Abstract
BackgroundCarbapenem-resistant Klebsiella pneumoniae are becoming increasingly common in hospital settings worldwide and are a source of increased morbidity, mortality and health care costs. The global epidemiology of carbapenem-resistant K. pneumoniae is characterized by different strains distributed geographically, with the strain ST258 being predominant in Europe and USA, and ST11 being most common in East Asia. ST15 is a less frequently occurring strain but has nevertheless been reported worldwide as a source of hospital outbreaks of carbapenem-resistant K. pneumoniae.MethodsIn this study, whole-genome sequencing and antimicrobial susceptibility testing was used to characterize 57 clinical isolates of carbapenem-resistant K. pneumoniae belonging to a strain of ST15, which were collected at a Vietnamese pediatric hospital from February throughout September 2015.ResultsAside from the carbapenem resistance gene blaKPC-2, which was carried by all isolates, prevalence of resistance genes to other antibiotics including aminoglycosides, macrolides, quinolones, fosfomycin and trimethoprim, was also high. All isolates were multidrug-resistant. Susceptibility was highest to ceftazidime/avibactam (96%), gentamicin (91%) and tigecycline (82%). Notably, the colistin resistance rate was very high (42%). Single-nucleotide polymorphism analysis indicated that most isolates belonged to a single clone.ConclusionsThe diverse variety of antibiotic resistance genes and the high antibiotic resistance rates to last-resort antibiotics such as carbapenems and colistin, is indicative of a highly adaptable strain. This emphasizes the importance of implementation of infection controls measures, continued monitoring of antibiotic resistance and prudent use of antibiotics to prevent further selection of resistant strains and the emergence of pan-resistant clones.
Highlights
Emerging multidrug-resistant gram-negative bacteria are a global problem causing increased morbidity, mortality and health care costs, which threaten the modern medical system
Problematic is the dissemination of genes encoding carbapenem resistance among Klebsiella pneumoniae, with increasing prevalence reported in Europe [1], USA [2] and China [3]
While ST15 isolates in specific outbreaks can be highly homogenic [9, 11], a high variability in antibiotic susceptibility and antibiotic resistance determinants among ST15 isolates from different study locations are indicative of a group of bacteria with high potential for horizontal gene acquisition
Summary
Emerging multidrug-resistant gram-negative bacteria are a global problem causing increased morbidity, mortality and health care costs, which threaten the modern medical system. Problematic is the dissemination of genes encoding carbapenem resistance among Klebsiella pneumoniae, with increasing prevalence reported in Europe [1], USA [2] and China [3]. The global epidemiology of carbapenem-resistant K. pneumoniae (CR-KP) is characterized by the spread of strains with mainly KPC-, NDM- and OXA-48-carbapenemases, and the distribution of strains differ geographically. ST15 is another K. pneumoniae clonal group associated with production of extended-spectrum β-lactamases (ESBLs) and carbapenemases and has been indicated in clinical cases and hospital outbreaks worldwide [4]. Carbapenem-resistant Klebsiella pneumoniae are becoming increasingly common in hospital settings worldwide and are a source of increased morbidity, mortality and health care costs. The global epidemiology of carbapenem-resistant K. pneumoniae is characterized by different strains distributed geographically, with the strain ST258 being predominant in Europe and USA, and ST11 being most common in East Asia. ST15 is a less frequently occurring strain but has been reported worldwide as a source of hospital outbreaks of carbapenemresistant K. pneumoniae
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