Nosocomial Outbreak of Extensively Drug-Resistant (Polymyxin B and Carbapenem) Klebsiella pneumoniae in a Collapsed University Hospital Due to COVID-19 Pandemic

Antibiotics

Renata Pocente¹  Maria Auxiliadora-Martins¹  María-Eugenia Guazzaroni²  Ana Flavia T. Scaranello²  Rafael Silva-Rocha³  Gilberto G. Gaspar³  Valdes R. Bollela³  Gustavo Tamasco³  Nathália Abichabki⁴  Leonardo N. Andrade⁴ 

[1] Clinics and University Hospital from Ribeirão Preto School of Medicine (FMRP), University of São Paulo (USP), Av. Bandeirantes 3900, Ribeirão Preto 14049-900, SP, Brazil;Faculty of Philosophy, Sciences and Letters of Ribeirão Preto (FFCLRP), University of São Paulo (USP), Av. Bandeirantes 3900, Ribeirão Preto 14049-900, SP, Brazil;Ribeirão Preto School of Medicine (FMRP), University of São Paulo (USP), Av. Bandeirantes 3900, Ribeirão Preto 14049-900, SP, Brazil;School of Pharmaceutical Sciences of Ribeirão Preto (FCFRP), University of São Paulo (USP), Av. Bandeirantes 3900, Ribeirão Preto 14049-900, SP, Brazil;

关键词: clinical evaluation;    polymyxin resistance;    extensively drug-resistance;    multidrug-resistance;    molecular epidemiology;    KPC;   

DOI  :  10.3390/antibiotics11060814

来源: DOAJ

【 摘 要 】

We correlated clinical, epidemiological, microbiological, and genomic data of an outbreak with polymyxin B (PB)- and carbapenem-resistant Klebsiella pneumoniae during the COVID-19 pandemic. Twenty-six PB- and carbapenem-resistant K. pneumoniae were isolated from patients in the COVID-19 ICU (Intensive Care Unit), non-COVID-19 ICU (Intensive Care Unit), clinical, or surgical ward. Bacterial identification, drug susceptibility tests, and DNA sequencing were performed, followed by in silico resistance genes identification. All isolates showed extensively drug-resistant (XDR) phenotypes. Four different sequence types (ST) were detected: ST16, ST11, ST258, and ST437. Nineteen isolates were responsible for an outbreak in the ICU in September 2020. They belong to ST258 and harbored the 42Kb IncX3plasmid (pKP98M3N42) with the same genomic pattern of two K. pneumoniae identified in 2018. Twenty-four isolates carried bla_-KPC-2 gene. No plasmid-mediated colistin (mcr) resistance genes were found. Eight isolates presented mgrB gene mutation. The clonal isolates responsible for the outbreak came from patients submitted to pronation, with high mortality rates in one month. XDR-K. pneumoniae detected during the outbreak presented chromosomal resistance to PB and plasmid-acquired carbapenem resistance due to KPC production in most isolates and 42Kb IncX3(pKP98M3N42) plasmid carrying bla_KPC-2 was associated with ST258 isolates. The outbreak followed the collapse of the local healthcare system with high mortality rates.

【 授权许可】

Unknown