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Cuicapuza D, Loyola S, Velásquez J, Fernández N, Llanos C, Ruiz J, Tsukayama P, Tamariz J. Molecular characterization of carbapenemase-producing Enterobacterales in a tertiary hospital in Lima, Peru. Microbiol Spectr 2024; 12:e0250323. [PMID: 38193666 PMCID: PMC10846045 DOI: 10.1128/spectrum.02503-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/26/2023] [Indexed: 01/10/2024] Open
Abstract
Carbapenemase-producing Enterobacterales (CPE) are a growing threat to global health and the economy. Understanding the interactions between resistance and virulence mechanisms of CPE is crucial for managing difficult-to-treat infections and informing outbreak prevention and control programs. Here, we report the characterization of 21 consecutive, unique clinical isolates of CPE collected in 2018 at a tertiary hospital in Lima, Peru. Isolates were characterized by phenotypic antimicrobial susceptibility testing and whole-genome sequencing to identify resistance determinants and virulence factors. Seven Klebsiella pneumoniae isolates were classified as extensively drug-resistant. The remaining Klebsiella, Enterobacter hormaechei, and Escherichia coli isolates were multidrug-resistant. Eighteen strains carried the metallo-β-lactamase NDM-1, two the serine-carbapenemase KPC-2, and one isolate had both carbapenemases. The blaNDM-1 gene was located in the truncated ΔISAba125 element, and the blaKPC-2 gene was in the Tn4401a transposon. ST147 was the most frequent sequence type among K. pneumoniae isolates. Our findings highlight the urgent need to address the emergence of CPE and strengthen control measures and antibiotic stewardship programs in low- and middle-income settings.IMPORTANCEGenomic surveillance of antimicrobial resistance contributes to monitoring the spread of resistance and informs treatment and prevention strategies. We characterized 21 carbapenemase-producing Enterobacterales collected at a Peruvian tertiary hospital in 2018, which exhibited very high levels of resistance and carried numerous resistance genes. We detected the coexistence of carbapenemase-encoding genes (blaNDM-1 and blaKPC-2) in a Klebsiella pneumoniae isolate that also had the PmrB(R256G) mutation associated with colistin resistance. The blaKPC-2 genes were located in Tn4401a transposons, while the blaNDM-1 genes were in the genetic structure Tn125 (ΔISAba125). The presence of high-risk clones among Klebsiella pneumoniae (ST11 and ST147) and Escherichia coli (ST410) isolates is also reported. The study reveals the emergence of highly resistant bacteria in a Peruvian hospital, which could compromise the effectiveness of current treatments and control.
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Affiliation(s)
- Diego Cuicapuza
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Genómica Microbiana, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge (Emerging Diseases and Climate Change Research Unit), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Steev Loyola
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Grupo de Investigación UNIMOL, Facultad de Medicina, Universidad de Cartagena, Cartagena de Indias, Colombia
| | - Jorge Velásquez
- Departamento de Patología Clínica y Banco de Sangre, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Nathaly Fernández
- Departamento de Patología Clínica y Banco de Sangre, Hospital Nacional Arzobispo Loayza, Lima, Peru
| | - Carlos Llanos
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
| | - Joaquim Ruiz
- Grupo de Investigación en Dinámicas y Epidemiología de la Resistencia a Antimicrobianos-“One Health”, Universidad Científica de Sur, Lima, Peru
| | - Pablo Tsukayama
- Laboratorio de Genómica Microbiana, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, Peru
- Emerge (Emerging Diseases and Climate Change Research Unit), Facultad de Salud Pública y Administración, Universidad Peruana Cayetano Heredia, Lima, Peru
- Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, Peru
- Parasites and Microbes Programme, Wellcome Sanger Institute, Hinxton, United Kingdom
| | - Jesús Tamariz
- Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
- Laboratorio de Resistencia Antibiótica e Inmunopatología, Facultad de Medicina, Universidad Peruana Cayetano Heredia, Lima, Peru
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