Intra- and Extra-Hospital Dissemination of IMP-22-Producing Klebsiella pneumonia e in Northern Portugal: The Breach of the Hospital Frontier Toward the Community

Daniela Gonçalves; Pedro Cecílio; Alberta Faustino; Carmen Iglesias; Fernando Branca; Alexandra Estrada; Helena Ferreira

doi:10.3389/fmicb.2021.777054

Intra- and Extra-Hospital Dissemination of IMP-22-Producing Klebsiella pneumonia e in Northern Portugal: The Breach of the Hospital Frontier Toward the Community

Front Microbiol. 2021 Dec 14:12:777054. doi: 10.3389/fmicb.2021.777054. eCollection 2021.

Authors

Daniela Gonçalves^{1

2

3

4}, Pedro Cecílio¹, Alberta Faustino⁵, Carmen Iglesias⁵, Fernando Branca⁵, Alexandra Estrada⁵, Helena Ferreira^{1

2}

Affiliations

¹ Microbiology Laboratory - Biological Sciences Department, Faculty of Pharmacy, University of Porto, Porto, Portugal.
² UCIBIO - Research Unit on Applied Molecular Biosciences, REQUIMTE, Porto, Portugal.
³ ISAVE - Instituto Superior de Saúde, Amares, Portugal.
⁴ CICS - Interdisciplinary Centre in Health Sciences, Amares, Portugal.
⁵ Clinical Pathology Service - Braga Hospital, Braga, Portugal.

Abstract

The emergence of infections (and colonization) with Enterobacteriaceae-producing carbapenemases is a threatening public health problem. In the last decades, we watched an isolated case becoming a brutal outbreak, a sporadic description becoming an endemic problem. The present study aims to highlight the dissemination of IMP-22-producing Klebsiella pneumoniae in the North of Portugal, through the phenotypic and genotypic characterization of isolates collected from hospitalized patients (n=5) and out-patients of the emergency ward of the same acute care hospital (n=2), and isolates responsible for the intestinal colonization of residents in a Long-Term Care Facility (n=4). Pulsed-field gel electrophoresis (PFGE) results, associated with conjugation experiments pointed to a pattern of both vertical and horizontal dissemination. Overall, and complementing other studies that give relevance to IMP-22-producing K. pneumoniae in the clinical settings, here we show for the first time the public health threatening breach of the hospital frontier of this resistance threat, toward the community.

Keywords: Klebsiella pneumoniae; antimicrobial resistance; carbapenemases; intestinal colonization; long-term care facilities; metallo-β-lactamases; nosocomial infections.