Multidrug-resistant Klebsiella pneumoniae clinical isolates producing NDM- and OXA-type carbapenemase in Nepal

Abstract

Objectives: The emergence of multidrug-resistant Klebsiella pneumoniae has become a serious problem in medical settings worldwide. Methods: A total of 46 isolates of multidrug-resistant K. pneumoniae were obtained from 2 hospitals in Nepal from October 2018 to April 2019. Results: Most of these isolates were highly resistant to carbapenems, aminoglycosides and fluoroquinolones with the minimum inhibitory concentrations (MICs) of more than 64 μg/mL. These isolates harbored carbapenemase-encoding genes, including blaNDM-1, blaNDM-5, blaOXA-181 and blaOXA-232, and 16S rRNA methyltransferase-encoding genes, including armA, rmtB, rmtC and rmtF. Multilocus sequence typing revealed that 44 of 46 isolates were high-risk clones such as ST11 (2%), ST14 (4%), ST15 (11%), ST37 (2%), ST101 (2%), ST147 (28%), ST231 (13%), ST340 (4%) and ST395 (28%). In particular, ST395 isolates, which spread across medical settings in Nepal, co-harbored blaNDM-5 and rmtB on IncFII plasmids and co-harbored blaOXA-181/-232 and rmtF on ColKP3 plasmids. Several isolates harbored blaOXA-181 or blaNDM-5 on their chromosomes and multi-copies of blaNDM-1 or genes encoding 16S rRNA methyltransferases on their plasmids. Conclusions: The presented study demonstrates that the high-risk clones of multidrug-resistant K. pneumoniae spread in a clonal manner across hospitals in Nepal.