Klebsiella pneumoniae ST307 with OXA-181: threat of a high-risk clone and promiscuous plasmid in a resource-constrained healthcare setting

Abstract Introduction Klebsiella pneumoniae with OXA-48-like enzymes were introduced into Tshwane Tertiary Hospital (TTH) (Pretoria, South Africa) during September 2015, causing nosocomial outbreaks. Methods PCR methodologies and WGS were used to characterize K. pneumoniae with carbapenemases (n = 124) from TTH (July 2015–December 2016). Results PCR was used to track K. pneumoniae ST307 with OXA-181 among 60% of carbapenemase-positive isolates in different wards/units over time and showed the transmission of IncX3 plasmids to other K. pneumoniae clones. WGS identified different ST307 clades: 307_OXA181 (consisting of two lineages, A and B) with OXA-181 on IncX3 plasmids (named p72_X3_OXA181) and clade 307_VIM with VIM-1 on IncFII plasmids. Clade 307_OXA181 lineage B was responsible for the rapid increase and transmission of OXA-181 K. pneumoniae in various wards/units throughout TTH, while the numbers of clade 307_OXA181 lineage A and clade 307_VIM remained low. Separate outbreaks were due to K. pneumoniae ST17 and ST29 with p72_X3_OXA181 plasmids. Conclusions The high-risk clone K. pneumoniae ST307 with OXA-181 rapidly spread to different wards/units despite infection and prevention measures. ST307 clades and lineages seemingly acted differently in outbreak situations. This study also highlighted the threat of promiscuous plasmids such as p72_X3_OXA181.

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High risk exposure to HIV among sexually active individuals who tested negative on rapid HIV Tests in the Tshwane District of South Africa—The importance of behavioural prevention measures

PLoS ONE ◽

10.1371/journal.pone.0192357 ◽

2018 ◽

Vol 13 (2) ◽

pp. e0192357 ◽

Cited By ~ 1

Author(s):

Simnikiwe H. Mayaphi ◽

Desmond J. Martin ◽

Steve A. S. Olorunju ◽

Brian G. Williams ◽

Thomas C. Quinn ◽

...

Keyword(s):

South Africa ◽

High Risk ◽

Risk Exposure ◽

Sexually Active ◽

Prevention Measures

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Prediction of Prognosis in Adult Patients With Carbapenem-Resistant Klebsiella pneumoniae Infection

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.818308 ◽

2022 ◽

Vol 11 ◽

Author(s):

Jihui Chen ◽

Yu Yang ◽

Huimin Yao ◽

Shuhong Bu ◽

Lixia Li ◽

...

Keyword(s):

High Risk ◽

Klebsiella Pneumoniae ◽

Treatment Effectiveness ◽

Risk Group ◽

Clinical Information ◽

Tertiary Hospital ◽

High Risk Group ◽

Adult Patients ◽

Carbapenem Resistant ◽

Prediction Of Prognosis

ObjectiveCarbapenem-resistant Klebsiella pneumoniae (CRKP) infections are associated with poor patient outcomes. We aimed to analyze the clinical information of adult patients with CRKP infection in order to establish a nomogram for mortality risk as well as to determine the treatment effectiveness of different antimicrobial regimens.MethodsAdult patients diagnosed with CRKP infection in a tertiary hospital in Shanghai between September 2019 and March 2021 were included. The clinical characteristics and clinical outcomes of these patients were analyzed.ResultsA total of 199 cases of CRKP infection were examined. Five factors, namely age ≥65 years, respiratory failure, Sequential Organ Failure Assessment score, serum procalcitonin ≥5 ng/mL, and appropriate treatments in 3 days, were found to be associated with 30-day mortality. Upon incorporating these factors, the nomogram achieved good concordance indexes of 0.85 (95% confidence interval [CI]: 0.80–0.90) and well-fitted calibration curves. Receiver-operating characteristic curves for 7-, 15-, and 30-day survival had areas under the curve of 0.90, 0.87, and 0.88, respectively. Three-drug combination therapy was observed to be associated with lower mortality in the high-risk group (adjusted hazard ratio = 0.24, 95% CI: 0.06–0.99) but not in the low-risk group. Ceftazidime–avibactam, fosfomycin, and amikacin were effective against infections caused by CRKP. Tigecycline improved the treatment efficiency in 7 days, but a trend toward increased mortality was seen (HR, 1.69; 95% CI: 0.98–2.94; P = 0.061).ConclusionThe antimicrobial regimen efficacy data and the predictive nomogram established in this study can help clinicians in identifying high-risk adult patients with CRKP infection, improving the therapeutic effect, and reducing mortality.

