Esposito Fernanda, Cardoso Brenda, Sellera Fábio P, Sano Elder, Fuentes-Castillo Danny, Fontana Herrison, Fuga Bruna, Moura Quézia, Sato Maria I Z, Brandão Carlos J, Lincopan Nilton
Department of Clinical Analysis, School of Pharmacy, University of São Paulo, São Paulo, Brazil.
One Health Brazilian Resistance Project (OneBR), Brazil.
One Health. 2023 Jun 26;17:100594. doi: 10.1016/j.onehlt.2023.100594. eCollection 2023 Dec.
The spread of carbapenemase-producing beyond hospital settings is a global critical issue within a public health and One Health perspective. Another worrisome concern is the convergence of virulence and resistance in healthcare-associated lineages of leading to unfavorable clinical outcomes. During a surveillance study of WHO critical priority pathogens circulating in an impacted urban river in São Paulo, Brazil, we isolate two hypermucoviscous and multidrug-resistant strains (PINH-4250 and PINH-4900) from two different locations near to medical centers. Genomic investigation revealed that both strains belonged to the global high-risk sequence type (ST) ST11, carrying the carbapenemase gene, besides other medically important antimicrobial resistance determinants. A broad virulome was predicted and associated with hypervirulent behavior in the infection model. Comparative phylogenomic analysis of PINH-4250 and PINH-4900 along to an international collection of publicly available genomes of ST11 revealed that both environmental strains were closely related to hospital-associated strains recovered from clinical samples between 2006 and 2018, in São Paulo city. Our findings support that healthcare-associated KPC-2-positive of ST11 clone has successfully expanded beyond hospital settings. In summary, aquatic environments can become potential sources of international clones of displaying carbapenem resistance and hypervirulent behaviors, which is a critical issue within a One Health perspective.
产碳青霉烯酶菌在医院环境之外的传播，从公共卫生和“同一健康”视角来看，是一个全球关键问题。另一个令人担忧的问题是，在医疗保健相关谱系中，毒力和耐药性相互交织，导致了不良的临床结果。在对巴西圣保罗一条受影响城市河流中传播的世界卫生组织关键优先病原体进行监测研究期间，我们从靠近医疗中心的两个不同地点分离出两株高黏液性和多重耐药的菌株（PINH - 4250和PINH - 4900）。基因组调查显示，这两株菌株都属于全球高危序列型（ST）ST11，除了其他医学上重要的抗菌药物耐药决定因素外，还携带碳青霉烯酶基因。预测了一个广泛的毒力组，并将其与感染模型中的高毒力行为相关联。对PINH - 4250和PINH - 4900以及国际上公开可用的ST11基因组集合进行比较系统发育基因组分析，结果显示这两株环境菌株与2006年至2018年在圣保罗市从临床样本中分离出的医院相关菌株密切相关。我们的研究结果支持，医疗保健相关的ST11克隆的KPC - 2阳性菌株已成功扩散到医院环境之外。总之，水生环境可能成为显示碳青霉烯耐药性和高毒力行为的国际克隆菌株的潜在来源，从“同一健康”视角来看，这是一个关键问题。
