Abstract
ObjectivesCarbapenemase-producing Klebsiella pneumoniae (CP-Kp) is a major cause of infections in transplanted patients and has been associated with high mortality rates in this group. There is a lack of information about the Brazilian structure population of CP-Kp isolated from transplanted patients. By whole-genome sequencing (WGS), we analyzed phylogeny, resistome, virulome of CP-Kp isolates, and the structure of plasmids encoding blaKPC–2 and blaNDM–1 genes.MethodsOne K. pneumoniae isolated from each selected transplanted patient colonized or infected by CP-Kp over a 16-month period in a hospital complex in Porto Alegre (Brazil) was submitted for WGS. The total number of strains sequenced was 80. The hospital complex in Porto Alegre comprised seven different hospitals. High-resolution SNP typing, core genome multilocus sequence typing (cgMLST), resistance and virulence genes inference, and plasmid reconstruction were performed in 80 CP-Kp.ResultsThe mortality rate of CP-Kp colonized or infected transplanted inpatients was 21.3% (17/80). Four CP-Kp epidemic clones were described: ST11/KPC-2, ST16/KPC-2, and ST15/NDM-1, all responsible for interhospital outbreaks; and ST437/KPC-2 affecting a single hospital. The average number of acquired resistance and virulence genes was 9 (range = 2–14) and 27 (range = 6–36), respectively. Two plasmids carrying the blaKPC–2 were constructed and belonged to IncN and IncM types. Additionally, an IncFIB plasmid carrying the blaNDM–1 was described.ConclusionWe detected intrahospital and interhospital spread of mobile structures and international K. pneumoniae clones as ST11, ST16, and ST15 among transplanted patients, which carry a significant range of acquired resistance and virulence genes and keep spreading across the world.
Highlights
AND OBJECTIVECarbapenemase-resistant Enterobacterales (CRE) infection or colonization is a threat to organ transplant recipients (OTRs)
We detected intrahospital and interhospital spread of mobile structures and international K. pneumoniae clones as ST11, ST16, and ST15 among transplanted patients, which carry a significant range of acquired resistance and virulence genes and keep spreading across the world
The number of patients admitted in each hospital was as follows: hospital A (HA) (61/80, 76.3%), hospital B (HB) (14/80, 17.5%), hospital C (HC) (1/80, 1.3%), and hospital D (HD) (4/80, 5.0%)
Summary
Carbapenemase-resistant Enterobacterales (CRE) infection or colonization is a threat to organ transplant recipients (OTRs). The mortality rates in OTR range from 30% to 50% in infections caused by CRE (Satlin et al, 2014; Xu et al, 2017), and when it is focused only in Klebsiella pneumoniae, this risk of death increases 10-fold (Brizendine et al, 2015; Lanini et al, 2015), resulting in a worldwide public health emergency, because these microorganisms have been reported in all continents (Nordmann et al, 2011; Satlin et al, 2014). The most important mechanisms of carbapenem resistance in Enterobacteriaceae are the plasmid-borne carbapenemases. Many carbapenemase genes are carried in different plasmid types (Poirel et al, 2011; Pitout et al, 2015; Raro et al, 2019)
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