Co-conjugation of Virulence Plasmid and KPC Plasmid in a Clinical Klebsiella pneumoniae Strain

Carbapenem-resistant hypervirulent Klebsiella pneumoniae (CR-HvKP) strains have been increasingly reported, and it is important to understand the evolutionary mechanisms of these highly pathogenic and resistant bacterial pathogens. In this study, we characterized a ST11 carbapenem-resistant K. pneumoniae strain which harbored an IncFIB/IncHI1B type virulence plasmid and an IncFII/IncR type blaKPC–2-bearing plasmid. The virulence plasmid was found to be conjugative and harbored a 35-kbp fragment including aerobactin encoding cluster from virulence plasmid pLVPK and multiple resistance genes, resulting in a mosaic multi-drug resistance and virulence plasmid. This virulence plasmid could be transferred via conjugation to Escherichia coli and K. pneumoniae strains alone as well as together with the blaKPC–2-bearing plasmid. Co-transmission of virulence and blaKPC–2-bearing plasmids would directly convert a classic K. pneumoniae strain into CR-HvKP strain, leading to a sharp increase in the prevalence of CR-HvKP in clinical settings, which poses a great threat to human health.

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Prevalence of Carbapenem-Resistant Klebsiella pneumoniae Co-Harboring blaKPC-Carrying Plasmid and pLVPK-Like Virulence Plasmid in Bloodstream Infections

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2020.556654 ◽

2021 ◽

Vol 10 ◽

Author(s):

Fang-ling Du ◽

Qi-sen Huang ◽

Dan-dan Wei ◽

Yan-fang Mei ◽

Dan Long ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Galleria Mellonella ◽

Bloodstream Infections ◽

Multi Drug Resistance ◽

Virulence Plasmid ◽

E Coli ◽

Plasmid Gene ◽

Carbapenem Resistant ◽

Large Plasmids ◽

Serotype K2

This study aimed to characterize carbapenem-resistant Klebsiella pneumoniae (CR-KP) co-harboring blaKPC-2-carrying plasmid and pLVPK-like virulence plasmid. Between December 2017 and April 2018, 24 CR-KP isolates were recovered from 24 patients with bacteremia. The mortality was 66.7%. Pulsed-field gel electrophoresis and multilocus sequence typing results indicated four clusters, of which cluster A (n = 21, 87.5%) belonged to ST11 and the three remaining isolates (ST412, ST65, ST23) had different pulsotypes (cluster B, C, D). The blaKPC-2-carrying plasmids all belonged to IncFIIK type, and the size ranged from 100 to 390 kb. Nineteen strains (79.2%) had a 219-kb virulence plasmid possessed high similarity to pLVPK from CG43 with serotype K2. Two strains had a 224-kb virulence plasmid resembled plasmid pK2044 from K. pneumoniae NTUH-K2044(ST23). Moreover, three strains carried three different hybrid resistance- and virulence-encoding plasmids. Conjugation assays showed that both blaKPC-2 and rmpA2 genes could be successfully transferred to E. coli J53 in 62.5% of the strains at frequencies of 4.5 × 10−6 to 2.4 × 10−4, of which three co-transferred blaKPC-2 along with rmpA2 in large plasmids. Infection assays in the Galleria mellonella model demonstrated the virulence level of these isolates was found to be consistently higher than that of classic Klebsiella pneumoniae. In conclusion, CR-KP co-harboring blaKPC-2-carrying plasmid and pLVPK-like virulence plasmid were characterized by multi-drug resistance, enhanced virulence, and transferability, and should, therefore, be regarded as a real superbug that could pose a serious threat to public health. Hence, heightened efforts are urgently needed to avoid its co-transmission of the virulent plasmid (gene) and resistant plasmid (gene) in clinical isolates.

