Comparative Analysis of Carbapenem-Resistant Sequence Types in Southern Brazil: From the First Outbreak (2007-2008) to the Endemic Period (2013-2014).

is considered an important pathogen of clinical significance that is responsible for a wide range of nosocomial infections. Carbapenem resistance among isolates has increased dramatically in the Past years because of the emergence and dissemination of specific epidemic clones. We aimed to characterize the population structure of isolates from Porto Alegre city, Southern Brazil, in two distinct periods: during the first carbapenem-resistant (CRAB) outbreak (2007-2008) and 5 years later when the CRAB reached endemic levels (2013-2014). The study included 49 CRAB isolates collected in two periods: 2007-2008 (31 isolates) and 2013-2014 (18 isolates). Multilocus sequence typing (MLST) was performed according to Institute Pasteur, followed by eBURST analysis. PCR was used to detect integrase gene, NDM, and oxacillinase genes, and also to detect the IS element upstream OXA-23. The eBURST analysis identified the clonal complexes (CCs) CC15, CC32, CC79, CC216, CC221, and CC464 in the first period (2007-2008) and CC1, CC2, CC15, CC79, and CC162 during the endemic period (2013-2014). Molecular analysis by MLST identified 13 new sequence types. As we found with the OXA-23 gene of several CCs, it can be concluded that the increase of CRAB infections are not related to a specific clone. Furthermore, the high-risk CC15 and CC79 were related to the first CRAB outbreak and these CCs persisted up to 2014 in Porto Alegre city. The international clones CC1 and CC2 were observed for the first time in only the second period (2013-2014), alerting to the emergence of these clones in Southern Brazil.