Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, Peru
ABSTRACT The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a significant public health threat, particularly in low- and middle-income countries (LMICs) with limited surveillance and treatment options. This study examines the genetic diversity, resistance patterns, and transmis...
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American Society for Microbiology
2025-02-01
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| Series: | Microbiology Spectrum |
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| Online Access: | https://journals.asm.org/doi/10.1128/spectrum.01825-24 |
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| author | Fiorella Krapp Diego Cuicapuza Guillermo Salvatierra Jean P. Buteau Catherine Amaro Lizeth Astocondor Noemí Hinostroza Jan Jacobs Coralith García Pablo Tsukayama |
| author_facet | Fiorella Krapp Diego Cuicapuza Guillermo Salvatierra Jean P. Buteau Catherine Amaro Lizeth Astocondor Noemí Hinostroza Jan Jacobs Coralith García Pablo Tsukayama |
| author_sort | Fiorella Krapp |
| collection | DOAJ |
| description | ABSTRACT The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a significant public health threat, particularly in low- and middle-income countries (LMICs) with limited surveillance and treatment options. This study examines the genetic diversity, resistance patterns, and transmission dynamics of 66 CRKP isolates recovered over 5 years (2015–2019) after the first case of CRKP was identified at a tertiary care hospital in Lima, Peru. Our findings reveal a shift from blaKPC-2 to blaNDM-1 as the dominant carbapenemase gene after 2017. Lineage ST45 was the most prevalent and persisted for multiple years, followed by high-risk clones ST11 and ST147. The blaNDM-1 gene was carried almost exclusively by a Tn125-like transposon, similar to the one reported in previous studies from two Peruvian hospitals. Long-read sequencing revealed nearly identical blaNDM-carrying plasmids across the four assessed lineages. A comparative analysis of 1,023 South American CRKP genomes confirmed a unique pattern in Peru, where blaNDM-1 (81.4%) outpaced blaKPC-2, which remained dominant (59.4%) elsewhere. In addition, emerging clones ST45 and ST348 found in Peru were rarely found elsewhere in South America, suggesting potential regional adaptation. In conclusion, our study provides a comprehensive picture of the intra-hospital dynamics of these emerging pathogens and provides a framework for studying their genomic diversity in the understudied South American region.IMPORTANCEThis study provides novel insights into the transmission and genetic diversity of carbapenem-resistant Klebsiella pneumoniae, a bacteria responsible for severe infections, with limited treatment options. By examining isolates recovered over 5 years at a major hospital in Lima, Peru, we demonstrated a shift from one type of resistance gene, blaKPC, to another, blaNDM, which is more challenging to treat. Our findings reveal that specific bacterial lineages carrying the blaNDM gene in a specific plasmid are emerging in Peru, including well-known high-risk strains and others rarely found elsewhere in South America. This pattern highlights an urgent need for targeted surveillance and infection control as these strains pose a significant challenge to healthcare systems. Our study provides crucial data on Klebsiella pneumoniae in Peru, contributing to broader efforts to monitor and control antibiotic-resistant infections in South America and globally. |
| format | Article |
| id | doaj-art-a0f862d52b8340f58f028f76ec14bac6 |
| institution | Kabale University |
| issn | 2165-0497 |
| language | English |
| publishDate | 2025-02-01 |
| publisher | American Society for Microbiology |
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| series | Microbiology Spectrum |
| spelling | doaj-art-a0f862d52b8340f58f028f76ec14bac62025-02-04T14:03:41ZengAmerican Society for MicrobiologyMicrobiology Spectrum2165-04972025-02-0113210.1128/spectrum.01825-24Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, PeruFiorella Krapp0Diego Cuicapuza1Guillermo Salvatierra2Jean P. Buteau3Catherine Amaro4Lizeth Astocondor5Noemí Hinostroza6Jan Jacobs7Coralith García8Pablo Tsukayama9Instituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruFacultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, PeruLaboratorio de Genómica Microbiana, Facultad de Ciencias e Ingeniería, Universidad Peruana Cayetano Heredia, Lima, PeruFacultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, PeruDepartment of Clinical Pathology, Hospital Nacional Cayetano Heredia, Lima, PeruInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruDepartment of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, BelgiumInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruInstituto de Medicina Tropical Alexander von Humboldt, Universidad Peruana Cayetano Heredia, Lima, PeruABSTRACT The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a significant public health threat, particularly in low- and middle-income countries (LMICs) with limited surveillance and treatment options. This study examines the genetic diversity, resistance patterns, and transmission dynamics of 66 CRKP isolates recovered over 5 years (2015–2019) after the first case of CRKP was identified at a tertiary care hospital in Lima, Peru. Our findings reveal a shift from blaKPC-2 to blaNDM-1 as the dominant carbapenemase gene after 2017. Lineage ST45 was the most prevalent and persisted for multiple years, followed by high-risk clones ST11 and ST147. The blaNDM-1 gene was carried almost exclusively by a Tn125-like transposon, similar to the one reported in previous studies from two Peruvian hospitals. Long-read sequencing revealed nearly identical blaNDM-carrying plasmids across the four assessed lineages. A comparative analysis of 1,023 South American CRKP genomes confirmed a unique pattern in Peru, where blaNDM-1 (81.4%) outpaced blaKPC-2, which remained dominant (59.4%) elsewhere. In addition, emerging clones ST45 and ST348 found in Peru were rarely found elsewhere in South America, suggesting potential regional adaptation. In conclusion, our study provides a comprehensive picture of the intra-hospital dynamics of these emerging pathogens and provides a framework for studying their genomic diversity in the understudied South American region.IMPORTANCEThis study provides novel insights into the transmission and genetic diversity of carbapenem-resistant Klebsiella pneumoniae, a bacteria responsible for severe infections, with limited treatment options. By examining isolates recovered over 5 years at a major hospital in Lima, Peru, we demonstrated a shift from one type of resistance gene, blaKPC, to another, blaNDM, which is more challenging to treat. Our findings reveal that specific bacterial lineages carrying the blaNDM gene in a specific plasmid are emerging in Peru, including well-known high-risk strains and others rarely found elsewhere in South America. This pattern highlights an urgent need for targeted surveillance and infection control as these strains pose a significant challenge to healthcare systems. Our study provides crucial data on Klebsiella pneumoniae in Peru, contributing to broader efforts to monitor and control antibiotic-resistant infections in South America and globally.https://journals.asm.org/doi/10.1128/spectrum.01825-24Klebsiella pneumoniaecarbapenem resistancemultidrug resistancewhole-genome sequencingKPC-2NDM-1 |
| spellingShingle | Fiorella Krapp Diego Cuicapuza Guillermo Salvatierra Jean P. Buteau Catherine Amaro Lizeth Astocondor Noemí Hinostroza Jan Jacobs Coralith García Pablo Tsukayama Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, Peru Microbiology Spectrum Klebsiella pneumoniae carbapenem resistance multidrug resistance whole-genome sequencing KPC-2 NDM-1 |
| title | Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, Peru |
| title_full | Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, Peru |
| title_fullStr | Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, Peru |
| title_full_unstemmed | Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, Peru |
| title_short | Emerging carbapenem-resistant Klebsiella pneumoniae in a tertiary care hospital in Lima, Peru |
| title_sort | emerging carbapenem resistant klebsiella pneumoniae in a tertiary care hospital in lima peru |
| topic | Klebsiella pneumoniae carbapenem resistance multidrug resistance whole-genome sequencing KPC-2 NDM-1 |
| url | https://journals.asm.org/doi/10.1128/spectrum.01825-24 |
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