Update on the epidemiology of carbapenemases in Latin America and the Caribbean

García-Betancur, Juan Carlos; Appel, Tobías Manuel; Esparza, German; Gales, Ana Cristina; Levy-Hara, Gabriel; Cornistein, Wanda; Núñez, Duilio; Cuéllar, Luis; Bavestrello, Luis; Castañeda-Méndez, Paulo; Villalobos-Vindas, Juan; Villegas, María Virginia

doi:10.1080/14787210.2020.1813023

Cited by 69 publications

(48 citation statements)

References 168 publications

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“…29 Importantly, we also detected the presence of class B metallo-betalactamases NDM-1 and NDM-6 which, unlike OXA-23, confer resistance to extendedspectrum cephalosporins as well as carbapenems. A. baumannii harbouring NDM-1 has been sporadically reported previously from other countries [30][31][32] , but NDM-6carrying A. baumannii has only recently been reported from Spain. 33 Resistance to extended-spectrum cephalosporins was mainly explained by the insertion of ISAba1 in the promoter of the intrinsic gene blaampC, which has been shown to lead to increased expression of the encoded cephalosporinase.…”

Section: Discussionmentioning

confidence: 94%

Genomic Surveillance ofAcinetobacter baumanniiin the Philippines, 2013-2014

Chilam

Argimón²,

et al. 2021

Preprint

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Acinetobacter baumannii is an opportunistic nosocomial pathogen that has increasingly become resistant to carbapenems worldwide. In the Philippines, carbapenem resistance and multi-drug resistance (MDR) rates are above 50%. We undertook a genomic study of carbapenem resistant A. baumannii in the Philippines to characterize the population diversity and antimicrobial resistance (AMR) mechanisms. We sequenced the whole genomes of 117 A. baumannii isolates recovered by 16 hospitals in the Philippines between 2013 and 2014. We determined the multi-locus sequence type (MLST), presence of acquired AMR determinants and relatedness between isolates from the genome sequences. We also compared the phenotypic and genotypic resistance results. Carbapenem resistance was mainly explained by the acquisition of class-D beta-lactamase gene blaOXA-23. The concordance between phenotypic and genotypic resistance to imipenem was 98.15% and 94.97% overall for the seven antibiotics analysed. Twenty-two different sequence types (ST) were identified, including 7 novel STs. The population was dominated by high-risk international clone 2 (i.e., clonal complex 92), in particular by ST195 and ST208 and their single locus variants. With WGS we identified local clusters representing potential undetected nosocomial outbreaks, as well as multi-hospital clusters indicating inter-hospital transmission. Comparison with global genomes suggested that the establishment of carbapenem-resistant IC2 clones in the Philippines is likely the result of clonal expansion and geographical dissemination and at least partly explained by inadequate hospital infection control and prevention. This study is the first extensive genomic study of carbapenem-resistant A. baumannii in the Philippines and underscores the importance of hospital infection control and prevention to contain high-risk clones.

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Section: Discussionmentioning

confidence: 94%

Genomic Surveillance ofAcinetobacter baumanniiin the Philippines, 2013-2014

Chilam

Argimón²,

et al. 2021

Preprint

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“…The resistance trend for 3rd/4th generation cephalosporins and carbapenems among K. pneumoniae isolates have been reported in several countries, and in Latin America, countries including Brazil, Argentina and Chile account for most of the cases [ 1 , 2 , 5 ]. Indeed, on recently reported data of national surveillance on antimicrobial resistance, K. pneumoniae isolated in adult and pediatric Brazilian ICUs presented resistance rates ranging 49.3% to 68.1% and 19.3% to 51.8% to 3rd/4th generation cephalosporins and carbapenems, respectively [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

“…CR-Kp has been typically related to transmissible genetic elements added to carbapenemases genes, such as bla NDM and bla KPC , which have been increasingly detected in different countries, emphasizing their worldwide dissemination [ 7 , 8 , 25 , 26 ]. In Brazil, KPC has become endemic and widely disseminated among K. pneumoniae from hospitals in all Brazilian regions [ 5 , 14 , 17 , 20 , 21 , 27 , 28 , 29 , 30 ]. Since 2013, NDM-producing isolates have been reported in different Brazilian regions and associated with a wide variety of bacterial species, including Escherichia coli , Acinetobacter baumannii , A. nosocomialis , A. pittii, Enterobacter cloacae, Enterobacter hormaechei, and K. pneumoniae [ 12 , 15 , 16 , 31 , 32 , 33 , 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

