| Congresso Brasileiro de Microbiologia 2023 | Resumo: 75-1 | ||||
Resumo:Over the last decade, NDM-carbapenemase has silently spread in Brazil, a country with high endemic rates of another carbapenemase, KPC. In this study, we analyzed a large collection of Enterobacterales other than Klebsiella received in our reference laboratory during 2013-2022.
On a continuous and voluntary basis, Instituto Adolfo Lutz, a public health reference laboratory located in Sao Paulo, Brazil, receives clinical isolates associated with outbreaks or sporadic cases of infections/colonization (especially those with unusual antimicrobial resistances) for phenotypic and genotypic antimicrobial resistance surveillance. Thirty-four clinical isolates displaying different PFGE-profiles, and represented by 11 species in the family Enterobacteriaceae (Citrobacter freundii, C. portucalensis, Enterobacter hormaechei, Escherichia coli), Morganellaceae (Morganella morganii, Proteus mirabilis, P. vulgaris, Providencia rettgeri, P. stuartii, Raoultella ornithinolytica) and Yersiniaceae (Serratia marcescens) had their whole genomes sequenced and further analyzed. Polymyxin susceptibility was assessed by broth microdilution.
The blaNDM-1 allele was predominant (n=29), but blaNDM-5 was identified in an E. coli with a novel ST, and the blaNDM-7 was found in E. hormaechei ST45 and E. coli ST1049. Polymyxin was active against all but one Enterobacteriaceae isolate: an mcr-1-producing E. coli presenting MIC = 4 mg/L. Isolates co-producing extended spectrum β-lactamase (ESBL) enzymes were common: CTX-M-15 (n=10), CTX-M-2 (n=4), CTX-M-8 (n=3) were detected, and the mcr-1-producing E. coli was found to produce both CTX-M-8 and CTX-M-55 β-lactamases. The mcr-9 gene was found in 5/8 E. hoermaechei isolates, distributed in four different ST. This study showed that NDM-producing Enterobacterales other than Klebsiella are already spread in Brazil, in diversified species, and co-carrying important resistance genes. Prompt detection and effective implementation of measures to prevent further spread are mandatory for mitigating the dissemination of NDM carbapenemase in hospital settings and preserving the already limited antimicrobial therapy options.
Palavras-chave: Illumina, mcr-9, NDM-1, NDM-5, whole genome sequencing Agência de fomento:FAPESP (2020/06157-2; 2018/21193-5; 2018/21192-9; 2017/50333-7); CNPq (402158/2021-0; 302543/2021-0). | |||||