AUTHOR=Raro Otávio Hallal Ferreira , da Silva Ravena Maya Cardoso , Filho Edison Moraes Rodrigues , Sukiennik Teresa Cristina Teixeira , Stadnik Claudio , Dias Cícero Armídio Gomes , Oteo Iglesias Jesús , Pérez-Vázquez María 

TITLE=Carbapenemase-Producing Klebsiella pneumoniae From Transplanted Patients in Brazil: Phylogeny, Resistome, Virulome and Mobile Genetic Elements Harboring blaKPC–2 or blaNDM–1

JOURNAL=Frontiers in Microbiology

VOLUME=11

YEAR=2020

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2020.01563

DOI=10.3389/fmicb.2020.01563

ISSN=1664-302X

ABSTRACT=<sec><title>Objectives</title><p>Carbapenemase-producing <italic>Klebsiella pneumoniae</italic> (CP-Kp) is a major cause of infections in transplanted patients and has been associated with high mortality rates in this group. There is a lack of information about the Brazilian structure population of CP-Kp isolated from transplanted patients. By whole-genome sequencing (WGS), we analyzed phylogeny, resistome, virulome of CP-Kp isolates, and the structure of plasmids encoding <italic>bla</italic><sub>KPC–</sub><sub>2</sub> and <italic>bla</italic><sub>NDM–</sub><sub>1</sub> genes.</p></sec><sec><title>Methods</title><p>One <italic>K. pneumoniae</italic> isolated from each selected transplanted patient colonized or infected by CP-Kp over a 16-month period in a hospital complex in Porto Alegre (Brazil) was submitted for WGS. The total number of strains sequenced was 80. The hospital complex in Porto Alegre comprised seven different hospitals. High-resolution SNP typing, core genome multilocus sequence typing (cgMLST), resistance and virulence genes inference, and plasmid reconstruction were performed in 80 CP-Kp.</p></sec><sec><title>Results</title><p>The mortality rate of CP-Kp colonized or infected transplanted inpatients was 21.3% (17/80). Four CP-Kp epidemic clones were described: ST11/KPC-2, ST16/KPC-2, and ST15/NDM-1, all responsible for interhospital outbreaks; and ST437/KPC-2 affecting a single hospital. The average number of acquired resistance and virulence genes was 9 (range = 2–14) and 27 (range = 6–36), respectively. Two plasmids carrying the <italic>bla</italic><sub>KPC</sub><sub>–</sub><sub>2</sub> were constructed and belonged to IncN and IncM types. Additionally, an IncFIB plasmid carrying the <italic>bla</italic><sub>NDM–</sub><sub>1</sub> was described.</p></sec><sec><title>Conclusion</title><p>We detected intrahospital and interhospital spread of mobile structures and international <italic>K</italic>. <italic>pneumoniae</italic> clones as ST11, ST16, and ST15 among transplanted patients, which carry a significant range of acquired resistance and virulence genes and keep spreading across the world.</p></sec>