“…The aggravating problem of AMR among K. pneumoniae isolates is commonly related to the spread of plasmid-borne resistance genes, including metallo-beta-lactamases (MβLs) and extended spectrum beta-lactamases (ESβLs). Carbapenem-resistant K. pneumoniae isolates (CR-Kp) are usually detected harboring the bla KPC gene, with endemicity reported in Brazil and several other countries, while the dissemination of NDM-producing K. pneumoniae has increased in several regions, and mainly during the COVID-19 pandemic [ 3 , 4 , 5 , 6 , 7 , 8 ]. Such highly resistant-strains carrying resistance mechanisms are associated with so-called high-risk clones (HRCs), particularly to strains belonging to the clonal complex 258 (CC258) and CC15, which have been detected in multiclonal expansion at several Brazilian hospitals [ 9 , 10 , 11 , 12 , 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

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The Spread of NDM-1 and NDM-7-Producing Klebsiella pneumoniae Is Driven by Multiclonal Expansion of High-Risk Clones in Healthcare Institutions in the State of Pará, Brazilian Amazon Region

et al. 2021

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Carbapenem resistance among Klebsiella pneumoniae isolates is often related to carbapenemase genes, located in genetic transmissible elements, particularly the blaKPC gene, which variants are spread in several countries. Recently, reports of K. pneumoniae isolates harboring the blaNDM gene have increased dramatically along with the dissemination of epidemic high-risk clones (HRCs). In the present study, we report the multiclonal spread of New Delhi metallo-beta-lactamase (NDM)-producing K. pneumoniae in different healthcare institutions in the state of Pará, Northern Brazil. A total of 23 NDM-producing isolates were tested regarding antimicrobial susceptibility testing features, screening of carbapenemase genes, and genotyping by multilocus sequencing typing (MLST). All K. pneumoniae isolates were determined as multidrug-resistant (MDR), being mainly resistant to carbapenems, cephalosporins, and fluoroquinolones. The blaNDM-7 (60.9%—14/23) and blaNDM-1 (34.8%—8/23) variants were detected. MLST genotyping revealed the predomination of HRCs, including ST11/CC258, ST340/CC258, ST15/CC15, ST392/CC147, among others. To conclude, the present study reveals the contribution of HRCs and non-HRCs in the spread of NDM-1 and NDM-7-producing K. pneumoniae isolates in Northern (Amazon region) Brazil, along with the first detection of NDM-7 variant in Latin America and Brazil, highlighting the need for surveillance and control of strains that may negatively impact healthcare and antimicrobial resistance.

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“…This situation has demanded major adjustments to health-care systems and infrastructure, and especially to the infection control and antimicrobial stewardship programmes. 10 Unfortunately, less robust health-care systems, such as those in many Latin American and Asian countries where antimicrobial resistance rates are already perilously high 11,12 and antimicrobial stewardship programmes are just beginning to be implemented, 13 are adjusting their response to the pandemic at varying degrees. [14][15][16] Regrettably, these circumstances create a so-called perfect storm for an accelerated evolution of antimicrobial resistance.…”

mentioning

confidence: 99%

The urgent need for metallo-β-lactamase inhibitors: an unattended global threat

Mojica

Rossi

Vila

et al. 2022

The Lancet Infectious Diseases

132

106

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Due to their superior tolerability and efficacy, β-lactams are the most potent and prescribed class of antibiotics in the clinic. The emergence of resistance to those antibiotics, mainly due to the production of bacterial enzymes called β-lactamases, has been partially solved by the introduction of β-lactamase inhibitors, which restore the activity of otherwise obsolete molecules. This solution is limited because currently available β-lactamase inhibitors only work against serine β-lactamases, whereas metallo-β-lactamases continue to spread, evolve, and confer resistance to all β-lactams, including carbapenems. Furthermore, the increased use of antibiotics to treat secondary bacterial pneumonia in severely sick patients with COVID-19 might exacerbate the problem of antimicrobial resistance. In this Personal View, we summarise the main advances accomplished in this area of research, emphasise the main challenges that need to be solved, and the importance of research on inhibitors for metallo-B-lactamases amidst the current pandemic.

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Update on the epidemiology of carbapenemases in Latin America and the Caribbean

Cited by 69 publications

References 168 publications

Genomic Surveillance ofAcinetobacter baumanniiin the Philippines, 2013-2014

Genomic Surveillance ofAcinetobacter baumanniiin the Philippines, 2013-2014

The Spread of NDM-1 and NDM-7-Producing Klebsiella pneumoniae Is Driven by Multiclonal Expansion of High-Risk Clones in Healthcare Institutions in the State of Pará, Brazilian Amazon Region

The urgent need for metallo-β-lactamase inhibitors: an unattended global threat

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