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Characterization of Multidrug-resistant and Virulent Klebsiella Pneumoniae Strains Belonging to the High-risk CG258 Isolated from Inpatients in Northeastern Brazil

10.21203/rs.3.rs-436335/v1 ◽

2021 ◽

Author(s):

Rafael Nakamura-Silva ◽

Mariana Oliveira-Silva ◽

João Pedro Rueda Furlan ◽

Eliana Guedes Stehling ◽

Carlos Eduardo Saraiva Miranda ◽

...

Keyword(s):

High Risk ◽

Klebsiella Pneumoniae ◽

Tertiary Hospital ◽

Multidrug Resistant ◽

Northeastern Brazil ◽

Hospital Environment ◽

Global Public Health ◽

Antimicrobial Resistance Profile ◽

First Time

Abstract Multidrug-resistant (MDR) and hypervirulent Klebsiella pneumoniae (hvKp) clones have become a major threat to global public health. The CG258 is considered a high-risk CG and the K. pneumoniae strains belonging to it are known to be often multi-resistant and to spread mainly in the hospital environment. This study aimed to characterize the antimicrobial resistance profile, virulence factors, and the clonal relationships among 13 K. pneumoniae strains belonging to CG258 from patients admitted to a tertiary hospital in Teresina, in the state of Piauí, northeastern Brazil. Ten strains were classified as MDR and three as extensively drug-resistant (XDR). Three different β-lactamase-encoding genes ( bla KPC , bla OXA-1- like , and bla CTX-M-Gp1) and six virulence genes ( fimH , ycfM , mrkD , entB , ybtS , and kfu ) were detected. Moreover, two hypermucoviscous K. pneumoniae strains and one capsular K-type 2 were found. Multilocus sequence typing analysis revealed 10 different sequence types (STs) (ST14, ST17, ST20, ST29, ST45, ST101, ST268, ST1800, ST3995, and ST3996) belonging to CG258, being two (ST3995 and ST3996) described for the first time in this study.

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Spread of multidrug-resistant high-risk Klebsiella pneumoniae clones in a tertiary hospital from southern Brazil

Infection Genetics and Evolution ◽

10.1016/j.meegid.2017.10.011 ◽

2017 ◽

Vol 56 ◽

pp. 1-7 ◽

Cited By ~ 11

Author(s):

Guilherme Bartolomeu Gonçalves ◽

João Pedro Rueda Furlan ◽

Eliana Carolina Vespero ◽

Marsileni Pelisson ◽

Eliana Guedes Stehling ◽

...

Keyword(s):

High Risk ◽

Klebsiella Pneumoniae ◽

Tertiary Hospital ◽

Multidrug Resistant ◽

Southern Brazil

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High-risk human papillomavirus detection in self-collected vaginal samples compared with healthcare worker collected cervical samples among women attending gynecology clinics at a tertiary hospital in Pretoria, South Africa

Virology Journal ◽

10.1186/s12985-021-01662-5 ◽

2021 ◽

Vol 18 (1) ◽

Author(s):

Teboho Amelia Tiiti ◽

Tebogo Loraine Mashishi ◽

Varsetile Varster Nkwinika ◽

Ina Benoy ◽

Selokela Gloria Selabe ◽

...

