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

• Published in: Frontiers in microbiology Vol. 13; p. 831770
• Main Authors: Rocha, Verônica França Diniz, Barbosa, Matheus Sales, Leal, Helena Ferreira, Silva, Giulyana Evelyn Oliveira, Sales, Nabila Monalisa Mendes Dantas, Monteiro, Adriano de Souza Santos, Azevedo, Jailton, Malheiros, Allan Roberto Xavier, Ataide, Ledilce Almeida, Moreira, Beatriz Meurer, Reis, Mitermayer Galvão, Bahia, Fabianna Márcia Maranhão, Reis, Joice Neves
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 09-03-2022
• Subjects: carbapenem-resistant Klebsiella pneumoniae; colistin-resistant Klebsiella pneumoniae; Enterobacterales infections; Microbiology; multidrug-resistant gram-negative bacteria; outbreak; outbreak; Enterobacterales infections; multidrug-resistant gram-negative bacteria; carbapenem-resistant Klebsiella pneumoniae; colistin-resistant Klebsiella pneumoniae
• ISSN: 1664-302X; 1664-302X
• DOI: 10.3389/fmicb.2022.831770

Multidrug-resistant gram-negative bacteria, such as carbapenem and colistin-resistant
(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
gene was detected in 94.7% of the isolates,
in 16.0%, and
in 1.7%. The
,
and
genes were not detected. The
test was negative in all 56 isolates. Alteration of the
gene was detected in 87.5% (
= 49/56) of the isolates, and of these, 49.0% (24/49) had alteration in size probably due to IS
, 22.4% (11/49) did not have the
gene detected, 20.4% (10/49) presented the IS
, 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.