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OUTBREAK REPORT OF P OLY MYX INCAR BAP ENE M‑R ESISTANT KLEBSIELLA PNEUMONIAE CAUSING UNTREATABLE INFECTIONS EVIDENCED BY SYNERGY TESTS AND BACTERIAL GENOMES
Gomes, Marisa Zenaide Ribeiro et al. | Date Issued: 2023
Author
Gomes, Marisa Zenaide Ribeiro
Lima, Elisangela Martins de
Aires, Caio Augusto Martins
Pereira, Polyana Silva
Yim, Juwon
Silva, Fernando Henrique
Rodrigues, Caio Augusto Santos
Oliveira, Thamirys Rachel Tavares e
Silva, Priscila Pinho da
Eller, Cristiane Monteiro
Souza, Claudio Marcos Rocha de
Rybak, Michael J.
Albano, Rodolpho Mattos
Miranda, Antonio Basílio de
Machado, Edson
Catanho, Marcos
Nucleus of Hospital Research (NPH) study collaborators *
Affilliation
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ, Brasil / Ministério da Saúde. Hospital Federal Servidores do Estado. Rio de janeiro, RJ, Brasill / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ, Brasil / Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto. Comitê de Controle da Infecção Hospitalar. Rio de Janeiro, RJ, Brasil.
Ministério da Saúde. Hospital Federal Servidores do Estado. Rio de janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ, Brasil / Departamento de Ciência da Saúde, Universidade Federal Rural do Semi-Árido (UFERSA). Mossoró, RN, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ, Brasil.
Anti‑Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ, Brasil.
Ministério da Saúde. Hospital Federal Servidores do Estado. Rio de janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ, Brasil
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório Laboratório de Pesquisa em Infecção Hospitalar. Rio de Janeiro, RJ, Brasil.
4Anti‑Infective Research Laboratory, Eugene Applebaum College of Pharmacy and Health Sciences, Department of Medicine, Division of Infectious Diseases, School of Medicine, Wayne State University, Detroit, MI, USA.
Universidade do Estado do Rio de Janeiro. Departamento de Bioquímica, IBRAG. Rio de janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ, Brasil / Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Biologia Molecular Aplicada a Micobactérias. Rio de Janeiro, RJ, Brasil.
Fundação Oswaldo Cruz. Instituto Oswaldo Cruz. Laboratório de Genética Molecular de Microrganismos. Rio de Janeiro, RJ, Brasil.
Abstract
Polymyxin-carbapenem-resistant Klebsiella pneumoniae (PCR-Kp) with pan (PDR)- or extensively drugresistant phenotypes has been increasingly described worldwide. Here, we report a PCR-Kp outbreak causing untreatable infections descriptively correlated with bacterial genomes. Hospital-wide surveillance of PCR-Kp was initiated in December-2014, after the first detection of a K. pneumoniae phenotype initially classified as PDR, recovered from close spatiotemporal cases of a sentinel hospital in Rio de Janeiro. Whole-genome sequencing of clinical PCR-Kp was performed to investigate similarities and dissimilarities in phylogeny, resistance and virulence genes, plasmid structures and genetic polymorphisms. A target phenotypic profile was detected in 10% (12/117) of the tested K. pneumoniae complex bacteria recovered from patients (8.5%, 8/94) who had epidemiological links and were involved in intractable infections and death, with combined therapeutic drugs failing to meet synergy. Two resistant bacterial clades belong to the same transmission cluster (ST437) or might have different sources (ST11). The severity of infection was likely related to patients’ comorbidities, lack of antimicrobial therapy and predicted bacterial genes related to high resistance, survival, and proliferation. This report contributes to the actual knowledge about the natural history of PCR-Kp infection, while reporting from a time when there were no licensed drugs in the world to treat some of these infections. More studies comparing clinical findings with bacterial genetic markers during clonal spread are needed.
Keywords in Portuguese
Relatório de surto de poly myx incar bap pneumoniae causando infecções intratáveis evidenciadas por testes de sinergia e genomas bacterianos
Keywords
Outbreak report of poly myx incar bap ene eneeumoniae
Causing untreatable infections
Evidenced by synergy tests and bacterial genomes
Outbreak report of poly myx incar bap ene Incar bap ene m‑r esistant Klebsiella pn
 
Publisher
Nature Portfolio
Citation
GOMES, Marisa Zenaide Ribeiro et al. Outbreak report of p oly myx incar bap ene m‑r esistant Klebsiella pneumoniae causing untreatable infections evidenced by synergy tests and bacterial genomes. Scientific Report, v. 13: 6238, p. 1 - 19, 2023.
DOI
10.1038/s41598-023-31901-4
ISSN
2045-2322