scholarly journals Resistance phenotype and molecular epidemiology of Carbapenem-resistant Klebsiella pneumoniae isolates in Shanghai

2020 ◽  
Author(s):  
Jue Zhang ◽  
Wenxia Zhang ◽  
Hongyou Chen ◽  
Chen Chen ◽  
Junhao Chen ◽  
...  
Keyword(s):  
Drug Resistance ◽  
Klebsiella Pneumoniae ◽  
Molecular Epidemiology ◽  
Genetic Relatedness ◽  
Control Strategies ◽  
Microdilution Method ◽  
Carbapenem Resistant ◽  
Broth Microdilution Method ◽  
Polymerase Chain ◽  
Relationship Of

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 (PCR) assays were used to investigate the presence of drug resistance genes. A modified carbapenem inactivation method (mCIM) was performed to detect carbapenemases. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were conducted for genetic relatedness of 50 CRKP isolates selected. Results: Among 670 isolates of K. pneumoniae, 133 (19.85%) strains were identified as carbapenem-resistant K. pneumoniae (CRKP), of which, 76.69% (102/133) strains were isolated from 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 more than 95% of resistance to cephalosporins and carbapenems, except for gentamicin, Trimethoprim-sulfamethoxazole, amikacin, tigecycline and colistin. The most common sequence type was ST11, accounting for 90.0% of the 50 CRKP selected, followed by ST15 (10%). PFGE analysis clustered the 50 KPC-2-producing isolates into seven (A-G) distinct clonal clusters at 85% cut off. Of which, cluster 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 cluster D and E were collected in cardiothoracic surgery ICU, expect 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.

scholarly journals Dissemination of ST101 blaOXA-48 producing Klebsiella pneumoniae at tertiary care setting

2018 ◽  
Vol 12 (06) ◽  
pp. 422-428 ◽  
Author(s):  
Hadir ElMahallawy ◽  
Mai Mahmoud Zafer ◽  
Mohamed Al-Agamy ◽  
Magdy Aly Amin ◽  
Mai Muhammed Mersal ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Genetic Relatedness ◽  
Tertiary Care ◽  
Pcr Amplification ◽  
Beta Lactamases ◽  
Patients With Cancer ◽  
Carbapenem Resistant ◽  
Distinct Sequence ◽  
Study Association ◽  
Relationship Of

Introduction: The worldwide dissemination of the acquired carbapenemases in Gram-negative bacteria is a strongly expressed demand for the emergence of post antibiotic era. The aim of this study was to test the production of carbapenemase by Klebsiella pneumoniae strains isolated from hospitalized cancer patients and to investigate the genetic relationship of carbapenemase producing carbapenem resistant K. pneumoniae using multilocus sequence typing (MLST). Methodology: Antibiotic susceptibility testing and phenotypic testing for extended spectrum b-lactamases (ESBL) and carbapenemases production were performed. PCR amplification of ESBL and carbapenemase genes was performed. MLST was done to detect the genetic relatedness of the isolates. Results: Our data showed all strains were sensitive to colistin. Carba NP test was positive in thirty-one carbapenem resistant K. pneumoniae isolates and 26 out of 34 K. pneumoniae isolates were metallo-beta-lactamases (MBL) positive. All carbapenemase-positive isolates were ESBL CTX-M-1-like positive. blaOXA-48 gene was detected in 25 isolates (80.65%) and 21 isolates (67.75%) produced blaNDM-1 like enzyme. VIM and KPC genes were not identified in this study. Association of blaOXA-48 like and blaNDM-1 like was found in 15 (48.39%) isolates, while the coproduction of OXA-48-like and IMP-1 was revealed in only one K. pneumoniae isolate. MLST revealed ten distinct sequence types (STs). Conclusion: Here we have documented the coexistence of NDM-type and OXA-48-like, and the coproduction of OXA-48-like and IMP in carbapenem resistant K. pneumoniae in patients with cancer. The dominant clone of the OXA-48-like-producing K. pneumoniae isolates from Egypt was ST101 epidemic clone belonging to clonal complex 101, an association that has been reported worldwide. The second most frequent ST was ST383.ST11 was assigned to OXA-48-producing K. pneumoniae.

scholarly journals Susceptibility to antibiotic combinations of Klebsiella pneumoniae and Acinetobacter baumannii strains isolated from COVID-19 patients

