P-1372. Distribution and Mechanisms of Resistance among Carbapenem-Resistant Enterobacterales in Peru
Authors: Reyes Quevedo Yelinda V , Astocondor Aurora L , Riveros Maribel D , Krapp Fiorella , Huamaní Liliana Caytuiro , Sandoval Roxana , Pérez-Lazo Giancarlo , Cucho Carolina , Sabogal Iván , Lachira Arnaldo , Michilot Kattya , Cuaresma Edwin A , Diaz Roberto R , Amaro Catherine , Briones Alexander , Olivares Araceli , Burgos Segundo A , Garcia Coralith , Melo Manuel , Andrade Stephanie , Hernández Luis A , Lino Liz 
Published: January 2025

Abstract

Background
Carbapenem-resistant Enterobacterales (CRE) are a public health threat due to their rapid worldwide spreading and the limited options to treat these infections.
Our aim was to describe the distribution and the type of carbapenemases produced by CRE isolates recovered in ten hospitals of Peru.

Methods
A prospective collection of CRE isolates from clinical sources was obtained from 10 hospitals, located in Lima (capital of Peru) and other five Peruvian regions (Piura, Lambayeque, Loreto, Pucallpa and Tacna). Only one isolate per patient was included. The present work represents the first 171 consecutive isolates analyzed.
Identification and antimicrobial susceptibility were performed by the Phoenix ID-406 (Becton Dickinson, USA). For the determination of carbapenemase production the modified Carbapenem Inactivation Method was used. For the identification of carbapenemase types the NG-TEST CARBA-5, (Biotech, France) which identifies five carbapenemase families (blaKPC, blaNDM, blaVIM, blaIMP y blaOXA-48), was used.Figure 1:Distribution of Carbapenem resistance genes among hospitals surveilled. 1. Hospital III José Cayetano Heredia Red Asistencial EsSalud Piura; 2. Hospital Regional de Lambayeque, Lambayeque; 3. Hospital Nacional Cayetano Heredia, Lima; 4. Hospital Nacional Dos de Mayo, Lima; 5. Hospital Nacional Guillermo Almenara Irigoyen, Lima; 6. Hospital Regional de Loreto “Felipe Arriola Iglesias”, Loreto; 7. Hospital Nacional Sergio E. Bernales, Lima; 8. Hospital Nacional Daniel Alcides Carrión, Callao; 9. Hospital III Daniel Carrión de EsSalud, Tacna.

Results
CRE isolates (n = 171) were recovered in 9/10 surveilled hospitals. Carbapenemase detection occurred in 94.7% of isolates distributed among 10 species, the most common ones were Klebsiella pneumoniae (66.6%) and Escherichia coli (24.0%) (Table 1).
NDM was the most common carbapenemase detected (59.9%) followed by KPC (25.3%) and OXA-48 (8.0%) distributed mainly among K. pneumoniae and E. coli isolates. Co-production of carbapenemases were identified in 6.8% of CRE isolates, including OXA+NDM among eight E. coli and KPC+NDM in three K. pneumoniae isolates (Table 1).
Regarding the distribution of carbapenemases, NDM was present in 9 hospitals and was the predominant in 6 of them; followed by KPC that was found in 6/9 hospitals and was predominant in one. OXA-48 was found in 4 hospitals (Figure 1).

Conclusion
The most common CRE in Peruvian hospitals are K. pneumoniae and E. coli species, accounting for 90% of all CRE isolates recovered from clinical sources. NDM is the most common carbapenemase, being predominant in 6 out of 9 surveilled hospitals. Double carbapenemase production was detected in over 6% of CRE isolates, both in K. pneumoniae and E.coli isolates.

Disclosures
Giancarlo Pérez-Lazo, n/a, Pfizer: Grant/Research Support|Pfizer: Honoraria Arnaldo Lachira, n/a, MSD: Advisor/Consultant Coralith Garcia, PhD, Pfizer: Advisor/Consultant|Pfizer: Grant/Research Support