Update of the molecular epidemiology of KPC-2-producing Klebsiella pneumoniae in Brazil: spread of clonal complex 11 (ST11, ST437 and ST340)

Abstract

In Brazil, the spread of bla(KPC-2) is occurring due to dispersion of Tn4401 'b', carried by IncN plasmids of 40 kb, and mainly the dissemination of CC11, with ST437 and ST11 playing an important role.

Induction and nosocomial dissemination of carbapenem and polymyxin-resistant Klebsiella pneumoniae

“…The isolation of carbapenem-resistant K. pneumoniae from blood cultures and other samples has increased in recent years; these isolates were characterized as KPC-2 producers as well as ST-258, ST-11, and ST-48 clones (10) . This epidemiological change is similar to those that have occurred in hospitals in other regions and countries, i.e., increases in cases of infection attributed to the ST-11 and other clones of KPC-producing K. pneumoniae (11) .…”

Molecular Epidemiology of KPC-2 Producing Klebsiella pneumoniae

“…These clones were observed in different states of Brazil such as Ceará, Pernambuco, Rio de Janeiro, Piauí, Alagoas and Federal District [13]. To date, only one clone (ST841) was described in Manaus, Amazonas [13]. The ST2230 clone, that has been described before in China, was isolated from a blood sample of a newborn from a maternity hospital, being the first description in the city and in Brazil, and possibly representing an important fact, once it is associated with multidrug resistance.…”

“…The ST258 clone, predominant in European countries, has contributed significantly to the worldwide distribution of the carbapenem resistance [4]. In Asia, there are different clones such as ST392 and ST395, which also harbor the bla KPC-2 gene, whereas in Brazil, different STs such as ST437, ST340 and ST842, harboring the KPC-2 variant, have been described and isolated from different healthcare settings [12,13]. The spread of the antibiotic resistance genes maybe be associated with the dissemination of clones, and other factors such as plasmids, and transposons -i.e.…”

“…Horizontal Gene Transfer (HGT) -between bacteria [4,14,15]. Furthermore, the capacity of the K. pneumoniae to colonize medical equipment and to survive for long periods of time, at extreme temperature in the environment, explains why this pathogen can also be isolated from hospital environment and play an important role in the horizontal transfer of antibiotic resistance, acting also as an efficient donor and receptor [4,13,[16][17][18][19]. The events observed in the present study, suggest that asymptomatic carriers, such as health professionals and their flow between different hospitals; patient or other people who move through hospitals, may be contributing to the local dissemination of these clones, which may affect vulnerable patients [13].…”

“…The ST11 and ST340 clones were isolated from inpatients at the same general hospital. These clones were observed in different states of Brazil such as Ceará, Pernambuco, Rio de Janeiro, Piauí, Alagoas and Federal District [13]. To date, only one clone (ST841) was described in Manaus, Amazonas [13].…”