Spread of antimicrobial-resistant clones of the ESKAPEE group: From the clinical setting to hospital effluent
Damaris Krul, Bianca Ribeiro da Silva Negoseki, Adriele Celine Siqueira, Ana Paula de Oliveira Tomaz, Érika Medeiros dos Santos, Inayara de Sousa, Thaís Muniz Vasconcelos, I Marinho, Lavinia Nery Villa Stangler Arend, Dany Mesa, Danieli Conte, Líbera Maria Dalla-Costa
Abstract
Antimicrobial resistance is a public health concern affecting human, animal, and environmental health. Antimicrobial-resistant pathogens, such as E nterococcus spp., S taphylococcus aureus , K lebsiella pneumoniae, A cinetobacter baumannii , P seudomonas aeruginosa, E nterobacter spp., and E scherichia coli (ESKAPEE), the most important microorganisms involved in healthcare-related infections, can be excreted by patients into hospital effluent which then becomes a reservoir for these pathogens. In this context, we characterized and compared resistant microorganisms of the ESKAPEE group, isolated from hospital effluent and clinical samples from patients of the Pequeno Príncipe Hospital, located at Curitiba, Paraná. Out of 345 microorganisms isolated, 208 from the ESKAPEE group were obtained from hospital effluent and 18 were from clinical samples. Among them, K. pneumoniae was the most frequently identified microorganism in both clinical and environmental settings. The genomic context of the resistance of 52 single-clone isolates with satisfactory genome assembly parameters was analyzed. The identified carbapenem resistance genes were bla KPC-2, bla GES-5 , and bla NDM-1 . Two Enterobacter kobei isolates co-produced the carbapenemases bla KPC-2 and bla GES-5 . The samples were defined as polyclonal for K. pneumoniae and E. cloacae complexes and clonal for E. coli isolates. ST392 and ST11 were identified in both clinical and environmental samples of K. pneumoniae that produces Klebsiella pneumoniae carbapenemase (KPC) or New Delhi metallo-β-lactamase (NDM), suggesting the persistence of these microorganisms in hospital effluents. The ESKAPEE group is present in hospitals, and its dissemination through hospital effluents is a significant concern due to its capacity to transfer antimicrobial resistance genes, which poses a risk to public health and food safety. • The bla KPC in hospital wastewater was widely detected. • Co-production of bla KPC and bla GES genes in E. kobei isolates. • ST11 and ST392 K. pneumoniae isolates were identified in clinical and effluent samples • Surveilling hospital effluents is important for monitoring the spread of MDR bacteria