2021 ◽  
Vol 18 (4) ◽  
pp. 33-40
Author(s):  
D. V. Tapalski ◽  
E. V. Karpova
Keyword(s):  
Klebsiella Pneumoniae ◽  
Bactericidal Activity ◽  
Antibacterial Effect ◽  
Bactericidal Effect ◽  
Bacteriostatic Activity ◽  
Broth Microdilution ◽  
Colistin Resistance ◽  
Microdilution Method ◽  
Carbapenem Resistant ◽  
Broth Microdilution Method

Objective. To assess the susceptibility of K.pneumoniae and A.baumanii strains isolated from hospitalized COVID-19 patients to antibiotics and their combinations.Materials and methods. The minimum inhibitory concentrations (MICs) of meropenem and colistin were determined for 47 A.baumannii and 51K.pneumoniaestrains isolated from the hospitalized COVID-19 patients by the broth microdilution method. The susceptibility to 11 antibiotic combinations was assessed using the method of multiple combination bactericidal testing.Results. Colistin resistance was detected in 31.9 % of A.baumannii strains (MIC50 — 0.5 mg/l, MIC90 — 16 mg/l) and in 80.4 % of K.pneumoniaestrains (MIC50 — 16 mg/l, MIC90 — 256 mg/l). It has been shown that double antibiotic combinations with the inclusion of colistin exhibit bactericidal or bacteriostatic activity against 76.6–87.2 % of A.baumannii strains. Combinations with the addition of meropenem, colistin and macrolides exhibited bactericidal activity against 78.4–80.4 % of K.pneumoniae strains. Combinations of two carbapenems were not active, the combination of meropenem-colistin had a bactericidal effect only in 13.7 % of K.pneumoniae strains.Conclusion. Widespread colistin resistance was found in carbapenem-resistant K.pneumoniae and A.baumannii strains isolated from the hospitalized COVID-19 patients. The combinations of antibiotics that have a synergistic antibacterial effect in their pharmacokinetic/pharmacodynamic concentrations have been determined.

scholarly journals Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China

2021 ◽  
Vol 8 ◽  
Author(s):  
Shuzhen Xiao ◽  
Tianchi Chen ◽  
Hairu Wang ◽  
Qian Zeng ◽  
Qing Chen ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Molecular Epidemiology ◽  
Bloodstream Infections ◽  
Drug Susceptibility ◽  
Resistance Rate ◽  
Icu Patients ◽  
Microdilution Method ◽  
Antimicrobial Resistance Genes ◽  
Broth Microdilution Method ◽  
Almost All

Background: Bloodstream infections (BSIs) are recognized as important nosocomial infections. Klebsiella pneumoniae is one of the major causes of bacteremia. This retrospective study focused on drug susceptibility and molecular epidemiology of K. pneumoniae isolated from intensive care unit (ICU) patients with BSI in Shanghai, China.Methods: Consecutive K. pneumoniae isolates were collected from ICU patients. Antibiotic susceptibility testing was conducted by the broth microdilution method. PCR was performed to detect antimicrobial resistance genes. We also completed multilocus sequence typing (MLST) and GoeBURST was used to analyze the result of MLST.Results: A total of 78 K. pneumoniae isolates were enrolled. K. pneumoniae from ICU-BSIs were highly resistant to almost all common antibiotics. The most frequent resistance determinants responsible for extended-spectrum β-lactamase (ESBL) producers were blaCTX−M−14, blaCTX−M−15, and blaCTX−M−55. KPC was the only enzyme, which was detected by the carbapenemase producers. The most principal sequence types (STs) were ST11, ST15, and ST23.Conclusion: This study presents for the first time the antibiotic resistance phenotype and molecular epidemiology of K. pneumoniae isolated from ICU patients with BSIs in Shanghai. ICU-BSI K. pneumoniae is characteristic of a high resistance rate. The occurrence of the KPC-2 enzyme may result from nosocomial clonal dissemination of ST11 K. pneumoniae.

scholarly journals Drug susceptibility and molecular epidemiology of Klebsiella pneumoniae bloodstream infection in ICU patients in Shanghai, China

2020 ◽  
Author(s):  
Shuzhen Xiao ◽  
Tianchi Chen ◽  
Hairu Wang ◽  
Qing Chen ◽  
Feifei Gu ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Molecular Epidemiology ◽  
Bloodstream Infections ◽  
Drug Susceptibility ◽  
Resistance Rate ◽  
Icu Patients ◽  
Microdilution Method ◽  
Antimicrobial Resistance Genes ◽  
Broth Microdilution Method ◽  
Almost All

