학술논문
Dynamics of bla KPC-2 Dissemination from Non-CG258 Klebsiella pneumoniae to Other Enterobacterales via IncN Plasmids in an Area of High Endemicity.
Document Type
Academic Journal
Author
Rada AM; Department of Microbiology and Parasitology, Bacteria and Cancer Group, Universidad de Antioquia, Medellín, Colombia ana.rada@colmayor.edu.co Cesar.Arias@uth.tmc.edu.; Faculad de Ciencias de la Salud, Biociencias Group, Institución Universitaria Colegio Mayor de Antioquia, Medellín, Colombia.; De La Cadena E; Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia.; Agudelo C; Clinica Universitaria Bolivariana, School of Health Sciences, Universidad Pontificia Bolivariana, Medellín, Colombia.; Capataz C; Fundación Clínica del Norte, Bello, Colombia.; Orozco N; Department of Microbiology and Parasitology, Bacteria and Cancer Group, Universidad de Antioquia, Medellín, Colombia.; Pallares C; Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia.; Dinh AQ; Division of infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern Medical School, Houston, Texas, USA.; Panesso D; Division of infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern Medical School, Houston, Texas, USA.; Molecular Genetics and Antimicrobial Resistance Unit-International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.; Ríos R; Division of infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern Medical School, Houston, Texas, USA.; Molecular Genetics and Antimicrobial Resistance Unit-International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.; Diaz L; Division of infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern Medical School, Houston, Texas, USA.; Molecular Genetics and Antimicrobial Resistance Unit-International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.; Correa A; Universidad Santiago de Cali, Facultad de Ciencias Básicas, Cali, Colombia.; Hanson BM; Division of infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern Medical School, Houston, Texas, USA.; Villegas MV; Research Group on Antimicrobial Resistance and Hospital Epidemiology, Universidad El Bosque, Bogotá, Colombia.; Arias CA; Division of infectious Diseases and Center for Antimicrobial Resistance and Microbial Genomics, UTHealth, McGovern Medical School, Houston, Texas, USA ana.rada@colmayor.edu.co Cesar.Arias@uth.tmc.edu.; Molecular Genetics and Antimicrobial Resistance Unit-International Center for Microbial Genomics, Universidad El Bosque, Bogotá, Colombia.; Center for Infectious Diseases, UTHealth, School of Public Health, Houston, Texas, USA.; Restrepo E; Department of Microbiology and Parasitology, Bacteria and Cancer Group, Universidad de Antioquia, Medellín, Colombia.
Source
Publisher: American Society for Microbiology Country of Publication: United States NLM ID: 0315061 Publication Model: Electronic-Print Cited Medium: Internet ISSN: 1098-6596 (Electronic) Linking ISSN: 00664804 NLM ISO Abbreviation: Antimicrob Agents Chemother Subsets: MEDLINE
Subject
Language
English
Abstract
Carbapenem-resistant Enterobacterales (CRE) pose a significant threat to global public health. The most important mechanism for carbapenem resistance is the production of carbapenemases. Klebsiella pneumoniae carbapenemase (KPC) represents one of the main carbapenemases worldwide. Complex mechanisms of bla KPC dissemination have been reported in Colombia, a country with a high endemicity of carbapenem resistance. Here, we characterized the dynamics of dissemination of bla KPC gene among CRE infecting and colonizing patients in three hospitals localized in a highly endemic area of Colombia (2013 and 2015). We identified the genomic characteristics of KPC-producing Enterobacterales recovered from patients infected/colonized and reconstructed the dynamics of dissemination of bla KPC-2 using both short and long read sequencing. We found that spread of bla KPC-2 among Enterobacterales in the participating hospitals was due to intra- and interspecies horizontal gene transfer (HGT) mediated by promiscuous plasmids associated with transposable elements that was originated from a multispecies outbreak of KPC-producing Enterobacterales in a neonatal intensive care unit. The plasmids were detected in isolates recovered in other units within the same hospital and nearby hospitals. The gene "epidemic" was driven by IncN-pST15-type plasmids carrying a novel Tn 4401 b structure and non-Tn 4401 elements (NTE KPC ) in Klebsiella spp., Escherichia coli , Enterobacter spp., and Citrobacter spp. Of note, mcr-9 was found to coexist with bla KPC-2 in species of the Enterobacter cloacae complex. Our findings suggest that the main mechanism for dissemination of bla KPC-2 is HGT mediated by highly transferable plasmids among species of Enterobacterales in infected/colonized patients, presenting a major challenge for public health interventions in developing countries such as Colombia.
(Copyright © 2020 American Society for Microbiology.)
(Copyright © 2020 American Society for Microbiology.)