Molecular characterization of carbapenemase-producing Enterobacterales in a tertiary hospital in Lima, Peru.

Carbapenemase-producing Enterobacterales (CPE) are a growing threat to global health and the economy. Understanding the interactions between resistance and virulence mechanisms of CPE is crucial for managing difficult-to-treat infections and informing outbreak prevention and control programs. Here, we report the characterization of 21 consecutive, unique clinical isolates of CPE collected in 2018 at a tertiary hospital in Lima, Peru. Isolates were characterized by phenotypic antimicrobial susceptibility testing and whole-genome sequencing to identify resistance determinants and virulence factors. Seven Klebsiella pneumoniae isolates were classified as extensively drug-resistant. The remaining Klebsiella, Enterobacter hormaechei, and Escherichia coli isolates were multidrug-resistant. Eighteen strains carried the metallo-ß-lactamase NDM-1, two the serine-carbapenemase KPC-2, and one isolate had both carbapenemases. The blaNDM-1 gene was located in the truncated ΔISAba125 element, and the blaKPC-2 gene was in the Tn4401a transposon. ST147 was the most frequent sequence type among K. pneumoniae isolates. Our findings highlight the urgent need to address the emergence of CPE and strengthen control measures and antibiotic stewardship programs in low- and middle-income settings.IMPORTANCEGenomic surveillance of antimicrobial resistance contributes to monitoring the spread of resistance and informs treatment and prevention strategies. We characterized 21 carbapenemase-producing Enterobacterales collected at a Peruvian tertiary hospital in 2018, which exhibited very high levels of resistance and carried numerous resistance genes. We detected the coexistence of carbapenemase-encoding genes (blaNDM-1 and blaKPC-2) in a Klebsiella pneumoniae isolate that also had the PmrB(R256G) mutation associated with colistin resistance. The blaKPC-2 genes were located in Tn4401a transposons, while the blaNDM-1 genes were in the genetic structure Tn125 (ΔISAba125). The presence of high-risk clones among Klebsiella pneumoniae (ST11 and ST147) and Escherichia coli (ST410) isolates is also reported. The study reveals the emergence of highly resistant bacteria in a Peruvian hospital, which could compromise the effectiveness of current treatments and control.

Frequency of colistin resistance in Pseudomonas aeruginosa: first report from Peru. / Frecuencia de resistencia a la colistina en Pseudomonas aeruginosa: primer reporte en el Perú.

This study aimed to determine the frequency of colistin resistance in Pseudomonas aeruginosa isolates obtained from three healthcare facilities in Lima and cryopreserved at the Laboratorio de Resistencia Antimicrobianos e Inmunopatología of the Universidad Peruana Cayetano Heredia (UPCH). The colistin broth disk elution method was used for the phenotypic identification of colistin resistance. We detected the expression of the mcr-1 gene by using the phenotypic diffusion method with combined colistin and ethylenediaminetetraacetic acid (EDTA) disks; and polymerase chain reaction (PCR) was used for molecular identification of the gene. Of the 97 isolates, 7 (7.2%) were resistant to colistin; however, none carried the mcr-1 gene. This is the first report from Peru on clinical isolates of colistin-resistant Pseudomonas aeruginosa, which suggests the need for implementation of appropriate methodologies for the epidemiological surveillance of colistin-resistant pathogens.

El objetivo del estudio fue determinar la frecuencia de resistencia a la colistina en Pseudomonas aeruginosa provenientes de tres establecimientos de salud de Lima, criopreservados en el banco de cepas del Laboratorio de Resistencia a Antimicrobianos e Inmunopatología de la Universidad Peruana Cayetano Heredia (UPCH). El método de elución de discos de colistina en caldo fue empleado para la identificación fenotípica de la resistencia a la colistina; la detección de la expresión del gen mcr-1 se realizó mediante el método fenotípico de difusión de discos combinados de colistina y ácido etilendiaminotetraacético (EDTA) y la reacción en cadena de la polimerasa (PCR) para la identificación molecular del gen. De los 97 aislados estudiados, 7 (7,2%) fueron resistentes a la colistina y ninguno fue portador del gen mcr-1. Este estudio constituye el primer reporte en el Perú de aislados clínicos de Pseudomonas aeruginosa resistentes a la colistina, lo que implica la necesidad de implementar metodologías apropiadas para la vigilancia epidemiológica de patógenos resistentes a la colistina.

A novel AAGAB mutation in a Peruvian family with punctate palmoplantar keratoderma.

Buschke-Fischer-Brauer (BFB) disease is a rare keratoderma characterized by multiple hyperkeratotic lesions on the palms and soles, with an autosomal dominant pattern. In several countries, some genetic alterations have been associated with this clinical entity. A 68-year-old Peruvian woman presenting with hyperkeratotic lesions on both her palms and soles was diagnosed with BFB keratoderma. After sequencing of the genes that had previously been related to this disease, a mutation (c.249C>G) that was predicted to generate a termination codon (Tyr83*) was found in the alpha and gamma adaptin binding protein P34 gene (AAGAB). After treatment with 30% urea plus 10% salicylic acid, the patient experienced an improvement in her condition. Here we report a novel mutation in the AAGAB gene of a patient diagnosed with BFB keratoderma and a treatment that improved her symptoms.

