摘要：Resistance to carbapenems in
Klebsiella
pneumoniae has been mostly related with the worldwide dissemination of KPC, largely due to the pandemic clones belonging to the complex clonal (CC) 258. To unravel
bla
KPC post-endemic clinical impact, here we describe clinical characteristics of 68 patients from a high complexity hospital, and the molecular and genetic characteristics of their 139
bla
KPC—
K.
pneumoniae (KPC-
Kp) isolates. Of the 26 patients that presented relapses or reinfections, 16 had changes in the resistance profiles of the isolates recovered from the recurrent episodes. In respect to the genetic diversity of KPC-
Kp isolates, PFGE revealed 45 different clonal complexes (CC). MLST for 12 representative clones showed ST258 was present in the most frequent CC (23.0%), however, remaining 11 representative clones belonged to non-CC258 STs (77.0%). Interestingly, 16 patients presented within-patient genetic diversity of KPC-
Kp clones. In one of these, three unrelated KPC-
Kp clones (ST258, ST504, and ST846) and a
bla
KPC—
K.
variicola isolate (ST182) were identified. For this patient, complete genome sequence of one representative isolate of each clone was determined. In
K.
pneumoniae isolates
bla
KPC was mobilized by two Tn
3-like unrelated platforms: Tn
4401b (ST258) and Tn
6454 (ST504 and ST846)
, a new NTE
KPC-IIe transposon for first time characterized also determined in the
K.
variicola isolate of this study. Genome analysis showed these transposons were harbored in different unrelated but previously reported plasmids and in the chromosome of a
K.
pneumoniae (for Tn
4401b). In conclusion, in the
bla
KPC post-endemic dissemination in Colombia, different KPC-
Kp clones (mostly non-CC258) have emerged due to integration of the single
bla
KPC gene in new genetic platforms. This work also shows the intra-patient resistant and genetic diversity of KPC-
Kp isolates. This circulation dynamic could impact the effectiveness of long-term treatments.
