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Reversion of KPC-114 to KPC-2 in ceftazidime-avibactam- resistant/meropenem-susceptible Klebsiella pneumoniae ST11 is related to low mutation rates.
Pariona, Jesus G M; Vásquez-Ponce, Felipe; Becerra, Johana; Martins-Gonçalves, Thais; Pariona, Eva M M; Madueño, Fabio T; Esposito, Fernanda; V de Lima, Aline; Mello Sampaio, Jorge L; Galhardo, Rodrigo S; Lincopan, Nilton.
Afiliación
  • Pariona JGM; Department of Clinical Analysis, Faculty of Pharmaceutical Sciences, Universidade de São Paulo, São Paulo, Brazil.
  • Vásquez-Ponce F; One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil.
  • Becerra J; One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil.
  • Martins-Gonçalves T; Department of Microbiology, Instituto de Ciências Biomédicas II, Universidade de São Paulo, São Paulo, Brazil.
  • Pariona EMM; One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil.
  • Madueño FT; Department of Microbiology, Instituto de Ciências Biomédicas II, Universidade de São Paulo, São Paulo, Brazil.
  • Esposito F; Antimicrobial Resistance Institute of São Paulo (ARIES), São Paulo, Brazil.
  • V de Lima A; One Health Brazilian Resistance Project (OneBR), São Paulo, Brazil.
  • Mello Sampaio JL; Department of Microbiology, Instituto de Ciências Biomédicas II, Universidade de São Paulo, São Paulo, Brazil.
  • Galhardo RS; Universidad Peruana Cayetano Heredia, Unidad de Investigación de Enfermedades Emergentes y Cambio Climático, San Martín de Porres, Peru.
  • Lincopan N; Escola Politécnica, Engenharia Elétrica, Universidade de São Paulo, São Paulo, Brazil.
Microbiol Spectr ; : e0117324, 2024 Aug 27.
Article en En | MEDLINE | ID: mdl-39190636
ABSTRACT
Klebsiella pneumoniae strains that produce Klebsiella pneumoniae Carbapenemase (KPC) variants displaying resistance to ceftazidime-avibactam (CZA) often remain susceptible to meropenem (MEM), suggesting a potential therapeutic use of this carbapenem antibiotic. However, in vitro studies indicate that these sorts of strains can mutate becoming MEM-resistant, raising concerns about the effectiveness of carbapenems as treatment option. We have studied mutation rates occurring from the reversion of MEM-susceptible KPC-114 to MEM-resistant KPC-2, in CZA-resistant K. pneumoniae belonging to ST11. Two-step fluctuation assays (FAs) were conducted. In brief, initial cultures of KPC-114-producing K. pneumoniae showing 1 µg/mL MEM MIC were spread on Mueller-Hinton agar plates containing 2-8 µg/mL MEM. A second step of FA, at 4-16 µg/mL MEM was performed from a mutant colony obtained at 2 µg/mL MEM. Mutation rates were calculated using maximum likelihood estimation. Parental and mutant strains were sequenced by Illumina NextSeq, and mutations were predicted by variant-calling analysis. At 8 µg/mL MEM, mutants derived from parental CZA-resistant (MIC ≥ 64 µg/mL)/MEM-susceptible (MIC = 1 µg/mL) KPC-114-positive K. pneumoniae exhibited an accumulative mutation rate of 3.05 × 10-19 mutations/cell/generation, whereas at 16 µg/mL MEM an accumulative mutation rate of 1.33 × 10-19 mutations/cell/generation resulted in the reversion of KPC-114 (S181_P182 deletion) to KPC-2. These findings highlight that the reversion of MEM-susceptible KPC-114 to MEM-resistant KPC-2, in CZA-resistant K. pneumoniae ST11 is related to low mutation rates suggesting a low risk of therapeutic failure. In vivo investigations are necessary to confirm the clinical potential of MEM against CZA-resistant KPC variants.IMPORTANCEThe emergence of ceftazidime-avibactam (CZA) resistance among carbapenem-resistant Klebsiella pneumoniae is a major concern due to the limited therapeutic options. Strikingly, KPC mutations mediating CZA resistance are generally associated with meropenem susceptibility, suggesting a potential therapeutic use of this carbapenem antibiotic. However, the reversion of meropenem-susceptible to meropenem-resistant could be expected. Therefore, knowing the mutation rate related to this genetic event is essential to estimate the potential use of meropenem against CZA-resistant KPC-producing K. pneumoniae. In this study, we demonstrate, in vitro, that under high concentrations of meropenem, reversion of KPC-114 to KPC-2 in CZA-resistant/meropenem-susceptible K. pneumoniae belonging to the global high-risk ST11 is related to low mutation rates.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Microbiol Spectr Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Microbiol Spectr Año: 2024 Tipo del documento: Article País de afiliación: Brasil Pais de publicación: Estados Unidos