Expansion of healthcare-associated hypervirulent KPC-2-producing ST11/KL64 beyond hospital settings.

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.