Impact of the COVID-19 Pandemic on Carbapenem-Resistant Klebsiella pneumoniae in Northern Region, Brazil: A Shift Towards NDM Producers

<b>Background:</b> The global impact of the SARS-CoV-2 pandemic on antimicrobial resistance (AMR) patterns has been significant. In northern Brazil, Carbapenem-resistant <i>Klebsiella pneumoniae</i> (CRKP) are a major concern, with an observed shift from <i>Klebsiella pneumoniae</i> carbapenemase (KPC) to New Delhi metallo-β-lactamase (NDM) during the pandemic. <b>Methods:</b> This cross-sectional study analyzed 775 carbapenem-resistant <i>K. pneumoniae</i> isolates collected from 25 hospitals in the Brazilian Amazon Region (states of Pará and Acre) between 2018 and 2021. The isolates were tested for the presence of carbapenemase genes (<i>bla</i>_KPC, <i>bla</i>_NDM, <i>bla</i>_OXA-48, <i>bla</i>_IMP, <i>bla</i>_VIM, <i>bla</i>_AIM, <i>bla</i>_DIM, <i>bla</i>_GIM and <i>bla</i>_SIM). <b>Results:</b> Of the isolates analyzed, n = 653/775 (84%) were carbapenemase producers, with the most prevalent being <i>bla</i>_KPC n = 446/775 (57.5%) and <i>bla</i>_NDM n = 243/775 (31.4%). A significant increase in NDM producers was observed during the pandemic, rising from n = 1/250 (8.4%) pre-pandemic to n = 222/525 (42.3%) during the pandemic, while KPC producers declined from n = 172/250 (68.8%) to n = 274/525 (52.2%) (<i>p</i> < 0.001). Adult intensive care units (ICUs) were the primary source of isolates n = 357/775 (46%), with a notable increase in tracheal secretion and surveillance swab samples during the pandemic. Regression analysis confirmed a strong upward trend in the prevalence of <i>bla</i>_NDM (R² = 0.778). <b>Conclusions:</b> The shift from KPC to NDM producers in northern Brazil highlights an evolving AMR landscape, partly driven by the pandemic. Strengthened infection control measures, antimicrobial stewardship and continuous surveillance are essential to mitigate the spread of NDM-producing <i>K. pneumoniae</i> in settings with limited resources.