Abstract
Limited data is available on the epidemiology and characteristics of carbapenem-resistant Enterobacteriaceae (CRE) and their associated plasmids or virulence determinants from Sri Lanka. Through whole genome sequencing of CREs from the intensive care units of a Sri Lankan teaching hospital, we identified a carbapenemase gene, blaOXA–181 in 10 carbapenemase-producing Klebsiella pneumoniae isolates (two strains of ST437 and eight strains of ST147) from 379 respiratory specimens. blaOXA–181 was carried in three variants of ColE-type plasmids. K. pneumoniae strains with ompK36 variants showed high minimum inhibitory concentrations to carbapenem. Furthermore, genes encoding for extended spectrum β-lactamases (ESBL), plasmid-mediated quinolone resistance (PMQR) determinants (qnr, aac(6′)-Ib-cr, and oqxAB) were present in all 10 strains. Amino acid substitution in chromosomal quinolone resistance-determining regions (QRDRs) gyrA (Ser83Ile) and parC (Ser80Ile) were also observed. All strains had yersiniabactin genes on mobile element ICEkp. Strict infection control practices and judicious use of antibiotics are warranted to prevent further spread of multidrug-resistant K. pneumoniae.
Highlights
Carbapenem-resistant Enterobacteriaceae (CRE) is a global threat and infections caused by carbapenemresistant Enterobacteriaceae (CRE) are associated with high morbidity and mortality (Centers for Disease Control and Prevention, 2013)
We sequenced the CRE strains isolated from patient specimens in the intensive care units of one Sri Lankan hospital using whole genome sequencing (WGS) to describe their antimicrobial resistance and genetic profiles so as to provide a more in-depth view of the CRE in Sri Lanka
All strains were confirmed K. pneumoniae and the susceptibility testing revealed all strains to be resistant to CIP, CTX, and sensitive to FOS and AK, while Minimum inhibitory concentrations (MICs) for CT was ≤0.5 mg/L and MIC for TG was ≤2 mg/L (Table 1)
Summary
Carbapenem-resistant Enterobacteriaceae (CRE) is a global threat and infections caused by CRE are associated with high morbidity and mortality (Centers for Disease Control and Prevention, 2013). Among all the resistance mechanisms, plasmid-mediated horizontal transfer of carbapenemase genes is the main route for acquiring resistance in CRE (Nordmann et al, 2012). These mobile elements are capable of transferring resistance between different lineages and pose a potential for dissemination. BlaOXA−181 in Sri Lanka have been known to associate with epidemic plasmids carrying numerous antimicrobial resistance genes and virulence factors like yersiniabactin. These interactions were hypothesized to provide a survival advantage for these clones (Holt et al, 2015). We sequenced the CRE strains isolated from patient specimens in the intensive care units of one Sri Lankan hospital using whole genome sequencing (WGS) to describe their antimicrobial resistance and genetic profiles so as to provide a more in-depth view of the CRE in Sri Lanka
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