Abstract Background Bloodstream infections (BSIs) are always associated with increased cost, prolonged hospitalization and higher mortality, especially for patients in intensive care units (ICUs). Klebsiella pneumoniae is recognized as the major cause of bacteremia around the world and resistant to most clinically significant antibiotics. This retrospective study focused on drug susceptibility and molecular epidemiology of K. pneumoniae isolated from ICU patients with BSI in Shanghai, China.Methods Consecutive K. pneumoniae isolates were collected from ICU patients with bacteremia in Shanghai from January 2016 to December 2019. Antibiotic susceptibility testing and primary screening test for extended-spectrum β-lactamase (ESBL) and carbapenemase production were conducted by broth microdilution method. Polymerase chain reaction (PCR) was performed to detect antimicrobial resistance genes and to confirm carbapenemase production. We also conducted multilocus sequence typing (MLST), of which the result was analyzed by GoeBURST.Results A total of 78 K. pneumoniae isolates were enrolled. K. pneumoniae isolated from ICU bloodstream infections (ICU-BSIs) were highly resistant to almost all clinically common antibiotics, except for colistin (11.5%) and tigecycline (23.0%). ESBL-producing and carbapenemase-producing K. pneumoniae accounted for 74.4% and 71.7%, respectively. The most frequently found genotype in ESBL producers was blaCTX−M−14 (44/58, 75.9%), followed by blaCTX−M−15 (15/58, 25.9%) and blaCTX−M−55 (8/58, 13.8%). KPC is the only enzyme generated by carbapenemase producers and all KPC enzymes were encoded by blaKPC−2. The most principal ST was ST11 (50/78, 64.1%), followed by ST15 (7/78, 9.0%) and ST23 (3/78, 3.8%). Two newfound sequence types were identified in our study.Conclusions This study is the first to demonstrate the antibiotic resistance phenotype and molecular epidemiology of K. pneumoniae isolated from ICU patients with bloodstream infections in Shanghai. It is noteworthy that ICU-BSI K. pneumoniae is characteristic of high resistance rate. According to the consequence of resistance gene detection and MLST analysis, the prevalence of KPC-2 enzyme may result from nosocomial clonal dissemination of ST11 K. pneumoniae.

scholarly journals Mortality of Pandrug-Resistant Klebsiella pneumoniae Bloodstream Infections in Critically Ill Patients: A Retrospective Cohort of 115 Episodes

Antibiotics ◽  
2021 ◽  
Vol 10 (1) ◽  
pp. 76
Author(s):  
Matthaios Papadimitriou-Olivgeris ◽  
Christina Bartzavali ◽  
Alexandra Georgakopoulou ◽  
Fevronia Kolonitsiou ◽  
Chrisavgi Papamichail ◽  
...  
Keyword(s):  
Septic Shock ◽  
Klebsiella Pneumoniae ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Primary Outcome ◽  
Bloodstream Infections ◽  
Microdilution Method ◽  
Broth Microdilution Method ◽  
Carbapenemase Gene ◽  
Comorbidity Index

Background: The increased frequency of bacteraemias caused by pandrug-resistant Klebsiella pneumoniae (PDR-Kp) has significant implications. The aim of the present study was to identify predictors associated with mortality of PDR-Kp bacteraemias. Methods: Patients with monomicrobial bacteraemia due to PDR-Kp were included. K. pneumoniae was considered PDR if it showed resistance to all available groups of antibiotics. Primary outcome was 30-day mortality. Minimum inhibitory concentrations (MICs) of meropenem, tigecycline, fosfomycin, and ceftazidime/avibactam were determined by Etest, whereas for colistin, the broth microdilution method was applied. blaKPC, blaVIM, blaNDM, and blaOXA genes were detected by PCR. Results: Among 115 PDR-Kp bacteraemias, the majority of infections were primary bacteraemias (53; 46.1%), followed by catheter-related (35; 30.4%). All isolates were resistant to tested antimicrobials. blaKPC was the most prevalent carbapenemase gene (98 isolates; 85.2%). Thirty-day mortality was 39.1%; among 51 patients with septic shock, 30-day mortality was 54.9%. Multivariate analysis identified the development of septic shock, Charlson comorbidity index, and bacteraemia other than primary or catheter-related as independent predictors of mortality, while a combination of at least three antimicrobials was identified as an independent predictor of survival. Conclusions: Mortality of PDR-Kp bloodstream infections was high. Administration of at least three antimicrobials might be beneficial for infections in critically ill patients caused by such pathogens.

scholarly journals An Outbreak of Carbapenem-Resistant Klebsiella Pneumoniae of K57 Capsular Serotype in an Emergency Intensive Care Unit of a Teaching Hospital in China

