Phylogeny, resistome, virulome and organizational structure of plasmids containing blaKPC-2 or blaNDM-1 of carbapenemase-producing Klebsiella pneumoniae from transplanted patients. CP-Kp from transplanted patients

Objectives: Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) are a major cause of infections in transplanted patients and have been associated with high mortality rates in this group. There is a lack of information about the Brazilian structure population of CP-Kp isolated from transplanted patients. By WGS we tried to improve the understanding about phylogeny, resistome, virulome and to determine the plasmids encoding blaKPC-2 and blaNDM-1 genes. Methods: Clinical and demographic data were analyzed from 80 colonized or infected transplanted patients over a 16-month period in Brazil. One K. pneumoniae isolate per patient was collected and submitted to high-resolution single nucleotide polymorphism typing, core genome multilocus sequence typing, resistance and virulence genes inference, and plasmid reconstruction.Results: The mortality rate of the transplanted inpatients colonized or infected by CP-Kp was of 21.3% (17/80). The isolates were divided in five clusters and four CP-Kp epidemic clones were identified as outbreaks responsible, being three KPC-2-producer (ST11/KPC-2, outbreak A; ST437/KPC-2, outbreak B; and ST16/KPC-2, outbreak C) and one NDM-1-producer (ST15/NDM-1; outbreak D). CP-Kp presented an average number of 9 (range 2-14) acquired resistance genes. The isolates presented a total average mean of 27 (range 6-36) virulence genes. Two plasmids carrying the blaKPC-2, IncN and IncL/M(pMU407), and one carrying the blaNDM-1, IncFIB(pQil), were detected in this study.Conclusions:We suggest intra- and inter-hospital spread of mobile structures and international K. pneumoniae clones as ST11, ST16 and ST15, which carries a significant range of acquired resistance and virulence gene and keep spreading across the world.