Portal de investigação
Genomic and epidemiological insight of an outbreak of carbapenemaseproducing Enterobacterales in a Portuguese hospital with the emergence of the new KPC-124
Data de publicação:
Data Ahead of Print:
Autores da FMUP
Participantes de fora da FMUP
- Manageiro, Vera
- Cano, Manuela
- Furtado, Cristina
- Iglesias, Carmen
- Reis, Ligia
- Vieira, Patricia
- Teixeira, Aida
- Martins, Claudia
- Veloso, Isabel
- Machado, Jorge
- Canica, Manuela
Unidades de investigação
Abstract
Background: Carbapenemase-producing Enterobacterales (CPE) is an increasing problem in healthcare settings. This study aimed to identify the source of a CPE outbreak that occurred in 2022, in a tertiary hospital in the North of Portugal, to identify exposed patients, and to assess the risk of becoming CPEpositive following hospital admission. Methods: A multi-disciplinary investigation was conducted including descriptive, analytical, and molecular epidemiology, environmental screening, and assessment of infection control measures. Clinical and environmental isolates were analyzed using whole-genome sequencing and phylogenetic analysis. Additionally, a prospective observational cohort study was conducted to further investigate the risk factors associated with the emergence of new cases in cohorts of CPE-negative admitted patients. Results: We observed the presence of multispecies KPC-, IMP-, and/or NDM-producing isolates. Genetically indistinguishable clinical and environmental isolates were found on the same room/ward. The ST45 KPC-3producing Klebsiella pneumoniae clone was the responsible for the outbreak. During patients' treatment, we detected the emergence of resistance to ceftazidime-avibactam, associated with mutations in the blaKPC-3 gene (blaKPC-46, blaKPC-66 and blaKPC-124, the last variant never previously reported), suggesting a vertical evolutionary trajectory. Patients aged >= 75 years, hygiene/feeding-care dependent, and/or subjected to secretion aspiration were risk factors for CPE colonization after hospital admission. Additionally, cases with previous admission to the emergency department suggest that CPE dissemination may occur not only during hospitalization but also in the emergency department. Conclusion: Overall, the study highlights that selection pressure with antibiotics, like ceftazidime-avibactam, is a contributing factor to the emergence of new beta-lactamase variants and antibiotic resistance. It also shows that the hospital environment can be a significant source of CPE transmission, and that routine use of infection control measures and real-time molecular epidemiology investigations are essential to ensure the long-term termination of CPE outbreaks and prevent future resurgences.
Dados da publicação
- ISSN/ISSNe:
- 1876-0341, 1876-035X
- Tipo:
- Article
- Páginas:
- 386-395
- Link para outro recurso:
- www.scopus.com
Journal of Infection and Public Health Elsevier BV
Documentos
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Filiações
Keywords
- Outbreak; CPE; Ceftazidime-avibactam resistance; Portugal; Infection prevention and control
Campos de estudo
Proyectos asociados
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Investigador Principal: José Artur Osório de Carvalho Paiva
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Severe community-acquired pneumonia: from severity assessment to outcome.
Investigador Principal: José Artur Osório de Carvalho Paiva
Estudo Clínico Académico . 2022
Citar a publicação
Manageiro V,Cano M,Furtado C,Iglesias C,Reis L,Vieira P,Teixeira A,Martins C,Veloso I,Machado J,Paiva JA,Canica M. Genomic and epidemiological insight of an outbreak of carbapenemaseproducing Enterobacterales in a Portuguese hospital with the emergence of the new KPC-124. J. Infect. Public Health. 2024. 17. (3):p. 386-395. IF:6,700. (1).
