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Molecular epidemiology based on Next Generation Sequencing (NGS) of KPC producing Klebsiella pneumoniae causing hospital related infections in Brasil: EPISEK project

Abstract

We have reported an index case of HAI caused by KpKPC in 2009 with its subsequent dissemination among hospitalized patients in intensive care units of postoperative cardiac surgery in a Brazilian hospital of high complexity [Abboud et al., 2011]. As part of this study (FAPESP 2014/12108 recently finalized and reported), 170 isolates of KpKPC involved in this outbreak over five years were submitted to molecular characterisation and sequencing of genes of resistance and epidemiological investigation using the methodologies of Pulsed Field Gel Electrophoresis (PFGE) and Multilocus Sequence Typing (MLST). We found a prevalence of a single type of carbapenem resistance enzyme (KPC-2), associated with one prevalent clonal pattern by PFGE and phylogenetic type by MLST. In addition, we initiated the complete sequencing analyses in one (1) KpKPC isolate from this outbreak, with identification of multiple resistance genes so far. Although it seems that horizontal transmission of plasmid(s) or mobile genetic element(s) have occurred, our evidence shows that one single prevalent and persistent isolate of K. pneumoniae has predominately occurred in this epidemiological environment, finding also supported by our research group in other environments [Monteiro et al 2016]. This leads us to the hypothesis that before the transmission of mobile elements of resistance occurs in a more prevalent manner, there seems to be a clonal prevalence of a few isolates with better fitness, possibly facilitated by genetic elements related to survival or fitness, at least for K. pneumoniae in similar situations. The EPISEK Project aims to deepen the knowledge and elucidate the conditions involved in the clonal pattern persistence over the five years of study, in addition to further clarifying the micro evolutionary events during the hospital outbreak described. (AU)

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