Spread of antimicrobial-resistant clones of the ESKAPEE group: From the clinical setting to hospital effluent

Antimicrobial resistance is a public health concern affecting human, animal, and environmental health. Antimicrobial-resistant pathogens, such as Enterococcus spp., Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp., and Escherichia coli (ESKAPEE), the most important microorganisms involved in healthcare-related infections, can be excreted by patients into hospital effluent which then becomes a reservoir for these pathogens. In this context, we characterized and compared resistant microorganisms of the ESKAPEE group, isolated from hospital effluent and clinical samples from patients of the Pequeno Príncipe Hospital, located at Curitiba, Paraná. Out of 345 microorganisms isolated, 208 from the ESKAPEE group were obtained from hospital effluent and 18 were from clinical samples. Among them, K. pneumoniae was the most frequently identified microorganism in both clinical and environmental settings. The genomic context of the resistance of 52 single-clone isolates with satisfactory genome assembly parameters was analyzed. The identified carbapenem resistance genes were bla_KPC-2,bla_GES-5, and bla_NDM-1. Two Enterobacter kobei isolates co-produced the carbapenemases bla_KPC-2 and bla_GES-5. The samples were defined as polyclonal for K. pneumoniae and E. cloacae complexes and clonal for E. coli isolates. ST392 and ST11 were identified in both clinical and environmental samples of K. pneumoniae that produces Klebsiella pneumoniae carbapenemase (KPC) or New Delhi metallo-β-lactamase (NDM), suggesting the persistence of these microorganisms in hospital effluents. The ESKAPEE group is present in hospitals, and its dissemination through hospital effluents is a significant concern due to its capacity to transfer antimicrobial resistance genes, which poses a risk to public health and food safety.