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27/07/2022

Interregional spread of two antibiotic multidrug-resistant bacteria studied by sequencing their entire genome

DNA-bacteria-CIBER

27/07/2022

Vall d'Hebron is one of the participants in the CARB-ES-19 research, led by the CIBER, in which 71 hospitals throughout the peninsula have collaborated.

University Hospital Vall d'Hebron has participated in CARB-ES-19, a multicenter study of the Infectious Diseases area of CIBER (CIBERINFEC), published in Frontiers in Microbiology, which has sequenced the complete genome of the carbapenems-producing enterobacteria K. pneumoniae and E. coli, a threat to public health worldwide because of their resistance to antibiotics and because they cause urinary and systemic infections.  In addition, the study has detected the dissemination of high-risk clones in Spain.
Some enterobacteria are capable of producing carbapenems, enzymes that degrade carbapenem antibiotics, a group of last-line beta-lactam antibiotics, i.e. they are reserved for treating infections that are not responsive to other antibiotics. The increasing incidence of these carbapenem-resistant enterobacteria is a growing international public health problem.

In this research, coordinated by the scientific director of CIBERINFEC Jesús Oteo and researcher at the Centro Nacional de Microbiología del Instituto de Salud Carlos III, have participated in addition to Vall d'Hebron: Instituto de Biomedicina de Sevilla (IBIS), Instituto de Investigación Sanitaria Ramón y Cajal (IRYCIS), Instituto de Investigación Biomédica de A Coruña (INIBIC), Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Fundació Institut d'Investigació Sanitària Illes Balears (IdISBa), Hospital Clínic de Barcelona, and Hospital Universitario Marqués de Valdecilla (IDIVAL).

A total of 71 Spanish hospitals, representing all provinces, have participated in CARB-ES-19, a surveillance project of carbapenems-producing K. pneumoniae and E. coli to determine their incidence, geographical distribution, phylogeny and resistance mechanisms. As Jesús Oteo explains, "this study serves as a first step towards the integration of whole genome sequencing in the surveillance of carbapenemase-producing enterobacteria in Spain, detecting important epidemiological changes, including increased prevalence and incidence compared to previous studies, wide interregional dissemination and increased dissemination of high-risk clones".

A total of 403 samples of K. pneumoniae and E. coli were collected at the hospitals.  Prevalence and incidence were calculated according to population densities, and antibiotic sensitivity was analyzed by microdilution using EUCAST (European Committee for Antimicrobial Susceptibility Testing) criteria. In total, 377 K. pneumoniae and 26 E. coli strains were collected, all of them resistant to at least one carbapenem. Interregional dissemination of eight high-risk K. pneumoniae clones was also detected, two of which (ST512-258/KPC and ST15/OXA-48) were responsible for the majority of bacteremias in this study.

For Javier Cañada, researcher at the Research Laboratory on Antibiotic Resistance and Healthcare-Related Infections of the National Microbiology Center (ISCIII), first author of the paper, "the overall incidence increased by 25% between 2014 and 2019, with a wide geographical distribution, with strains detected in 92% of the 50 Spanish provinces and the presence of seven high-risk clones in at least three provinces".

The researchers consider that this study analyzes the epidemiology of these Enterobacterias by genomic sequencing, "which means a first step towards the integration of this method in surveillance in Spain, helping the development of the Network of Laboratories for the Surveillance of Resistant Microorganisms", Jesús Oteo sentences.

About CIBERINFEC

The CIBER Consortium (Biomedical Research Network Center) depends on the Instituto de Salud Carlos III -Ministry of Science and Innovation. The Infectious Diseases area (CIBERINFEC), promoted through NextGenerationEU funds, is formed by 46 research groups working in four major research programs: Global Health, emerging and re-emerging infections; antimicrobial resistance; HIV/AIDS and sexually transmitted infections; and infections in non-HIV immunocompromised and healthcare-associated infections.
 

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