2020 ◽  
Author(s):  
Chunhong Shao ◽  
Yan Jin ◽  
Shuang Liu ◽  
Meijie Jiang ◽  
Shuping Zhao
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Teaching Hospital ◽  
Galleria Mellonella ◽  
Pulse Field ◽  
Carbapenem Resistant ◽  
Surrounding Environment ◽  
Antimicrobial Resistance Genes ◽  
Broth Microdilution Method

Abstract Background: Klebsiella pneumoniae is a common causative pathogen of nosocomial infections. The emergence of carbapenem-resistant hypervirulent K. pneumoniae (CR-hvKP) strains has further increased the threat posed by this bacterium. Here, we described an outbreak of 32 CR-hvKP isolates from the emergency intensive care unit (EICU) of a teaching hospital in China. Methods: From January 29, 2019 to March 11, 2019, 32 CRKp isolates were collected from 6 patients and their surrounding environment in EICU. Patient information including age, gender, length of EICU stay, diagnosis, treatment, and outcomes were obtained from electronic medical records. The isolates were identified using Vitek-MS system. The hypermucoviscosity phenotype was determined by the “string test”. Antimicrobial susceptibility testing was performed using VITEK 2 compact system, E-test or the broth microdilution method. All isolates were serotyped for K1, K2, K5, K20, K54, and K57 serotypes, antimicrobial resistance genes and twelve virulence-associated genes were screened using PCR and DNA sequencing. Multilocus sequence typing (MLST) and pulse-field gel electrophoresis (PFGE) were employed to characterize the genetic relationships among the CPKP isolates. The virulence capability of 11 CRKp isolates from 6 patients was evaluated through Galleria mellonella larva infection assay. Results: This outbreak involved 6 patients and lasted for 40 days. All 32 CR-hvKp isolates were obtained from 6 patients and their surrounding environment. PFGE showed that all 32 isolates belonged to one cluster, and MLST revealed that belonged to ST11. All isolates exhibited high resistance to β-lactam antibiotics, quinolones, and aminoglycosides. They were susceptible to ceftazidime/averbatan, tigecycline, and colistin. All 32 isolates harbored multiple resistance determinants, including blaKPC-2, blaSHV-11, blaTEM-1, rmtB, and qnrD. The serotype of all 32 isolates was K57 that was rarely reported. In the virulence gene analysis, all 32 isolates contained 6 virulence genes, namely, fimH, iucB, mrkD, rmpA, uge, and wabG. Infection assays demonstrated high mortality in the Galleria mellonella model. Following measures implemented by the hospital, the outbreak was controlled. The mortality rate was 83.3%.Conclusions: The epidemiology of CR-hvKP should be monitored closely to detect early indications of this emerging public health threat.

scholarly journals Carbapenemase Production and Epidemiological Characteristics of Carbapenem-Resistant Klebsiella pneumoniae in Western Chongqing, China

2022 ◽  
Vol 11 ◽  
Author(s):  
Wan Huang ◽  
Jisheng Zhang ◽  
Lingyi Zeng ◽  
Chengru Yang ◽  
Lining Yin ◽  
...  
Keyword(s):  
Polymerase Chain Reaction ◽  
Klebsiella Pneumoniae ◽  
Virulence Genes ◽  
Resistance Rate ◽  
Molecular Characteristics ◽  
Chain Reaction ◽  
Detection Rates ◽  
Carbapenem Resistant ◽  
Polymerase Chain ◽  
Epidemiological Characteristics

BackgroundThis study aimed to determine the molecular characteristics of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates in a hospital in western Chongqing, southwestern China.MethodsA total of 127 unique CRKP isolates were collected from the Yongchuan Hospital of Chongqing Medical University, identified using a VITEK-2 compact system, and subjected to microbroth dilution to determine the minimal inhibitory concentration. Enterobacteriaceae intergenic repeat consensus polymerase chain reaction and multilocus sequence typing were used to analyze the homology among the isolates. Genetic information, including resistance and virulence genes, was assessed using polymerase chain reaction. The genomic features of the CRKP carrying gene blaKPC-2 were detected using whole-genome sequencing.ResultsST11 was the dominant sequence type in the homology comparison. The resistance rate to ceftazidime-avibactam in children was much higher than that in adults as was the detection rate of the resistance gene blaNDM (p < 0.0001). Virulence genes such as mrkD (97.6%), uge (96.9%), kpn (96.9%), and fim-H (84.3%) had high detection rates. IncF (57.5%) was the major replicon plasmid detected, and sequencing showed that the CRKP063 genome contained two plasmids. The plasmid carrying blaKPC-2, which mediates carbapenem resistance, was located on the 359,625 base pair plasmid IncFII, together with virulence factors, plasmid replication protein (rep B), stabilizing protein (par A), and type IV secretion system (T4SS) proteins that mediate plasmid conjugation transfer.ConclusionOur study aids in understanding the prevalence of CRKP in this hospital and the significant differences between children and adults, thus providing new ideas for clinical empirical use of antibiotics.

