Dynamics and characterization of carbapenemase-producing Enterobacterales isolated from clinical specimens in a private healthcare center in Lima, Peru, from 2018 to 2019

Abstract

Introduction: Antimicrobial resistance is a major and growing concern worldwide. The study aimed to describe the occurrence and characterize the antimicrobial resistance profile of carbapenemase-producing Enterobacterales (CPE) isolated from clinical specimens at a private healthcare center in Lima, Peru, between January 2018 and December 2019.

Methodology: A total of 59 bacterial isolates were identified as CPE using the modified carbapenem inactivation method. Bacterial identification and antimicrobial susceptibility testing were performed using the Vitek 2 system, and colistin susceptibility was determined using the compact antimicrobial susceptibility panel. Five carbapenemase encoding genes, including bla_NDM, bla_IMP, bla_VIM, bla_OXA-48, and bla_KPC, were screened using PCR and lateral flow assay. Also, carbapenemases were screened using the boronic acid- and EDTA-based disk synergy methods. The dynamics of CPE were described every month.

Results: Carbapenemase-producing Klebsiella pneumoniae was the most prevalent agent (83.1%), followed by Providencia spp. (6.8%), Escherichia coli (5.1%), Enterobacter cloacae (3.4%), and Citrobacter freundii (1.6%). The isolation of bla_NDM-carrying CPE was frequent and increased during the second half of 2019, while bla_KPC carriers were detected in the second half of 2018. One CPE carrying bla_OXA-48 was detected in June 2019. No other carbapenemase-encoding genes were detected. Conclusions: This report is among the first to document CPE in private health care institutions in Lima, Peru. Results suggest that the emergence and spread of carbapenemases are becoming a latent and growing threat in private healthcare settings.