Association of blaNDM-1 with blaKPC-2 and aminoglycoside-modifying enzymes genes among Klebsiella pneumoniae, Proteus mirabilis and Serratia marcescens clinical isolates in Brazil

Abstract Objective Carbapenemase producingEnterobacterales are often involved in healthcare-associated infections worldwide. Therefore, the objective of this study was to investigate the frequency of the main genes for carbapenemases, methylases, aminoglycoside-modifying enzymes (AMEs), and mcr gene, as well as the clonal relationship of enterobacteria isolates resistant to carbapenems and aminoglycosides from colonization and infection in patients from hospitals in northeastern Brazil. Methods The antimicrobial susceptibility was determined by automated system, and the occurrence of carbapenemase, AME and 16S rRNA methylase genes, as well as mcr, was determined by PCR and amplicon sequencing. The genetic variability was determined by ERIC-PCR. Results Among the 35 isolates selected, because they were resistant to carbapenems and aminoglycosides, Klebsiella pneumoniae was the most detected, followed by Proteus mirabilis and Serratia marcescens. AME genes were found in 97% of the isolates. The most common being aph (3)-VI, followed by aac (6')- Ib. blaNDM-1 and blaKPC-2 were detected in 26% and 89% of the isolates, respectively. Five isolates presented these genes concomitantly. According to the literature, this is the first report of the association of blaNDM-1 and blaKPC-2 in P. mirabilis and S. marcescens isolates. The isolates showed a multiclonal profile by ERIC-PCR. Conclusions The emergence of the blaNDM-1associated with blaKPC-2 and AMEs genes in K. pneumoniae, P. mirabilis and S. marcescens isolates, with a multiclonal profile is of concern, as this limits the therapeutic options. These results should alert medical authorities to institute rigorous methods of detection and thus reduce the spread of these bacterial genes.