Carbapenem resistance in Escherichia coli and Klebsiella pneumoniae among Indian and international patients in North India

This study was conducted to analyse the presence of a plasmid-mediated carbapenem resistance mechanism in a clinical Enterobacter aerogenes isolate from a patient from Jiangsu province, People’s Republic of China. PCR and sequencing confirmed that the isolate harboured Klebsiella pneumoniae carbapenemase (KPC)-2, DHA-1 and TEM-1 β-lactamase genes. Both the KPC-2 and DHA-1 genes were transferred to Escherichia coli C600 by transconjugation, and Southern blotting confirmed that these two genes were located on the same plasmid, which was of approximately 56 kb in size. The Enterobacter aerogenes isolate was resistant to carbapenems and other tested antimicrobial agents. The Escherichia coli transconjugant showed reduced susceptibility but not resistance to carbapenems and other β-lactams, indicating the presence of another, possibly permeability-related, resistance mechanism in the clinical isolate.

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Emergence of Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli Isolates Possessing the Plasmid-Mediated Carbapenem-Hydrolyzing β-Lactamase KPC-2 in Intensive Care Units of a Chinese Hospital

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01539-07 ◽

2008 ◽

Vol 52 (6) ◽

pp. 2014-2018 ◽

Cited By ~ 125

Author(s):

Jia Chang Cai ◽

Hong Wei Zhou ◽

Rong Zhang ◽

Gong-Xiang Chen

Keyword(s):

Escherichia Coli ◽

Intensive Care ◽

Klebsiella Pneumoniae ◽

Serratia Marcescens ◽

Intensive Care Units ◽

Gel Electrophoresis ◽

Outer Membrane Proteins ◽

Carbapenem Resistance ◽

E Coli ◽

Insertional Inactivation

ABSTRACT Twenty-one Serratia marcescens, ten Klebsiella pneumoniae, and one Escherichia coli isolate with carbapenem resistance or reduced carbapenem susceptibility were recovered from intensive care units (ICUs) in our hospital. Enterobacterial repetitive intergenic consensus-PCR and pulsed-field gel electrophoresis demonstrated that all the S. marcescens isolates belonged to a clonal strain and the 10 K. pneumoniae isolates were indistinguishable or closely related to each other. The MICs of imipenem, meropenem, and ertapenem for all isolates were 2 to 8 μg/ml, except for K. pneumoniae K10 (MICs of 128, 256, and >256 μg/ml). Isoelectric focusing, PCRs, and DNA sequencing indicated that all S. marcescens isolates produced KPC-2 and a β-lactamase with a pI of 6.5. All K. pneumoniae isolates produced TEM-1, KPC-2, CTX-M-14, and a β-lactamase with a pI of 7.3. The E. coli E1 isolate produced KPC-2, CTX-M-15, and a β-lactamase with a pI of 7.3. Conjugation studies with E. coli (EC600) resulted in the transfer of reduced carbapenem susceptibility compared to that of the original isolates, and only the bla KPC-2 gene was detected in E. coli transconjugants. Plasmid restriction analysis showed identical restriction patterns among all E. coli transconjugants. Sodium dodecyl sulfate-polyacrylamide gel electrophoresis and ompK35/36 gene sequence analysis of outer membrane proteins revealed that K. pneumoniae K10 failed to express OmpK36, because of insertional inactivation by an insertion sequence ISEcp1. All these results indicate that KPC-2-producing S. marcescens, K. pneumoniae, and E. coli isolates emerged in ICUs in our hospital. KPC-2 combined with porin deficiency results in high-level carbapenem resistance in K. pneumoniae. The same bla KPC-2-encoding plasmid was spread among the three different genera.

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Underlying mechanisms of carbapenem resistance in extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli isolates at a tertiary care centre in Lebanon: role of OXA-48 and NDM-1 carbapenemases

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2012.08.010 ◽

2013 ◽

Vol 41 (1) ◽

pp. 75-79 ◽

Cited By ~ 68

Author(s):

M. Baroud ◽

I. Dandache ◽

G.F. Araj ◽

R. Wakim ◽

S. Kanj ◽

...

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Tertiary Care ◽

Carbapenem Resistance ◽

Care Centre ◽

Tertiary Care Centre ◽

Extended Spectrum ◽

Underlying Mechanisms

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Ten years of population-level genomic Escherichia coli and Klebsiella pneumoniae serotype surveillance informs vaccine development for invasive infections

10.1101/2020.07.08.20140707 ◽

2020 ◽

Author(s):

Samuel Lipworth ◽

Karina-Doris Vihta ◽

Kevin K Chau ◽

James Kavanagh ◽

Timothy Davies ◽

...

