LETTER
We read with interest the article by Andrade et al. (1) describing the presence of the KPC-producing Klebsiella pneumoniae clonal complex 258 (CC258), including sequence type 258 (ST258), ST11, and ST437, in Brazilian hospitals. CC258 K. pneumoniae strains have been described in several countries and have been associated with the dissemination of blaKPC-2 and blaKPC-3. As part of the SENTRY Antimicrobial Surveillance Program, we monitored the prevalence of carbapenem resistance among 1,684 Enterobacteriaceae isolates collected during 2010 in five Latin American countries: Argentina (two hospitals), Brazil (six hospitals), Chile (two hospitals), Colombia (one hospital), and Mexico (four hospitals), and we have recently noticed a dramatic increase in carbapenem resistance in these institutions (3). The findings published by Andrade et al. (1) led us to screen isolates for the presence of carbapenemases (3) and evaluate the genetic relationships among KPC-producing K. pneumoniae isolates from Latin America and the presence of CC258.
Among 70 (4.2% overall) carbapenem-nonsusceptible Enterobacteriaceae isolates (MIC, ≥2 μg/ml for imipenem or meropenem) (4) submitted by Latin American hospitals during 2010, blaKPC-2 was detected in 56 strains (3.3% overall; 47 K. pneumoniae, 3 Escherichia coli, 4 Enterobacter cloacae, and 2 Citrobacter freundii strains), and all were recovered from patients in three countries: Argentina (15 strains from two hospitals), Brazil (44 strains from three hospitals), and Colombia (5 strains from one hospital) (Table 1). The remaining carbapenem-resistant strains were either negative for the production of carbapenemases (12 strains) or produced VIM-23 (two strains from Durango, Mexico) (2). All 47 KPC-2-producing K. pneumoniae isolates were typed by pulsed-field gel electrophoresis (PFGE), as previously described (6), and selected strains were evaluated by multilocus sequence type (MLST) according to the instructions on the website http://www.pasteur.fr/recherche/genopole/PF8/mlst/Kpneumoniae.html.
Table 1.
KPC-2-producing Enterobacteriaceae from Latin American hospitals collected during the SENTRY Antimicrobial Surveillance Program in 2010
| Country and city | KPC-2-producing species (no. of strains) | PFGE pattern (no. of strains) | MLSTa |
|---|---|---|---|
| Argentina | |||
| Buenos Aires—hospital 1 | K. pneumoniae (10) | 39A (1) | NTb |
| 39B (1) | ST738 | ||
| 39C (1) | NT | ||
| 39D (2) | ST11 | ||
| 39E (1) | ST11 | ||
| 39F (2) | NT | ||
| 39G (2) | NT | ||
| E. cloacae (1) | NT | NT | |
| Buenos Aires—hospital 2 | K. pneumoniae (1) | 40A (1) | ST258 |
| Brazil | |||
| Brasília | K. pneumoniae (21) | 101A (1) | NT |
| 101B (6) | ST11 | ||
| 101C (4; 3 subtypes) | ST11 | ||
| 101D (4; 2 subtypes) | ST11 | ||
| 101E (3; 2 subtypes) | ST340 | ||
| 101F (1) | ST11 | ||
| 101G (1) | ST11 | ||
| 101H (1) | ST37 | ||
| E. coli (1) | NT | NT | |
| São Luís | K. pneumoniae (2) | 327A | ST737 |
| E. cloacae (1) | NT | NT | |
| São Paulo | K. pneumoniae (12) | 48A (1) | NT |
| 48B (11) | ST437 | ||
| E. coli (2) | NT | NT | |
| Colombia | |||
| Medellin | K. pneumoniae (1) | 44A (1) | ST327 |
| C. freundii (2) | NT | NT | |
| E. cloacae (2) | NT | NT |
Underlined types are those not related to CC258 (>2 different allelic variants).
NT, not tested.
Molecular typing showed that among 10 KPC-2-producing K. pneumoniae strains from one Argentinean hospital, seven different PFGE patterns were detected, and 2 strains tested belonged to ST11, part of CC258 (Table 1). Similar genetic diversity was observed in Brasília, Brazil, where eight different patterns were noted among 21 strains, and among seven strains selected for MLST, six grouped within CC258 (ST11 [5 strains] and ST340) (1) (Table 1). Among 12 isolates collected in São Paulo, Brazil, the strains clustered in two patterns, one having the vast majority of the strains (11/12) and belonging to ST437, also part of CC258. Other hospitals had smaller numbers of strains and, as a consequence, less genetic diversity. CC258-related STs were only detected in one of the three remaining hospitals (hospital 2 in Buenos Aires, Argentina [ST258]) (Table 1). Two new ST types unrelated to CC258, ST737 and ST738, were assigned to strains from São Luís, Brazil, and Buenos Aires, Argentina, respectively.
In summary, STs belonging to CC258 were detected in hospitals from Argentina and Brasília and São Paulo, Brazil, including a total of 34 of 47 KPC-2-producing K. pneumoniae strains collected in Latin American hospitals. In this report, we document and confirm the findings of Andrade et al. (1) and others (5) of the expansion of CC258 strains carrying blaKPC-2 for Latin American hospitals. We further detected CC258 KPC-2-producers among the majority of the carbapenem-resistant strains from monitored Latin American hospitals. The presence of other resistance mechanisms and other strain types was also observed.
ACKNOWLEDGMENTS
We thank the Latin American participants of the SENTRY Antimicrobial Surveillance Program: J. Smayevsky, Buenos Aires, Argentina; J. Casellas, Buenos Aires, Argentina; V. Prado, Santiago, Chile; P. Garcia, Santiago, Chile; J. Robledo, Medellin, Colombia; C. M. Zoccoli, Florianopolis, Brazil; A. C. Gales, São Paulo, Brazil; A. L. Barth, Porto Alegre, Brazil; J. Ribeiro, Brasília, Brazil, R. Morfin-Otero, Guadalajara, Mexico; J. C. Tinoco, Durango, Mexico; P. Del Peloso, Rio de Janeiro, Brazil; E. Garza-González, Monterrey, Mexico; P. Cornejo, Tlalpan, Mexico; and R. Cipriano, São Luís, Brazil.
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