Frecuencia de resistencia a la colistina en Pseudomonas aeruginosa: primer reporte en el Perú

El objetivo del estudio fue determinar la frecuencia de resistencia a la colistina en Pseudomonas aeruginosa provenientes de tres establecimientos de salud de Lima, criopreservados en el banco de cepas del Laboratorio de Resistencia a Antimicrobianos e Inmunopatología de la Universidad Peruana Cayetano Heredia (UPCH). El método de elución de discos de colistina en caldo fue empleado para la identificación fenotípica de la resistencia a la colistina; la detección de la expresión del gen mcr-1 se realizó mediante el método fenotípico de difusión de discos combinados de colistina y ácido etilendiaminotetraacético (EDTA) y la reacción en cadena de la polimerasa (PCR) para la identificación molecular del gen. De los 97 aislados estudiados, 7 (7,2%) fueron resistentes a la colistina y ninguno fue portador del gen mcr-1. Este estudio constituye el primer reporte en el Perú de aislados clínicos de Pseudomonas aeruginosa resistentes a la colistina, lo que implica la necesidad de implementar metodologías apropiadas para la vigilancia epidemiológica de patógenos resistentes a la colistina.

This study aimed to determine the frequency of colistin resistance in Pseudomonas aeruginosa isolates obtained from three healthcare facilities in Lima and cryopreserved at the Laboratorio de Resistencia Antimicrobianos e Inmunopatología of the Universidad Peruana Cayetano Heredia (UPCH). The colistin broth disk elution method was used for the phenotypic identification of colistin resistance. We detected the expression of the mcr-1 gene by using the phenotypic diffusion method with combined colistin and ethylenediaminetetraacetic acid (EDTA) disks; and polymerase chain reaction (PCR) was used for molecular identification of the gene. Of the 97 isolates, 7 (7.2%) were resistant to colistin; however, none carried the mcr-1 gene. This is the first report from Peru on clinical isolates of colistin-resistant Pseudomonas aeruginosa, which suggests the need for implementation of appropriate methodologies for the epidemiological surveillance of colistin-resistant pathogens.

Characterisation of the first KPC-2-producing Klebsiella pneumoniae ST340 from Peru.

OBJECTIVES: The aim of this study was to characterise a KPC-carrying Klebsiella pneumoniae isolate from a Peruvian hospital setting. METHODS: The identity of the isolate was confirmed by amplification and sequencing of the 16S rRNA gene, and the antibiotic resistance profile was determined by disk diffusion and automated methods The sequence type (ST) and phylogenetic group were established by PCR. The presence of different ß-lactamase genes was determined, including blaMBL, blaKPC, blaCTX-M, blaSHV, blaOXA-1-like, blaOXA-2-like, blaOXA-5-like, blaOXA-48-like and blaTEM and up to six different plasmid-encoded AmpC genes as well as class 1 integrons. The conjugability of ß-lactam resistance was assessed by conjugation. RESULTS: The isolate was confirmed to be K. pneumoniae classified as belonging to the KpI phylogenetic group within ST340, which belongs to the high-risk clonal complex 258 (CC258). The isolate was resistant to all ß-lactam agents tested, with only the presence of a non-conjugative blaKPC-2 gene being detected and carried in a non-classical genetic structure. CONCLUSIONS: This is the first description of a member of CC258 and of a blaKPC-2 gene in Peru. Intensive surveillance is needed to determine the relevance of both in this area.

Características epidemiológicas y clínicas en pacientes con vitíligo que acuden al Servicio de Dermatología del Hospital Policia Nacional del Perú Luis Nicasio Sáenz en el periodo enero a junio del 2013 / Epidemiological and clinical characteristics of patients with vitiligo attended in the Dermatology Service at the Hospital of National Police of Peru Luis Saenz Nicasio in the period January to June 2013

