluated by PCR and DNA sequencing. Clonal relatedness was assessed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmid typing was performed with a PCR-based method. Thirty CR-Kp isolates were recovered in June 2018. All isolates were non-susceptible to all β-lactams, ciprofloxacin, gentamicin and trimethoprim-sulfamethoxazole, while mostly remaining susceptible to colistin, tigecycline, levofloxacin and amikacin. All isolates carried the blaNDM-1 gene and were extended spectrum β-lactamase (ESBL) producers. PFGE showed four different pulsotypes although all isolates but two belonged to the ST348 sequence type, previously reported in Portugal. blaNDM-1 was located in an IncFIB-M conjugative plasmid. To our knowledge, this is the first report of an New Delhi metallo-β-lactamase (NDM)-producing K. pneumoniae recovered from both children and adults in Lima, Peru, as well as the first time that the outbreak strain ST348 is reported in Peru and is associated with NDM. Studies providing epidemiological and molecular data on CR-Kp in Peru are essential to monitor their dissemination and prevent further spread.

A multidrug-resistant Klebsiella pneumoniae outbreak in a Peruvian hospital: Another threat from the COVID-19 pandemic

“…3 Klebsiella pneumoniae MDR was described for some time in Latin America and specifically in Peru in 2016, where an increased proportion of Enterobacteriaceae cases were carrying the NDM gene (67.5%) compared to Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria (31.3%) and active-on-imipenem (IMP)-type NDM bacteria (1.2%). 4 Sacsaquispe et al 5 determined that the main mechanism of resistance to carbapenems is the expression of blaNDM carbapenemase.…”

Fungal, parasitological, and bacterial coinfection in a severely ill COVID‐19 patient in Peru

“…Bacterial infections are the most common cause of coinfection in patients with COVID‐19, generating high complications due to antibiotic resistance in most isolated patients 13,14 . Acinetobacter baumanii and Cp‐Kpn are frequently isolated pathogens worldwide.…”

“…These coinfections may complicate the borderline health of COVID‐19 patients by requiring new care, multi‐drug therapy, and increased risk of complications and patient mortality 11,12 . In Peru, coinfections in patients with COVID‐19 have not been reported yet despite the high frequency of Carbapenem ‐ Resistant K. pneumoniae (Cp‐Kpn) and Multidrug ‐ Resistant Acinetobacter Enterobacteriaceae isolations 13 …”

Genome Sequencing Identifies Previously Unrecognized Klebsiella pneumoniae Outbreaks in Neonatal Intensive Care Units in the Philippines

“…The phylogenetic tree of the 259 genomes in the Philippines showed deep branches separating the K. pneumoniae complex into K. pneumoniae and K. quasipneumoniae . K. quasipneumoniae is said to be less pathogenic than K. pneumoniae , which is more frequently associated with colonization or hospital-acquired infections [ 55 ].…”