scholarly journals A public health concern: emergence of carbapenem-resistant Klebsiella pneumoniae in a public transportation environment

2020 ◽  
Vol 75 (10) ◽  
pp. 2769-2772
Author(s):  
Tingting Cao ◽  
Yuanyuan Liu ◽  
Yiming Li ◽  
Yang Wang ◽  
Zhangqi Shen ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Public Transportation ◽  
Genetic Relationships ◽  
Brain Heart Infusion ◽  
Health Concern ◽  
Resistant Bacteria ◽  
Carbapenem Resistant ◽  
Broth Microdilution Method ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Beijing Subway

Abstract Objectives This study was designed to understand the prevalence of antibiotic-resistant bacteria in the Beijing subway environment and the potential transmission of carbapenem-resistant Enterobacteriaceae in a public transportation environment. Methods Carbapenem-resistant isolates were selected on brain heart infusion agar supplemented with meropenem (0.5 mg/L) and antimicrobial susceptibility testing was conducted using the broth microdilution method. WGS analyses were conducted for 11 Klebsiella pneumoniae isolates to identify resistance genes. The genetic relationships among the isolates were evaluated by MLST and PFGE. Results We identified 11 carbapenem-resistant K. pneumoniae isolates from the Beijing subway environment. WGS revealed three STs among the 11 isolates, with 9 isolates classified as ST726 and containing a blaNDM-5-carrying IncX3 plasmid. The genetic environment of blaNDM-5 was very similar to that observed in other blaNDM-5-containing clinical isolates. Conclusions The presence of carbapenem-resistant Enterobacteriaceae in a public transportation environment is concerning and indicates that regular antimicrobial resistance surveillance is urgent and necessary.

scholarly journals Isolation and characterization of a sequence type 25 carbapenem-resistant hypervirulent Klebsiella pneumoniae from the mid-south region of China

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jun Li ◽  
Zi-Yan Huang ◽  
Ting Yu ◽  
Xiao-Yan Tao ◽  
Yong-Mei Hu ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Capsular Polysaccharide ◽  
Control Strategies ◽  
Virulence Gene ◽  
Sequence Type ◽  
Pfge Typing ◽  
Main Cluster ◽  
Carbapenem Resistant ◽  
Isolation And Characterization

Abstract Background The molecular characterization of carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-hvKP) isolates is not well studied. Our goal was to investigate the molecular epidemiology of CR-hvKP strains that were isolated from a Chinese hospital. Results All clinical carbapenem-resistant K. pneumoniae (CR-KP) isolates were collected and identified from patient samples between 2014 and 2017 from a Chinese hospital. The samples were subjected to screening for CR-hvKP by string test and the detection of the aerobactin gene. CR-hvKP isolates were further confirmed through neutrophil phagocytosis and a mice lethality assay. The CR-hvKP isolates were investigated for their capsular genotyping, virulence gene profiles, and the expression of carbapenemase genes by PCR and DNA sequencing. Multilocus sequence type (MLST) and pulsed-field gel electrophoresis (PFGE) were performed to exclude the homology of these isolates. Twenty strains were identified as CR-hvKP. These strains were resistant to imipenem and several other antibiotics, however, most were susceptible to amikacin. Notably, two isolates were not susceptible to tigecycline. Capsular polysaccharide synthesis genotyping revealed that 17 of the 20 CR-hvKP strains belonged to the K2 serotype, while the others belonged to serotypes other than K1, K2, K5, K20, and K57. The strains were found to be positive for 10 types of virulence genes and a variety of these genes coexisted in the same strain. Two carbapenemase genes were identified: blaKPC-2 (13/20) and blaNDM-1 (1/20). PFGE typing revealed eight clusters comprising isolates that belonged to MLST types ST25, ST11 and ST375, respectively. PFGE cluster A was identified as the main cluster, which included 11 isolates that belong to ST25 and mainly from ICU department. Conclusions Our findings suggest that hospital-acquired infections may contribute in part to the CR-hvKP strains identified in this study. It also suggests that ST25 CR-hvKP strain has a clonal distribution in our hospital. Therefore, effective surveillance and strict infection control strategies should be implemented to prevent outbreak by CR-hvKP strains in hospitals setting.

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