Abstract
Background: The emergence and wide global spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates are of great concern, and the aim of this study was to investigate drug resistance, molecular epidemiology, and genetic relationship of CRKP isolates from patients in Shanghai, China. Methods: A retrospective study was conducted from April 2018 to July 2019, and a total of 133 CRKP isolates were collected. Antimicrobial susceptibility was determined by VITEK-2 automated microbiology analyzer platform (bioMérieux, France) and the broth microdilution method. Polymerase chain reaction assays were used to investigate the presence of drug resistance genes. A modified carbapenem inactivation method was performed to detect carbapenemases. Multilocus sequence typing and pulsed-field gel electrophoresis (PFGE) were conducted for genetic relatedness of 50 CRKP isolates selected. Results: Among 670 isolates of K. pneumoniae, 133 (19.9%) strains were identified as CRKP, of which, 76.7% (102/133) strains were isolated from intensive care units (ICUs). All the 133 CRKP isolates were found to be carbapenemase-producers and harbor blaKPC-2 gene. No other carbapenemase genes of blaNDM, blaOXA-48, blaVIM, and blaIMP were detected. Furthermore, β-lactamase genes of blaSHV, blaCTX, and blaTEM were the most common resistance-associated genes among these KPC-2 producing isolates. All the 133 CRKP strains displayed >95% of resistance to cephalosporins and carbapenems, except for gentamicin, trimethoprim-sulfamethoxazole, amikacin, tigecycline and colistin, and ceftazidime-avibactam. The most common sequence type was ST11, accounting for 90.0% of the 50 CRKP selected, followed by ST15 (10.0%). PFGE analysis clustered the 50 KPC-2-producing isolates into seven (A-G) distinct clonal clusters at 85% cutoff. Of which, A and G were the two major clusters, accounting for the majority of the strains collected in emergency ICU and neurosurgical ICU. And all the strains of clusters D and E were collected in cardiothoracic surgery ICU, except for one strain collected in one outpatient. Conclusion: The KPC-2-producing K. pneumoniae belonged to ST11 was widely disseminated in ICUs, and active and effective surveillance of infection control strategies was initiated to limit the spread of CRKP strains.
Highlights
Klebsiella pneumoniae is a common nosocomial infection pathogen in hospitals, especially the infection caused by carbapenem-resistant K. pneumoniae (CRKP) clinical isolates has spread widely throughout the world[1,2,3,4]
The K. pneumoniae carbapenemases (KPCs)-2-producing K.pneumoniae belonged to ST11 was widely disseminated in intensive care unit (ICU), and active and effective surveillance of infection control strategies was initiated to limit the spread of CRKP strains
Antimicrobial susceptibility testing and phenotypic analysis Antimicrobial susceptibility testing was performed by VITEK-2 system and broth microdilution method, and the results were interpreted according to 2018 Clinical and Laboratory Standards Institute(CLSI) guidelines[8] except for colistin and tigecycline, which according to the European Committee on Antimicrobial Susceptibility Testing (EUCAST)[9] interpretive criteria(http://www.eucast.org/)
Summary
Klebsiella pneumoniae is a common nosocomial infection pathogen in hospitals, especially the infection caused by carbapenem-resistant K. pneumoniae (CRKP) clinical isolates has spread widely throughout the world[1,2,3,4]. In China, KPC-producing K. pneumoniae strains were the most predominant in adults, while the NDMproducing strains were mainly isolated in children[7]. The both carbapenemase genes are predominantly plasmid encoded, which facilitated the highly transmission across multiple enterobacterial species. The emergence and wide global spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates are of great concern, and the aim of this study was to investigate drug resistance, molecular epidemiology, and genetic relationship of CRKP isolates from patients in Shanghai, China
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