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Veloso M, Arros P, Acosta J, Rojas R, Berríos-Pastén C, Varas M, Araya P, Hormazábal JC, Allende ML, Chávez FP, Lagos R, Marcoleta AE. Antimicrobial resistance, pathogenic potential, and genomic features of carbapenem-resistant Klebsiella pneumoniae isolated in Chile: high-risk ST25 clones and novel mobile elements. Microbiol Spectr 2023; 11:e0039923. [PMID: 37707451 PMCID: PMC10581085 DOI: 10.1128/spectrum.00399-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 07/26/2023] [Indexed: 09/15/2023] Open
Abstract
Multidrug- and carbapenem-resistant Klebsiella pneumoniae (CR-Kp) are critical threats to global health and key traffickers of resistance genes to other pathogens. Despite the sustained increase in CR-Kp infections in Chile, few strains have been described at the genomic level, lacking details of their resistance and virulence determinants and the mobile elements mediating their dissemination. In this work, we studied the antimicrobial susceptibility and performed a comparative genomic analysis of 10 CR-Kp isolates from the Chilean surveillance of carbapenem-resistant Enterobacteriaceae. High resistance was observed among the isolates (five ST25, three ST11, one ST45, and one ST505), which harbored 44 plasmids, most carrying genes for conjugation and resistance to several antibiotics and biocides. Ten plasmids encoding carbapenemases were characterized, including novel plasmids or variants with additional resistance genes, a novel genetic environment for blaKPC-2, and plasmids widely disseminated in South America. ST25 K2 isolates belonging to CG10224, a clone traced back to 2012 in Chile, which recently acquired blaNDM-1, blaNDM-7, or blaKPC-2 plasmids stood out as high-risk clones. Moreover, this corresponds to the first report of ST25 and ST45 Kp producing NDM-7 in South America and ST505 CR-Kp producing both NDM-7 and KPC-2 worldwide. Also, we characterized a variety of genomic islands carrying virulence and fitness factors. These results provide baseline knowledge for a detailed understanding of molecular and genetic determinants behind antibiotic resistance and virulence of CR-Kp in Chile and South America. IMPORTANCE In the ongoing antimicrobial resistance crisis, carbapenem-resistant strains of Klebsiella pneumoniae are critical threats to public health. Besides globally disseminated clones, the burden of local problem clones remains substantial. Although genomic analysis is a powerful tool for improving pathogen and antimicrobial resistance surveillance, it is still restricted in low- to middle-income countries, including Chile, causing them to be underrepresented in genomic databases and epidemiology surveys. This study provided the first 10 complete genomes of the Chilean surveillance for carbapenem-resistant K. pneumoniae in healthcare settings, unveiling their resistance and virulence determinants and the mobile genetic elements mediating their dissemination, placed in the South American and global K. pneumoniae epidemiological context. We found ST25 with K2 capsule as an emerging high-risk clone, along with other lineages producing two carbapenemases and several other resistance and virulence genes encoded in novel plasmids and genomic islands.
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Affiliation(s)
- Marcelo Veloso
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Patricio Arros
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Joaquin Acosta
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Roberto Rojas
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Camilo Berríos-Pastén
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Macarena Varas
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | | | | | - Miguel L. Allende
- Millennium Institute Center for Genome Regulation (CGR), Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Francisco P. Chávez
- Laboratorio de Microbiología de Sistemas, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Rosalba Lagos
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
| | - Andrés E. Marcoleta
- Grupo de Microbiología Integrativa, Laboratorio de Biología Estructural y Molecular BEM, Departamento de Biología, Facultad de Ciencias, Universidad de Chile, Santiago, Chile
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Lima O, Sousa A, Filgueira A, González-Novoa MC, Domínguez-López C, Ávila-Nuñez M, Represa M, Rubiñán P, Martínez-Lamas L, Pérez-Castro S, Rubianes M, Pérez-Rodríguez MT. Gastrointestinal colonization by OXA-48-producing Enterobacterales: risk factors for persistent carriage. Eur J Clin Microbiol Infect Dis 2022; 41:1399-1405. [PMID: 36205803 DOI: 10.1007/s10096-022-04504-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 09/28/2022] [Indexed: 11/25/2022]
Abstract
Carbapenem-resistant Enterobacterales (CRE) infections are a major health problem. Intestinal colonization is a key factor in developing infection. However, factors associated with persistent colonization by CRE are unknown. The aim of the study was to identify factors associated with persistent CRE gut colonization. This is a retrospective, single-centre, observational study of adult patients with CRE gut colonization between January 2015 and January 2020. Epidemiologic characteristics, comorbidities, infectious events, duration of hospitalization and antimicrobial treatment received in the follow-up period were collected. Colonization was defined as isolation in at least 2 rectal swab culture samples of CRE. Decolonization was defined as 3 negative rectal swab cultures or 2 negative cultures and a negative molecular test. A cohort of 86 patients with CRE gut colonization was selected: 44 patients with spontaneous decolonization (DC) and 42 patients with persistent colonization (PC). The mean follow-up period was 24 months (IQR 14-33) in the DC group vs. 25 months (IQR 16-36) in the PC group (p = 0.478). Patient characteristics were similar between both groups. Colonization by other MDR microorganisms was high (44 patients, 51%) and slightly more common in the PC group (PC 60% vs. DC 43%, p = 0.139). The use of ceftazidime-avibactam was more common among the PC group (PC 33% vs. DC 14%, p = 0.041). We observed a higher percentage of antimicrobial therapy in the previous 30 days (PC 68% vs. DC 57%, p = 0.371) and 90 days (PC 81% vs. DC 82%, p = 0.353) in the PC group. Multivariable analysis showed that patients that have received ceftazidime-avibactam therapy (OR 4.9 95% CI [1.45-16.39], p = 0.010), and those colonized by other MDR microorganisms (OR 2.5, 95% CI [0.96-6.25], p = 0.060) presented a higher risk of PC. Ceftazidime-avibactam use and colonization by other MDR microorganisms might be associated with CRE persistent gut colonization.
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Affiliation(s)
- O Lima
- Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain.
- Biomedical Research Institute Galicia Sur, Vigo, Spain.
| | - A Sousa
- Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain
- Biomedical Research Institute Galicia Sur, Vigo, Spain
| | - A Filgueira
- Vascular Surgery Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | | | | | - M Ávila-Nuñez
- Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain
| | - M Represa
- Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain
| | - P Rubiñán
- Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain
| | - L Martínez-Lamas
- Microbiology Department, Complexo Hospitalario Universitario de Vigo, Vigo, Spain
| | - Sonia Pérez-Castro
- Service of Preventive Medicine, University Hospital Complex of Vigo, Vigo, Spain
| | - M Rubianes
- Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain
| | - M T Pérez-Rodríguez
- Infectious Diseases Unit, Internal Medicine, Complexo Hospitalario Universitario de Vigo, Estrada Clara Campoamor, 341 Pontevedra, 36213, Vigo, Spain
- Biomedical Research Institute Galicia Sur, Vigo, Spain
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