Replacement of KPC-producing pandemic lineages and dissemination of plasmids associated to antimicrobial resistance determinants during inpatient´s hospitalization

ÁLVAREZ, VERÓNICA E.; ALLENDE, NATALIA GARCÍA; MASSÓ, MARIANA G.; PIEKAR MARIA; CAMPOS, JOSEFINA; FOX, BARBARA; GAMBINO, ANAHÍ S; FERNÁNDEZ-CANIGIA LILIANA; QUIROGA, MARÍA PAULA; CENTRÓN, DANIELA

Journal of global antimicrobial resistance

Elsevier

Año: 2022

2213-7165

<div id="abss0001"><h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="cesectitle0002">Objectives</h3><p id="spara003">The emergence of <em>bla</em>_KPC-2 within nosocomial settings has become a major public health crisis worldwide. Our aim was to perform WGS of three KPC-producing Gram-Negative Bacilli (KPC-GNB) strains isolated from a hospitalized patient to identify acquired antimicrobial resistance genes (ARGs).</p></div><div id="abss0002"><h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="cesectitle0003">Methods</h3><p id="spara004">WGS was made using Illumina MiSeq-I, and <em>de novo</em> assembly was achieved using SPAdes. Bioinformatics analysis was done using Resfinder, AMRFinder, ISFinder, plasmidSPAdes, PlasmidFinder, MOB-suite, PLSDB database and IntegronFinder. Conjugation assays were performed to assess the ability of <em>bla</em>_KPC-2 to transfer via a plasmid-related mobilization mechanism.</p></div><div id="abss0003"><h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="cesectitle0004">Results</h3><p id="spara005">High-risk clone KPC-producing <em>Klebsiella pneumoniae</em> sequence type (ST) 258 (HA3) was colonizing an inpatient who later was infected by KPC-producing <em>Escherichia coli</em> ST730 (HA4) and subsequently by KPC-producing <em>K. pneumoniae</em> ST11 (HA15) during hospitalization. Although belonging to different species, both strains causing infections harbored the same gene configuration for dissemination of <em>bla</em>_KPC-2 in related IncM1 plasmids recently found in other KPC-GNB isolated from Hospital Alemán at Ciudad Autónoma de Buenos Aires. Conjugation assays revealed that only pDCVEA4-KPC from <em>E. coli</em> HA4 was successfully transferred with a conjugation frequency of 3.66 × 10¹.</p></div><div id="abss0004"><h3 class="u-h4 u-margin-m-top u-margin-xs-bottom" id="cesectitle0005">Conclusions</h3><p id="spara006">Interchange of multidrug resistant <em>K. pneumoniae</em> lineages, ST258 replaced by ST11, in the framework of colonization and infection by KPC-GNB of an inpatient from our institution was found. In addition, the transfer of the gene configuration of <em>bla</em>_KPC–2 of infecting strains could have occurred in the nosocomial environment, but we cannot rule out that the event took place <em>in vivo</em> within the inpatient during hospitalization.</p></div>