A 7-Year Brazilian National Perspective on Plasmid-Mediated Carbapenem Resistance in Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii Complex and the Impact of the Coronavirus Disease 2019 Pandemic on Their Occurrence

Abstract

Background

Carbapenemase production is a global public health threat. Antimicrobial resistance (AMR) data analysis is critical to public health policy. Here we analyzed carbapenemase detection trends using the AMR Brazilian Surveillance Network.

Methods

Carbapenemase detection data from Brazilian hospitals included in the public laboratory information system dataset were evaluated. The detection rate (DR) was defined as carbapenemase detected by gene tested per isolate per year. The temporal trends were estimated using the Prais–Winsten regression model. The impact of COVID-19 on carbapenemase genes in Brazil was determined for the period 2015–2022. Detection pre- (October 2017 to March 2020) and post-pandemic onset (April 2020 to September 2022) was compared using the χ ² test. Analyses were performed with Stata 17.0 (StataCorp, College Station, TX).

Results

83 282 bla _KPC and 86 038 bla _NDM were tested for all microorganisms. Enterobacterales DR for bla _KPC and bla _NDM was 68.6% (41 301/60 205) and 14.4% (8377/58 172), respectively. P. aeruginosa DR for bla _NDM was 2.5% (313/12 528). An annual percent increase for bla _NDM of 41.1% was observed, and a decrease for bla _KPC of −4.0% in Enterobacterales, and an annual increase for bla _NDM of 71.6% and for bla _KPC of 22.2% in P. aeruginosa. From 2020 to 2022, overall increases of 65.2% for Enterobacterales, 77.7% for ABC, and 61.3% for P. aeruginosa were observed in the total isolates.

Conclusions

This study shows the strengths of the AMR Brazilian Surveillance Network with robust data related to carbapenemases in Brazil and the impact of COVID-19 with a change in carbapenemase profiles with bla _NDM rising over the years.

Abstract

Seven-year surveillance in Brazil showed a >60% increase in resistance genes during the COVID-19 pandemic, especially bla _NDM in Enterobacterales and Pseudomonas aeruginosa. bla _KPC in Enterobacterales and bla _SPM in P. aeruginosa decreased. These data contribute to Antimicrobial Resistance public policies.