Genomic_epidemiology_of_CTX_M_producing_Klebsiella_pneumoniae_in_Latin_America

Klebsiella pneumoniae is an opportunistic pathogen distributed worldwide. In recent years, this species has emerged as an important cause of nosocomial and community-acquired infections. K. pneumoniae strains are becoming increasingly resistant to most antibiotics, making the options for the treatment of the infections caused by this agent more restricted. Among the several mechanisms found in K. pneumoniae to resist antibiotics, the production of extended spectrum beta-lactamases (ESBL) have emerged as a major problem. Currently, ESBL have been the most spread cephalosporins resistance mechanism around the world4–6. Among many types of ESBL genes, blaCTX-M is the most common one and usually is carried on plasmids. The CTX-M enzymes hydrolyze penicillins, cephalosporins and monobactams, which are the antibiotics of choice for treating enterobacterial infections. There are several CTX-M variants classified in five groups: group 1, group 2, group 8, group 9 and group 25. CTX-M-2 variant present in group 2 was the first characterized variant in Latin American countries and was most prevalent during the 1990s and early 2000s. In Latin America the epidemiology of CTX-M-producing Enterobacteriaceae is changing, and CTX-M-2 has been replaced by other variants10. Additonally, pandemic CTXM-15 has been reported as the most widespread variant. Latin America is a region of the American continent where are located 21 countries with population of approximately 570 million inhabitants. Countries of this region have the higher rates of antimicrobial resistance in Enterobacteriaceae in the world. Socioeconomic differences, ineffective health systems, lack of regulation of access to antibiotics, poor sanitation, among other reasons, favors the emergence and dissemination of resistant strains in this region. Taking into account the above information and that genomic studies on K. pneumoniae in Latin America are still few, a genomic study of K. pneumoniae population in Latin America can contribute to the description of a scenario that can help to improve epidemiologic management of infections, the development of surveillance programs, and control measures.