Outbreak report of polymyxin-carbapenem-resistant Klebsiella pneumoniae causing untreatable infections evidenced by synergy tests and bacterial genomes
Year: 2023
Type: article
Study design: Observational Study
Abstract: Polymyxin-carbapenem-resistant Klebsiella pneumoniae (PCR-Kp) with pan (PDR)- or extensively drug-resistant 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.
Source: Scientific Reports
Authors: Marisa Zenaide Ribeiro Gomes, Elisangela Martins de Lima, Caio Augusto Martins Aires, Polyana Silva Pereira, Juwon Yim, Fernando Henrique Silva, Caio Augusto Santos Rodrigues, Thamirys Rachel Tavares e Oliveira, Priscila Pinho da Silva, Cristiane Monteiro Eller, Claudio Marcos Rocha de Souza, Michael J. Rybak, Rodolpho Mattos Albano, Antonio Basílio de Miranda, Edson Machado, Marcos Catanho, Vitoria Pinson Ruggi Dutra, Luciana Sênos de Mello, João Pedro Silva Tonhá, Murillo Marçal Castro, Amanda Aparecida da Silva Machado, Maxuel Cassiano da Silva, Yann Rodrigues Mathuiy, Thaisa Medeiros Tozo
Institutions: Universidade do Estado do Rio de Janeiro, Hospital Universitário Pedro Ernesto, Hospital Federal dos Servidores do Estado, Ministério da Saúde, Instituto Oswaldo Cruz, Fundação Oswaldo Cruz, Universidade Federal Rural do Semi-Árido, Eugene Applebaum College of Pharmacy and Health Sciences, Wayne State University
Language: English
Subfield: Molecular Medicine
Domain: Life Sciences
Open Access status: gold
Estimated APC paid: $2,390
Funders: American Academy of Sleep Medicine, Coordenação de Aperfeiçoamento de Pessoal de Nível Superior, Conselho Nacional de Desenvolvimento Científico e Tecnológico, Fundação Carlos Chagas Filho de Amparo à Pesquisa do Estado do Rio de Janeiro, Fundação Oswaldo Cruz, Office of the Vice-President for Research and Development, Hong Kong University of Science and Technology
Awards: G2924694538, G3914732244
OpenAlex ID: W4366189028