First detection and origin of multi-drug resistant Klebsiella pneumoniae ST15 harboring OXA-48 in South America

Objectives: The emergence and spread of carbapenem resistant clones is of major concern for global health. This study aimed to characterize the first detected Klebsiella pneumoniae ST15 harboring the epi-demic carbapenemase OXA-48 in South America.Methods: During a routine colonization screening with carbapenem-resistant bacteria, one K. pneumoniae strain (CGHM01) was isolated from the urine of a hospitalized patient suffering from a neurodegenera-tive disease in Uruguay. We used long-read whole-genome sequencing and a phylogenomic approach to characterize the emergence of K. pneumoniae CGHM01.Results: K. pneumoniae CGHM01 is a multi-drug resistant strain carrying an IncL/M plasmid that encodes the carbapenemase gene blaOXA-48 within the Tn1999.2 transposon. Also, it carries an IncR plasmid har-boring a class I integron with an array of antibiotic resistance genes including the extended-spectrum beta-lactamase blaCTX-M-15. Two copies of blaCTX-M-15 were also inserted in different positions of the chro-mosome. CGHM01 belongs to a ST15 sublineage that likely originated in continental Spain around 2012. Conclusions: The asymptomatic carriage of this strain in the urinary tract warns of difficulties for detec-tion and reporting of emerging carbapenem-resistant clones in new geographic areas where these are not endemic.(c) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy. This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/ )

Automated summary

This study characterized the first detected Klebsiella pneumoniae ST15 carrying the epi-demic carbapenemase OXA-48 in South America. The strain was found to be multi-drug resistant and carried multiple plasmids and transposons. The discovery of this strain in the urinary tract of a patient in Uruguay highlights the difficulties in detecting and reporting emerging carbapenem-resistant clones in non-endemic geographic areas.