A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence

Seven-year surveillance in Brazil showed a >60% increase in resistance genes during the COVID-19 pandemic, especially bla(NDM) in Enterobacterales and Pseudomonas aeruginosa. bla(KPC) in Enterobacterales and bla(SPM) in P. aeruginosa decreased. These data contribute to Antimicrobial Resistance public policies. Background Carbapenemase production is a global public health threat. Antimicrobial resistance (AMR) data analysis is critical to public health policy. Here we analyzed carbapenemase detection trends using the AMR Brazilian Surveillance Network. Methods Carbapenemase detection data from Brazilian hospitals included in the public laboratory information system dataset were evaluated. The detection rate (DR) was defined as carbapenemase detected by gene tested per isolate per year. The temporal trends were estimated using the Prais-Winsten regression model. The impact of COVID-19 on carbapenemase genes in Brazil was determined for the period 2015-2022. Detection pre- (October 2017 to March 2020) and post-pandemic onset (April 2020 to September 2022) was compared using the & chi;(2) test. Analyses were performed with Stata 17.0 (StataCorp, College Station, TX). Results 83 282 bla(KPC) and 86 038 bla(NDM) were tested for all microorganisms. Enterobacterales DR for bla(KPC) and bla(NDM) was 68.6% (41 301/60 205) and 14.4% (8377/58 172), respectively. P. aeruginosa DR for bla(NDM) was 2.5% (313/12 528). An annual percent increase for bla(NDM) of 41.1% was observed, and a decrease for bla(KPC) of -4.0% in Enterobacterales, and an annual increase for bla(NDM) of 71.6% and for bla(KPC) of 22.2% in P. aeruginosa. From 2020 to 2022, overall increases of 65.2% for Enterobacterales, 77.7% for ABC, and 61.3% for P. aeruginosa were observed in the total isolates. Conclusions This study shows the strengths of the AMR Brazilian Surveillance Network with robust data related to carbapenemases in Brazil and the impact of COVID-19 with a change in carbapenemase profiles with bla(NDM) rising over the years.

Automated summary

A seven-year surveillance in Brazil revealed a significant increase in resistance genes during the COVID-19 pandemic, particularly bla(NDM) in Enterobacterales and Pseudomonas aeruginosa. However, there was a decrease in bla(KPC) in Enterobacterales and bla(SPM) in P. aeruginosa. These findings are important for informing Antimicrobial Resistance public policies.