Abstract
Nosocomial infections caused by multidrug-resistant (MDR) Klebsiella pneumoniae are a major health problem worldwide. The aim of this study was to describe NDM-1-producing K. pneumoniae strains causing bacteremia in a tertiary referral hospital in Mexico. MDR K. pneumoniae isolates were screened by polymerase chain reaction for the presence of resistance genes. In resistant isolates, plasmids were identified and conjugation assays were performed. Clonal diversity and the sequence types were determined by pulsed-field gel electrophoresis and multilocus sequence typing. A total of 80 K. pneumoniae isolates were collected from patients with bacteremia over a 1-year period. These isolates showed a level of resistance of 59% (47/80) to aztreonam, 56–60% (45–48/80) to cephalosporins, 54% (43/80) to colistin and 12.5% (10/80) to carbapenems. The carbapenem resistant isolates were blaNDM–1 carriers and negative for blaKPC, blaNDM, blaIMP, blaVIM and blaOXA–48–like carbapenemases genes. Conjugative plasmids IncFIIA and IncF group with sizes of 82–195 kbp were carriers of blaNDM–1, blaCTX–M–15, blaTEM–1, aac(6′)-Ib and/or aac(3′)-IIa. Clonal variability and nine different multilocus sequence types were detected (ST661, ST683, ST1395, ST2706, ST252, ST1198, ST690, ST1535, and ST3368) for the first time in the isolates carrying blaNDM–1 in Mexico. This study demonstrates that blaNDM–1 has remained within this hospital in recent years and suggests that it is currently the most prevalent carbapenemase among K. pneumoniae MDR strains causing bacteremia in Mexico. The horizontal transfer of blaNDM–1 gene through IncF-like plasmids among different clones demonstrates the dissemination pathway of antimicrobial resistance and underscore the need for strong and urgent joint measures to control the spread of NDM-1 carbapenemase in the hospital.
Highlights
Klebsiella pneumoniae (K. pneumoniae) is the causative agent of community and hospital acquired infections (Ramirez et al, 2019)
Non-duplicate isolates of K. pneumoniae were consecutively collected from all blood cultures of patients with nosocomial bacteremia identified from January to December 2017 at Hospital Civil de Guadalajara, an 899-bed tertiary-care teaching hospital in Guadalajara, Jalisco, Mexico
The isolates were resistant to penicillin/tazobactam 26% (21/80), aztreonam 59% (47/80), cefepime 56% (45/80), ceftriaxone 60% (48/80), imipenem and meropenem 12.5% (10/80), ciprofloxacin 18% (14/80), tobramycin 50% (40/80), gentamicin 55% (44/80), nitrofurantoin 16% (13/80), tigecycline 5% (4/80), trimethoprimsulfamethoxazole 56% (45/80) and colistin 53% (42/80) (Table 2)
Summary
Klebsiella pneumoniae (K. pneumoniae) is the causative agent of community and hospital acquired infections (Ramirez et al, 2019) In recent years, this bacterium has acquired high resistance to broad-spectrum antibiotics such as β-lactams, aminoglycosides, and quinolones (Ferreira et al, 2019). The prevalence of carbapenemases in K. pneumoniae has been little studied in Mexico, recent research has demonstrated that NDM-1 carbapenemase is more frequent than that of KPC (RodríguezZulueta et al, 2013; Bocanegra-Ibarias et al, 2017; AquinoAndrade et al, 2018; Alcántar-Curiel et al, 2019b), which has been reported as endemic in the United States, Brazil, Argentina, Colombia and sporadically in Canada (Lee et al, 2016; Hammoudi Halat and Ayoub Moubareck, 2020)
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