Keyword(s):

South Africa ◽

Human Papillomavirus ◽

High Risk ◽

Healthcare Worker ◽

Age Groups ◽

Tertiary Hospital ◽

P Value ◽

Age Group ◽

Total Group ◽

Mcnemar Test

Abstract Background In 2017, the South African National Department of Health (NDoH) Cervical Cancer Prevention and Control Policy was revised. Human papillomavirus (HPV) testing on self-collected samples may offer improved screening uptake. The objectives of the study were to compare the positivity of high-risk (hr)-HPV deoxyribonucleic acid (DNA) and hrHPV viral messenger ribonucleic acid (mRNA) between healthcare worker-collected cervical and self-collected vaginal samples and investigate the accuracy of the applicator-tampon-based self-collected samples in detecting hrHPV DNA and hrHPV mRNA. Methods A total of 527 women aged 18 years and older and seeking gynecology services at a tertiary hospital in Pretoria, South Africa, were enrolled. Vaginal samples were self-collected using SelfCerv applicator tampon, followed by cervical samples collected by a healthcare worker using a Cervex Brush® Combi. Both samples were tested with the Abbott m2000 analyzer for 14-hrHPV types and 285 paired samples were tested for hrHPV E6/E7 mRNA using the Aptima HR-HPV mRNA assay. The prevalence of hrHPV DNA and hrHPV E6/E7 mRNA was estimated and the positivity between the two collection methods was compared for the total group as well as per age group. Results HrHPV prevalence was 48.0% (95% CI 43.7–52.4) among healthcare worker collected samples and 47.6% (95% CI 43.3–52.0) among self-collected samples. There was no difference in positivity between healthcare worker collection (48.0%) and applicator-tampon-based self-collection, 47.6% (p-value = 0.90). The proportions of hrHPV were equal between the age groups as shown by the McNemar test (p = 0.9036) results for correlated proportions. The prevalence of hrHPV mRNA was 78.6% (95% CI 73.4–83.2) and 58.6% (95% CI 52.6–64.4) for healthcare worker- and self-collection, respectively. The McNemar test for correlated proportions was highly significant (p < 0.0001), indicating that the hrHPV mRNA proportions are not comparable, although this differed between age groups. Conclusions Applicator-tampon-based self-collection has a comparable hrHPV DNA positivity rate as healthcare worker collection but different positivity rates for hrHPV mRNA. Self-sampling showed high concordance with healthcare worker-collected sampling for hrHPV DNA detection, especially regarding HPV 16/18 detection. HrHPV DNA was equally detected between the total group as well as per age group. Implementation of self-sampling using an applicator tampon as a primary screening tool may be considered.

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Methods of deliberate self-harm in a tertiary hospital in South Africa

South African Journal of Psychiatry ◽

10.4102/sajpsychiatry.v26i0.1399 ◽

2020 ◽

Vol 26 ◽

Author(s):

Deirdre Pieterse ◽

Jacqueline Hoare ◽

Kerry-Ann Louw ◽

Elsie Breet ◽

Michelle Henry ◽

...

Keyword(s):

Public Health ◽

South Africa ◽

Emergency Department ◽

Substance Use ◽

Healthcare Setting ◽

Tertiary Hospital ◽

Deliberate Self Harm ◽

Factors Associated ◽

Number Of Patients ◽

Self Harm

Background: Little is known about the methods of deliberate self-harm (DSH) in South Africa (SA), despite the importance of means restriction as a public health strategy to reduce the morbidity and mortality associated with self-harm.Aim: The aim of this study was to investigate the range of methods used in DSH and identify the socio-demographic and clinical factors associated with violent and non-violent methods of DSH among patients treated at a tertiary hospital in SA.Setting: The study was conducted at an urban, tertiary level emergency department at Groote Schuur hospital in Cape Town, South Africa.Method: Data were collected from 238 consecutive DSH patients who presented for emergency department treatment at the hospital. Logistic regression models were used to explore the factors associated with violent and non-violent methods of DSH.Results: Self-poisoning was the most common method of self-harm (80.3%). Prescription medication was the most common form of self-poison (57.6%), while a large number of patients used non-prescription paracetamol (40.9%). In the regression analysis, male gender, stating that the reason for DSH was to escape a situation and history of substance use were associated with violent method of DSH.Conclusion: Improved monitoring of prescription medications commonly used in DSH is integral to public health suicide prevention strategies in SA. This study underscores the need for substance use interventions in the healthcare setting.

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Dissemination of NDM-producing Klebsiella pneumoniae and Escherichia coli high-risk clones in Catalan healthcare institutions

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa459 ◽

2020 ◽

Author(s):

Marta Marí-Almirall ◽

Clara Cosgaya ◽

Cristina Pitart ◽

Joaquim Viñes ◽

Laura Muñoz ◽

...

