Emergence and establishment of KPC-2-producing ST11 Klebsiella pneumoniae in a general hospital in Shanghai, China

Jingxian Liu,Ying Liu,Pranita Tamma,Jing Yu,Patricia Simner,Jiajia Yu,Lisong Shen,Feng Chen

doi:10.1007/s10096-017-3131-4

Abstract

The aim of this study was to investigate the characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) collected during an outbreak in a Chinese teaching hospital and to provide insights into the prevention and control of nosocomial infection. We collected unique CRKP clinical isolates from 2009 to 2013. Antibiotic-resistant genes were identified by polymerase chain reaction (PCR) and sequencing. The isolates were typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Plasmids were classified using a PCR-based incompatibility/replicon typing method and a replicon sequence typing method. Conjugation experiments were performed to evaluate the transferability of carbapenem-resistant genes. Whole genome sequencing (WGS) was conducted to further investigate the genetic background of the isolates. Infection control practices were reviewed throughout the study period. Klebsiella pneumoniae sequence type (ST) 11 emerged in 2010 and acquired the blaKPC-2 gene by 2011. From 2011 to 2013, ST11 KPC-2-producing CRKP (G type) prevailed as the most common CRKP in our hospital, causing a prolonged outbreak. The majority of these CRKP strains possess an IncFII plasmid, with Tn1721-blaKPC-2-ΔTn3-IS26 bearing the genetic structure for blaKPC-2. Infection prevention control measures available at the time contained the initial outbreak, but had no effect on the spread of CRKP later. This study demonstrated the seriousness concerning the spread of KPC-2-producing ST11 CRKP in a Chinese hospital, indicating that current prevention and control strategies for carbapenem-resistant Enterobacteriaceae (CRE) nosocomial infection need to be investigated and adjusted.

Highlights

The emergence and transmission of carbapenem-resistant Enterobacteriaceae (CRE) over the past two decades has attracted worldwide attention, for its indication that most currently available broad-spectrum antibiotics may no longer be a therapeutic option for some patients [1]
Antibiotic susceptibility tests for tigecycline and colistin were performed using a broth microdilution method, and interpreted by Food and Drug Administration (FDA) and European Committee on Antimicrobial Susceptibility Testing (EUCAST) criteria, respectively, while the remaining antibiotics in Table S2 were tested using the VITEK 2 Compact system combined with a disk diffusion method and interpreted by Clinical and Laboratory Standards Institute (CLSI) criteria
We report an outbreak of carbapenemresistant Klebsiella pneumoniae (CRKP) ST11 in a Chinese hospital over a 4-year period of time

Summary

Introduction

The emergence and transmission of carbapenem-resistant Enterobacteriaceae (CRE) over the past two decades has attracted worldwide attention, for its indication that most currently available broad-spectrum antibiotics may no longer be a therapeutic option for some patients [1]. CRE have disseminated rapidly around the world, resulting in high morbidity and mortality [2]. To combat this problem, many healthcare facilities have implemented aggressive infectious control practices when patients with CRE are identified [3, 4]. As intensive infection control measures (ICMs) can require significant resources and personnel efforts, not all hospitals can implement potential solutions, such as individual patient rooms and dedicated nurses for CRE-positive patients, when healthcare facilities are insufficient in developing countries. We describe the emergence and establishment of carbapenemresistant Klebsiella pneumoniae (CRKP) sequence type (ST) 11 within our hospital and the measures taken to control the outbreak.

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