Abstract
A rectal swab sample was collected from a patient with Guillain–Barré syndrome and enriched in lysogeny broth. Carbapenem-resistant bacteria were selected by China Blue agar plates containing 0.3 μg/ml meropenem. Carbapenemase-producing Klebsiella michiganensis was identified and characterized by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF), immune colloidal gold technique, a conjugation experiment, PCR analysis, and antimicrobial susceptibility testing. The genome of K. michiganensis was determined by whole genome sequencing. Antimicrobial susceptibility testing showed that the K. michiganensis was resistant to imipenem, meropenem, ertapenem, cefmetazole, ceftazidime, cefotaxime, piperacillin/tazobactam, sulbactam/cefoperazone, ceftazidime/avibactam, cefepime, and aztreonam while susceptible to polymyxin B, ciprofloxacin, tigecycline, and amikacin. Immune colloidal gold technique suggested that this strain co-produced three different carbapenemases [Klebsiella pneumoniae carbapenemase (KPC), New Delhi metallo-beta-lactamase (NDM), and Imipenem (IMP)]. Whole genome sequencing analysis indicated that this strain belonged to ST91, and blaKPC–2, blaNDM–1, and blaIMP–4 were carried on different conjugative plasmids. Besides, the co-existence and transferability of blaKPC–2, blaNDM–1, and blaIMP–4 in K. michiganensis facilitates the potential horizontal dissemination and nosocomial spread of resistance genes among multidrug-resistant organisms.
Highlights
Klebsiella michiganensis, first recovered from a toothbrush holder in a Michigan household in 2013, was reported to be closely related to Klebsiella oxytoca with similarity of 16S rRNA sequence as high as 99% (Saha et al, 2013)
During a study to evaluate carbapenem-resistant strains from rectal swabs in 2021, an isolate of K. oxytoca identified by MALDI-TOF MS carrying Klebsiella pneumoniae carbapenemase (KPC)-2, New Delhi metallo-beta-lactamase (NDM)-1, and IMP-4 was detected, and later this isolate was reidentified as K. michiganensis according to whole genome sequencing (WGS) analysis
We report the first clinical K. michiganensis isolate harboring blaKPC−2, blaNDM−1, and blaIMP−4 located on different conjugative plasmids
Summary
Klebsiella michiganensis, first recovered from a toothbrush holder in a Michigan household in 2013, was reported to be closely related to Klebsiella oxytoca with similarity of 16S rRNA sequence as high as 99% (Saha et al, 2013). During a study to evaluate carbapenem-resistant strains from rectal swabs in 2021, an isolate of K. oxytoca identified by MALDI-TOF MS carrying KPC-2, NDM-1, and IMP-4 was detected, and later this isolate was reidentified as K. michiganensis according to whole genome sequencing (WGS) analysis. K. michiganensis K210011 was resistant to all the cephalosporins tested (including cefmetazole, ceftazidime, and cefepime), to the combinations with β-lactamase inhibitors (piperacillin/tazobactam, cefoperazone/sulbactam, and the novel combination ceftazidime/avibactam), and to carbapenems This isolate was susceptible to polymyxin B, ciprofloxacin, tigecycline, and amikacin. K210011 was found to belong to ST91 based on multilocus sequence typing (MLST) by BIGSdb (Jolley et al, 2018) This strain did not harbor virulence genes common in Klebsiella pneumoniae isolates, such as yersiniabactin, colibactin, aerobactin, salmochelin, rmpA, or rmpA2 by Kleborate (Lam et al, 2021). Assembled genome sequences were submitted to the National Center for Biotechnology Information (NCBI) database with accession number JAHNZR000000000
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