Prolonged Outbreak of Carbapenem and Colistin-Resistant Klebsiella pneumoniae at a Large Tertiary Hospital in Brazil

Verônica França Diniz Rocha; Matheus Sales Barbosa; Helena Ferreira Leal; Giulyana Evelyn Oliveira Silva; Nabila Monalisa Mendes Dantas Sales; Adriano de Souza Santos Monteiro; Jailton Azevedo; Allan Roberto Xavier Malheiros; Ledilce Almeida Ataide; Beatriz Meurer Moreira; Mitermayer Galvão Reis; Fabianna Márcia Maranhão Bahia; Joice Neves Reis

doi:10.3389/fmicb.2022.831770

Prolonged Outbreak of Carbapenem and Colistin-Resistant Klebsiella pneumoniae at a Large Tertiary Hospital in Brazil

Front Microbiol. 2022 Mar 9:13:831770. doi: 10.3389/fmicb.2022.831770. eCollection 2022.

Authors

Verônica França Diniz Rocha¹, Matheus Sales Barbosa², Helena Ferreira Leal¹, Giulyana Evelyn Oliveira Silva², Nabila Monalisa Mendes Dantas Sales¹, Adriano de Souza Santos Monteiro¹, Jailton Azevedo¹, Allan Roberto Xavier Malheiros³, Ledilce Almeida Ataide³, Beatriz Meurer Moreira⁴, Mitermayer Galvão Reis^{1

5

6}, Fabianna Márcia Maranhão Bahia⁵, Joice Neves Reis^{1

2}

Affiliations

¹ Laboratory of Pathology and Molecular Biology (LPBM), Gonçalo Moniz Research Institute, Oswaldo Cruz Foundation, Candeal, Brazil.
² Faculdade de Farmácia, Universidade Federal da Bahia, Salvador, Brazil.
³ Secretaria da Saúde do Estado da Bahia, Salvador, Brazil.
⁴ Instituto de Microbiologia Paulo de Góes, Universidade Federal Do Rio de Janeiro, Rio de Janeiro, Brazil.
⁵ Faculdade de Medicina da Bahia, Universidade Federal da Bahia, Salvador, Brazil.
⁶ Yale School of Public Health, Yale University, New Haven, CT, United States.

Abstract

Multidrug-resistant gram-negative bacteria, such as carbapenem and colistin-resistant Klebsiella pneumoniae (ColR-CRKP), represent a major problem for health systems worldwide and have high lethality. This study investigated the genetic relationship, antimicrobial susceptibility profile, and resistance mechanisms to ColR-CRKP isolates from patients infected/colonized in a tertiary hospital in Salvador, Bahia/Brazil. From September 2016 to January 2018, 46 patients (56 ColR-CRKP positive cultures) were enrolled in the investigation but clinical and demographic data were obtained from 31 patients. Most of them were men (67.7%) and elderly (median age of 62 years old), and the median Charlson score was 3. The main comorbidities were systemic arterial hypertension (38.7%), diabetes (32.2%), and cerebrovascular disease (25.8%). The average hospitalization stay until ColR-CRKP identification in days were 35.12. A total of 90.6% used mechanical ventilation and 93.7% used a central venous catheter. Of the 31 patients who had the data evaluated, 12 had ColR-CRKP infection, and seven died (58.4%). Previous use of polymyxins was identified in 32.2% of the cases, and carbapenems were identified in 70.9%. The minimum inhibitory concentration (MIC) for colistin was > 16 μg/mL, with more than half of the isolates (55%) having a MIC of 256 μg/mL. The bla _KPC gene was detected in 94.7% of the isolates, bla _NDM in 16.0%, and bla _GES in 1.7%. The bla _OXA-48, bla _VIM, and bla _IMP genes were not detected. The mcr-1 test was negative in all 56 isolates. Alteration of the mgrB gene was detected in 87.5% (n = 49/56) of the isolates, and of these, 49.0% (24/49) had alteration in size probably due to IS903B, 22.4% (11/49) did not have the mgrB gene detected, 20.4% (10/49) presented the IS903B, 6.1% (3/49) had a premature stop codon (Q30*), and 2.1% (1/49) presented a thymine deletion at position 104 - 104delT (F35fs). The PFGE profile showed a monoclonal profile in 84.7% of the isolates in different hospital sectors, with ST11 (CC-258) being the most frequent sequence type. This study presents a prolonged outbreak of ColR-CRKP in which 83.9% of the isolates belonged to the same cluster, and 67.6% of the patients evaluated had not used polymyxin, suggesting the possibility of cross-transmission of ColR-CRKP isolates.

Keywords: Enterobacterales infections; carbapenem-resistant Klebsiella pneumoniae; colistin-resistant Klebsiella pneumoniae; multidrug-resistant gram-negative bacteria; outbreak.