Objetivos: Determinar las características epidemiológicas y clínicas en pacientes con vitíligo que acuden al Hospital Policía Nacional del Perú Luis Nicasio Sáenz en el periodo de enero a junio del 2013. Introducción: A nivel mundial el vitíligo, es uno de los trastornos pigmentarios más frecuentes, caracterizado por la aparición de manchas acrómicas secundarias a la destrucción selectiva de melanocitos funcionales Se presenta a cualquier edad, apareciendo en más del 50 por ciento de los casos en menores de 20 años; y en igual proporción en mujeres y varones, siendo las mujeres más propensas a buscar tratamiento. Existe además una historia familiar positiva en al menos el 30 por ciento de los pacientes con vitíligo y es relacionada a múltiples enfermedades autoinmunes. Materiales y Métodos: Se realizó un estudio descriptivo observacional de corte transversal. Se encuestaron 71 pacientes, 2 fichas de recolección fueron eliminadas no poseer información completa. Los 69 pacientes incluidos en el estudio tenían diagnóstico clínico de vitíligo, obteniendo información sobre género, edad actual, edad de inicio, estado civil, grado de instrucción, patrón clínico, antecedentes familiares con vitíligo, y asociación con enfermedades autoinmunes. Los datos fueron sometidos a análisis estadístico en el programa SPSS 22.0 para Windows. Resultados: Se incluyeron 69 pacientes; el 46 por ciento fueron mujeres y el 54 por ciento hombres. La edad promedio fue de ±43.52 años. En el 49.3 por ciento el tiempo transcurrido desde el inicio de la enfermedad hasta el momento del examen fue en el periodo de 1 a 10 años. En el 43.5 por ciento la localización de inicio fue la cara. El 50.7 por ciento presentaron vitíligo vulgar, el 31.9 por ciento el tipo focal. El 10.1 por ciento presentó asociación con enfermedad tiroidea, y el 1.4 por ciento presentó alopecia areata. El 15.9 por ciento presentó antecedentes familiares. Conclusiones: En la población en estudio el vitíligo predominó en...

Objectives: To determine the epidemiological and clinical characteristics in patients with vitiligo who attend the Hospital Policia Nacional del Peru Luis Nicasio Saenz during the period from January to June 2013. Introduction: Vitiligo, is one of the most common pigmentary disorder worldwide, characterized by the appearance of amelanotic macules, secondary to a selective destruction of functional melanocytes. Vitiligo can onset at any age, appearing in more than 50 per cent of cases in people under 20 years old; it presents equally in men or women, the most likely to seek treatment being women. There is also a positive family history on at least 30 per cent of vitiligo patients and it exist an association to multiple autoimmune diseases. Materials and Methods: A descriptive cross-sectional study was carried out. We collect information from 71 patients, 2 records collection were eliminated for not possess complete information. The 69 patients included in the study had a clinical diagnosis of vitiligo, obtaining information on gender, current age, age of onset, marital status, level of education, clinical pattern, family history of vitiligo, and association with autoimmune diseases. The data were subjected to statistical analysis in SPSS 22.0 for Windows. Results: 69 patients were included; 46 per cent were women and 54 per cent men. The average age was 43.52 years ±. In 49.3 per cent the time passed since the onset of the disease until the time of examination was in the period of 1 to 10 years. In 43.5 per cent the most common site of onset of vitiligo lesion was the face. The 50.7 per cent of patients had vitiligo vulgaris, 3l.9 per cent had the focal type. The 10.1 per cent of patients had association with thyroid disease, and 1.4 per cent had alopecia are ataand 15.9 per cent had family history. Conclusions: In the study vitiligo predominated in males, and the most frequent clinical type was vulgar. Association with thyroid disease was found. Important to...

Klebsiella pneumoniae resistente a los carbapenemes: primer caso de carbapenemasa tipo KPC en Perú / Carbapenems resistant Klebsiella pneumoniae: first case of type KPC carbapenemase in Peru

Las betalactamasas que poseen una actividad de carbapenemasa constituyen los más poderosos mecanismos de resistencia a los carbapenemes (imipenem y meropenem). Estas carbapenemasas son identificadas de manera creciente en las enterobacterias, principalmente en Klebsiella pneumoniae. La carbapenemasa de tipo KPC, descrita inicialmente en EE UU y que posee en la actualidad una difusión mundial, ha sido detectada por primera vez en un hospital del Perú. Este hallazgo se ha realizado en el hemocultivo positivo a K. pneumoniae de una paciente diagnosticada de lupus eritematoso sistémico (LES), en hemodiálisis y tratada con diversas asociaciones de antibióticos (que incluyeron carbapenemes), debido a las infecciones nosocomiales que adquirió durante su hospitalización (infección urinaria, neumonía y sepsis). El hallazgo fue confirmado en el Instituto Nacional de Salud mediante pruebas fenotípicas y moleculares.

Carbapenem-hydrolyzing beta-lactamases constitute the most powerful mechanism of resistance to carbapenems (imipenem, meropenem). Carbapenemases have been reported increasingly in Enterobacteriaceae, mostly in Klebsiella pneumoniae. Carbapenemases of the KPC type, reported first from the USA, and then worldwide, have been detected, for the first time in Peru, in a strain of K. pneumoniae isolated from a blood culture from a hemodialyzed patient diagnosed with systemic lupus erythematosus (SLE). The patient was subjected to several antibiotic treatments (including carbapenems), in order to treat her episodes of nosocomial infections (UTI, pneumonia and sepsis). The presence of KPC enzymes in this bacterial strain, has been confirmed by phenotypic and molecular methods in the Peruvian National Health Institute.