Klebsiella pneumoniae produtora de KPC-2 no Brasil: epidemiologia genômica de clones de alto risco

Abstract

Concern with the rapid emergence and spread of the blaKPC-2 gene is increasing in Brazil and worldwide, as KPC-producing strains are resistant to most classes of antimicrobials. In this way, the clinically available therapeutic options for the treatment of these infections are limited, resulting in high mortality rates. The epidemiology and control of infections caused by bacteria that disseminate carbapenem resistance genes may be favored by genomic analysis from next-generation sequencing. Thus, this work has used this and other tool to try to elucidate some aspects of virulence, biofilm production, multiresistance and mobile genetic elements in Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae strains in Brazil. The results obtained were frightening, since it was possible to identify a very complex resistome in KPC-producing K. pneumoniae strains belonging to high-risk clones (CG258), also producing biofilms (90.9%), extremely hypermucoviscous and highly virulent, further complicating clinical treatment. The results are even more significant considering the description of a new variant of Tn4401 (Tn4401i) and an atypical IncX3 plasmid (12.757 bp) in a high-risk lineage of K. pneumoniae ST11/CG258, carrying the blaKPC-2 gene into an element non-Tn4401 (NTEKPC-Ic). Further negative aspect was observed that these lineages present high frequency (70%) of blaCTX-M genes coexisting with the gene blaKPC-2. The data contribute "a priori" to the understanding of genetic aspects of adaptation, resistance and virulence of endemic clones producing KPC-2. This study becomes essential so that soon, new strategies can be formulated and implemented to control the expansion of KPC-2-producing K. pneumoniae in Brazil.