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Vaccine Development ◽

Carbapenem Resistance ◽

Bloodstream Infections ◽

Population Level ◽

Small Subset ◽

Invasive Infections ◽

Common Serotypes ◽

O Antigens

The incidence of bloodstream infections (BSIs) caused by Enterobacteriaceae (e.g. Escherichia coli, Klebsiella pneumoniae) continues to increase globally and the threat of untreatable disease is substantial1. Prophylactic vaccines represent an alternative approach to combating antimicrobial resistance (AMR) by reducing antibiotic usage and preventing infections caused by AMR-associated strains. To investigate their potential utility, we performed in silico serotyping on 4035 E. coli/K. pneumoniae BSI from population-level surveillance in Oxfordshire (2008-2018) in addition to 3678 isolates from previous studies. Most infections, including those associated with AMR, were caused by isolates with a small subset of O-antigens, with no evidence that the proportion of BSIs caused by these changed significantly over time. O-antigen targeted vaccines might therefore be useful in reducing the significant morbidity and mortality2 associated with BSIs. Vaccines may also have a role in preventing the spread of carbapenem resistance genes into common serotypes associated with community-onset disease.

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Detection of carbapenem-resistant Escherichia coli and Klebsiella pneumoniae producing NDM-1 in Lebanon

The Journal of Infection in Developing Countries ◽

10.3855/jidc.2340 ◽

2012 ◽

Vol 6 (05) ◽

pp. 457-461 ◽

Cited By ~ 22

Author(s):

Rima I El-Herte ◽

George F Araj ◽

Ghassan M Matar ◽

Maysa Baroud ◽

Zeina A Kanafani ◽

...

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Carbapenem Resistance ◽

New Delhi ◽

Beta Lactamase ◽

The Novel ◽

First Report ◽

Carbapenem Resistant ◽

Lactamase Gene ◽

Carbapenem Resistant Enterobacteriaceae

Carbapenem resistance has been encountered globally with poor outcome of infected patients. NDM-1 (New Delhi metallo-beta-lactamase) gene containing organisms have emerged and are now spreading in all continents. This is the first report of Iraqi patients referred to Lebanon from whom carbapenem resistant Enterobacteriaceae were recovered. The genes involved in carbapenem resistance were bla-OXA-48 and the novel NDM-1. This report highlights the alarming introduction of such resistance among Enterobacteriaecae to this country.

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Prevalence of the carbapenem-heteroresistant phenotype among ESBL-producing Escherichia coli and Klebsiella pneumoniae clinical isolates

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa048 ◽

2020 ◽

Cited By ~ 1

Author(s):

Karen Tan ◽

James Nguyen ◽

Kevin Nguyen ◽

Holly K Huse ◽

Paul H Nieberg ◽

...

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Hospital Admissions ◽

Population Analysis ◽

Carbapenem Resistance ◽

Disc Diffusion ◽

First Line Therapy ◽

Potential Activity ◽

Pap Method ◽

Antibiotic Agents

Abstract Objectives Carbapenem-heteroresistant (cHR) Enterobacteriaceae strains have been reported worldwide; however, the prevalence among clinical ESBL-producing Enterobacteriaceae isolates obtained from patients with repeated hospital admissions remains largely unknown. Methods Heteroresistance was screened by disc diffusion and confirmed by a modified population analysis profiling (PAP) method against ertapenem, imipenem, meropenem and ceftolozane/tazobactam. MIC testing was performed by broth microdilution against carbapenems and a panel of agents with potential activity against ESBL-producing strains. Results One hundred and seventy-three ESBL-producing meropenem-susceptible Escherichia coli and Klebsiella pneumoniae isolates were selected for testing. A total of 519 bacteria/carbapenem combinations were screened by disc diffusion; 84 combinations were identified as cHR. Modified PAP confirmed 70 bacteria/carbapenem combinations as heteroresistant; most (63%, 44/70) confirmed cHR colonies grew within the ertapenem zone of inhibition, followed by imipenem (30%, 21/70), then meropenem (7%, 5/70). In total, one-third of the unique patient isolates (32%, 55/173) were identified as being heteroresistant to at least one carbapenem; of those patients, 16% (9/55) had a carbapenem-non-susceptible isolate on subsequent visits. Only two cHR isolates screened positive for ceftolozane/tazobactam heteroresistance (1%, 2/173), of which one was confirmed heteroresistant by modified PAP. cHR isolates were more likely to be collected from a non-urinary source (e.g. respiratory) compared with non-cHR isolates (31% versus 19%, P = 0.02). MIC distributions of all tested antibiotic agents did not differ between non-cHR and cHR isolates. Conclusions Our findings raise concerns for the continued use of carbapenems as first-line therapy for ESBL infections and for the potential selection for strains with full carbapenem resistance.

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