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Camargo CH, Yamada AY, de Souza AR, Cunha MPV, Ferraro PSP, Sacchi CT, Dos Santos MB, Campos KR, Tiba-Casas MR, Freire MP, Barretti P. Genomic analysis and antimicrobial activity of β-lactam/β-lactamase inhibitors and other agents against KPC-producing Klebsiella pneumoniae clinical isolates from Brazilian hospitals. Sci Rep 2023; 13:14603. [PMID: 37670032 PMCID: PMC10480165 DOI: 10.1038/s41598-023-41903-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 09/01/2023] [Indexed: 09/07/2023] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) are highly disseminated worldwide, and isolates co-resistant to other antimicrobial agents pose a threat to effective antimicrobial therapy. Therefore, evaluation of novel antimicrobial drugs is needed to identify potential treatments with better outcomes. We evaluated the in vitro activity of novel antimicrobial drugs/combinations against 97 KPC-producing Klebsiella pneumoniae isolates recovered from different hospitals in Brazil during 2021-2022. Clonality, resistance and virulence genes were detected by whole-genome sequencing. The majority of the isolates (54.6%) were classified as extensively drug resistant or multidrug resistant (44.3%); one isolate showed a pandrug resistance phenotype. The most active antimicrobial agents were meropenem-vaborbactam, cefiderocol, and ceftazidime-avibactam, with sensitivities higher than 90%; resistance to ceftazidime-avibactam was associated with KPC-33 or KPC-44 variants. Colistin and polymyxin B were active against 58.6% of the isolates. The 97 isolates were distributed into 17 different sequence types, with a predominance of ST11 (37.4%). Although high in vitro susceptibility rates were detected for meropenem-vaborbactam and cefiderocol, only ceftazidime-avibactam is currently available in Brazil. Our findings showed limited susceptibility to antimicrobial drugs employed for infection treatment of carbapenem-resistant K. pneumoniae, underscoring the urgent need for stringent policies for antimicrobial stewardship to preserve the activity of such drugs.
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Affiliation(s)
- Carlos Henrique Camargo
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil.
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil.
| | - Amanda Yaeko Yamada
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil
| | - Andreia Rodrigues de Souza
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Marcos Paulo Vieira Cunha
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Pedro Smith Pereira Ferraro
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Claudio Tavares Sacchi
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Marlon Benedito Dos Santos
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Karoline Rodrigues Campos
- Laboratório Estratégico, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 10º Andar, São Paulo, 01246-902, Brazil
| | - Monique Ribeiro Tiba-Casas
- Centro de Bacteriologia, Instituto Adolfo Lutz, Avenida Dr. Arnaldo 351, 9º Andar, São Paulo, SP, 01246-902, Brazil
| | - Maristela Pinheiro Freire
- Faculdade de Medicina, Universidade de São Paulo, Avenida Dr. Arnaldo 455, São Paulo, 01246-902, Brazil
| | - Pasqual Barretti
- Faculdade de Medicina de Botucatu, Universidade Estadual Paulista, Av. Prof. Montenegro, S/N, Botucatu, 18618-687, Brazil
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