1249. Emergence of Diverse Carbapenem-Resistant Enterobacteriaceae (CRE) in the Dominican Republic

Abstract

BackgroundDespite the global threat of CRE, data from resource-limited regions such as the Dominican Republic (DR) are limited. A lack of novel antibiotics and molecular diagnostic tools for outbreak detection, coupled with the role of travel in circulating CRE to and from the DR represent significant challenges to limiting their spread. Here, we report the first molecular characterization of DR CRE isolates and compared them to geographically diverse CRE.MethodsIsolates from DR (one Citrobacter freundii, three Klebsiella pneumoniae), obtained from patients with bacteremia (one) and pneumonia (three), were compared with CRE from a New York City hospital in a Dominican neighborhood, including isolates (two Enterobacter cloacae, one K. pneumoniae) from a patient transferred to NYC from another DR institution. Whole genome sequencing was used to determine multi-locus sequence type (MLST) and resistance gene profiles. Phylogenetic analyses of isolates with same ST were performed.ResultsIsolates from the DR and the Dominican patient were of unique genomic backgrounds including pandemic (K. pneumoniae ST11) and novel sequence types, and harbored either blaKPC-2 or blaKPC-3 (Table 1). Replicon typing suggested that these carbapenemase genes were located on distinct plasmids. Phylogenetic analyses using the NYC collection of ~400 sequenced CRE isolates indicated that DR and NYC K. pneumoniae ST307 isolates were related (33 SNPs). Further review showed that both patients had recent admissions in Puerto Rico (PR), highlighting the role of regional spread. K. pneumoniae ST11 isolates from DR and NYC, on the other hand, were not found to be closely related (1,418–1,440 SNPs).ConclusionGenotyping of DR CRE isolates revealed a high genomic diversity, suggesting multiple introductions. Phylogenetics of K pneumoniae ST307 place these within a global context, demonstrating links across the Caribbean and North America. International surveillance studies integrating genomics are needed to track and limit the spread of CRE in resource-limited settings such as DR. Table 1: Comparison of DR IsolatesOrganismMLSTKPC GeneOrigin K. pneumoniae ST11 bla KPC-2 DRST1040 bla KPC-3 NYC, DR patientST307 bla KPC-2 DR, travel to PRNovel ST bla KPC-3 DR C. freundii ST95 bla KPC-2 DR E. cloacae ST456 bla KPC-3 NYC, DR patientDisclosures A. C. Uhlemann, Merck: Investigator, Grant recipient.