Keyword(s):

Escherichia Coli ◽

High Risk ◽

Klebsiella Pneumoniae ◽

Antimicrobial Agents ◽

Tertiary Hospital ◽

E Coli ◽

Carbapenem Resistant ◽

Gradient Diffusion ◽

Oxford Nanopore ◽

Clonal Spread

Abstract Objectives To characterize the clonal spread of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli isolates between different healthcare institutions in Catalonia, Spain. Methods Antimicrobial susceptibility was tested by disc diffusion. MICs were determined by gradient diffusion or broth microdilution. Carbapenemase production was confirmed by lateral flow. PCR and Sanger sequencing were used to identify the allelic variants of resistance genes. Clonality studies were performed by PFGE and MLST. Plasmid typing, conjugation assays, S1-PFGE plus Southern blotting and MinION Oxford Nanopore sequencing were used to characterize resistance plasmids. Results Twenty-nine carbapenem-resistant isolates recovered from three healthcare institutions between January and November 2016 were included: 14 K. pneumoniae isolates from a tertiary hospital in the south of Catalonia (hospital A); 2 K. pneumoniae isolates from a nearby healthcare centre; and 12 K. pneumoniae isolates and 1 E. coli isolate from a tertiary hospital in Barcelona (hospital B). The majority of isolates were resistant to all antimicrobial agents, except colistin, and all were NDM producers. PFGE identified a major K. pneumoniae clone (n = 27) belonging to ST147 and co-producing NDM-1 and CTX-M-15, with a few isolates also harbouring blaOXA-48. Two sporadic isolates of K. pneumoniae ST307 and E. coli ST167 producing NDM-7 were also identified. blaNDM-1 was carried in two related IncR plasmid populations and blaNDM-7 in a conjugative 50 kb IncX3 plasmid. Conclusions We report the inter-hospital dissemination of XDR high-risk clones of K. pneumoniae and E. coli associated with the carriage of small, transferable plasmids harbouring blaNDM genes.

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Development and Delivery of a Real-time Hospital-onset COVID-19 Surveillance System Using Network Analysis

Clinical Infectious Diseases ◽

10.1093/cid/ciaa892 ◽

2020 ◽

Cited By ~ 1

Author(s):

James Richard Price ◽

Siddharth Mookerjee ◽

Eleonora Dyakova ◽

Ashleigh Myall ◽

Wendy Leung ◽

...

Keyword(s):

Network Analysis ◽

Real Time ◽

Surveillance System ◽

Healthcare Setting ◽

Prevention Measures ◽

Patient Pathways ◽

Prevention Interventions ◽

Target Prevention ◽

Trends Over Time ◽

Over Time

Abstract Background Understanding nosocomial acquisition, outbreaks, and transmission chains in real time will be fundamental to ensuring infection-prevention measures are effective in controlling coronavirus disease 2019 (COVID-19) in healthcare. We report the design and implementation of a hospital-onset COVID-19 infection (HOCI) surveillance system for an acute healthcare setting to target prevention interventions. Methods The study took place in a large teaching hospital group in London, United Kingdom. All patients tested for SARS-CoV-2 between 4 March and 14 April 2020 were included. Utilizing data routinely collected through electronic healthcare systems we developed a novel surveillance system for determining and reporting HOCI incidence and providing real-time network analysis. We provided daily reports on incidence and trends over time to support HOCI investigation and generated geotemporal reports using network analysis to interrogate admission pathways for common epidemiological links to infer transmission chains. By working with stakeholders the reports were co-designed for end users. Results Real-time surveillance reports revealed changing rates of HOCI throughout the course of the COVID-19 epidemic, key wards fueling probable transmission events, HOCIs overrepresented in particular specialties managing high-risk patients, the importance of integrating analysis of individual prior pathways, and the value of co-design in producing data visualization. Our surveillance system can effectively support national surveillance. Conclusions Through early analysis of the novel surveillance system we have provided a description of HOCI rates and trends over time using real-time shifting denominator data. We demonstrate the importance of including the analysis of patient pathways and networks in characterizing risk of transmission and targeting infection-control interventions.

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