Abstract
BackgroundThis study aimed to determine the molecular characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates in a hospital in western Chongqing, southwestern China.MethodsA total of 127 unique CRKP isolates were collected from the Yongchuan Hospital of Chongqing Medical University, identified using a VITEK-2 compact system, and subjected to microbroth dilution to determine the minimal inhibitory concentration. Enterobacteriaceae intergenic repeat consensus polymerase chain reaction and multilocus sequence typing were used to analyze the homology among the isolates. Genetic information, including resistance and virulence genes, was assessed using polymerase chain reaction. The genomic features of the CRKP carrying gene bla KPC-2 were detected using whole-genome sequencing.ResultsST11 was the dominant sequence type in the homology comparison. The resistance rate to ceftazidime-avibactam in children was much higher than that in adults as was the detection rate of the resistance gene bla NDM (p < 0.0001). Virulence genes such as mrkD (97.6%), uge (96.9%), kpn (96.9%), and fim-H (84.3%) had high detection rates. IncF (57.5%) was the major replicon plasmid detected, and sequencing showed that the CRKP063 genome contained two plasmids. The plasmid carrying bla KPC-2, which mediates carbapenem resistance, was located on the 359,625 base pair plasmid IncFII, together with virulence factors, plasmid replication protein (rep B), stabilizing protein (par A), and type IV secretion system (T4SS) proteins that mediate plasmid conjugation transfer.ConclusionOur study aids in understanding the prevalence of CRKP in this hospital and the significant differences between children and adults, thus providing new ideas for clinical empirical use of antibiotics.
Highlights
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has received increasing attention worldwide because of the widespread misuse of carbapenem antibiotics, with CRKP difficult to treat (Gong et al, 2018; Yungyuen et al, 2021)
A total of 127 unique isolates were obtained from 21 hospital departments; 13 isolates were from children and the remainder were from adults
56 (44.1%) were from the intensive care unit (ICU), 13 (10.2%) were from the respiratory medicine department, 10 (7.9%) were from the respiratory and critical care medicine department, nine (7.1%) were from the neonatal unit, and the remainder were from the rehabilitation medicine, hepatobiliary surgery, geriatrics, rheumatology, kidney disease, and endocrine departments
Summary
Carbapenem-resistant Klebsiella pneumoniae (CRKP) has received increasing attention worldwide because of the widespread misuse of carbapenem antibiotics, with CRKP difficult to treat (Gong et al, 2018; Yungyuen et al, 2021). In China, the detection rate of blaKPC-2 is approximately 73% (Zhang et al, 2017). The first detection of the OXA-48 enzyme in CRKP was found in a urine sample from a Turkish patient (Poirel et al, 2004), and more than 50 countries reported the OXA-48 outbreak, including Taiwan, Zhejiang, and other areas in China (Lu et al, 2018; Shu et al, 2019). This study aimed to determine the molecular characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates in a hospital in western Chongqing, southwestern China
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