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Epidemiology and clinical significance of pLVPK-like virulence plasmid in KPC-2-producing Klebsiella pneumoniae infections in eastern China: a preliminary exploration

10.21203/rs.3.rs-52971/v1 ◽

2020 ◽

Author(s):

Min Xu ◽

Qing Yang ◽

Yanchao Liu ◽

Xiao Chen ◽

Haishen Kong ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Clinical Characteristics ◽

Eastern China ◽

Multivariable Analysis ◽

Tertiary Hospital ◽

Multivariable Logistic Regression Analysis ◽

Virulence Plasmid ◽

Carbapenem Resistant ◽

Epidemiological Trend ◽

Wide Dissemination

Abstract Background: By acquiring a pLVPK-like virulence plasmid (pVir), Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-kp) evolves to a hypervirulent variant, with increasing cases reported worldwide. However, little is known about the epidemiological trend of pVir in KPC-kp, as well as clinical characteristics of infections caused by this novel strain (pVir+-KPC-kp). Methods: From 2014-2018, 662 carbapenem-resistant K. pneumoniae (CRKP) were consecutively collected from a tertiary hospital of eastern China. The confirmed KPC-kp were subjected to antimicrobial susceptibility testing, multilocus sequence typing and detection of pLVPK-related genetic loci (rmpA, rmpA2, iucA and iroN) to identify pVir+-KPC-kp strains. Then, the clinical characteristics and outcomes of KPC-kp infection patients with and without pVir were compared. Moreover, the risk factors for pVir+-KPC-kp infections also determined by a multivariable logistic regression analysis.Results: of the 662 CRKP, 86.6% (573/662) were KPC-kp including 285 (49.7%) pVir+-KPC-kp and 288 (50.3%) pVir--KPC-kp. Notably, the prevalence of pVir+-KPC-kp by year increased remarkably from 2014 (19.5%, 8/41) to 2018 (60.0%, 90/150). Sequence type (ST) 11 was the most predominant ST, accounting for 88.9% of all pVir+-KPC-kp. For the 352 KPC-kp infection cases (186 with pVir+-KPC-kp and 166 with pVir--KPC-kp), multivariable analysis indicated neurosurgery (Odds ratio [OR], 2.92; 95% confidence interval [CI], 1.48-5.75; P =0.002) was independently associated with pVir+-KPC-kp infections. Although patients with pVir+-KPC-kp infections had higher incidence of septic shock (31.2% vs. 21.1%, P =0.03), the two groups showed no significant differences in 7-day mortality (23.1% vs. 18.1%, P =0.24) or 28-day mortality (45.7% vs. 44.0%, P =0.75). Conclusions: Altogether, wide dissemination of pVir in ST11 KPC-kp has emerged in China. Neurosurgery is an independent risk factor for acquisition of pVir+-KPC-kp infections. The mortality rates were similar between patients infected with pVir+-KPC-kp or pVir--KPC-kp, suggesting uncertain impact of pVir in clinical outcome.

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Aerobactin Seems To Be a Promising Marker Compared With Unstable RmpA2 for the Identification of Hypervirulent Carbapenem-Resistant Klebsiella pneumoniae: In Silico and In Vitro Evidence

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.709681 ◽

2021 ◽

Vol 11 ◽

Author(s):

Chaitra Shankar ◽

Soumya Basu ◽

Binesh Lal ◽

Sathiya Shanmugam ◽

Karthick Vasudevan ◽

...

Keyword(s):

High Risk ◽

Antimicrobial Resistance ◽

Klebsiella Pneumoniae ◽

In Silico ◽

Fitness Cost ◽

Virulence Plasmid ◽

Virulence Determinants ◽

Carbapenem Resistant ◽

Antimicrobial Resistance Genes

BackgroundThe incidence of hypervirulent (hv) carbapenem-resistant (CR) Klebsiella pneumoniae (Kp) is increasing globally among various clones and is also responsible for nosocomial infections. The CR-hvKp is formed by the uptake of a virulence plasmid by endemic high-risk clones or by the uptake of plasmids carrying antimicrobial resistance genes by the virulent clones. Here, we describe CR-hvKp from India belonging to high-risk clones that have acquired a virulence plasmid and are phenotypically unidentified due to lack of hypermucoviscosity.MethodsTwenty-seven CRKp isolates were identified to possess rmpA2 by whole-genome sequencing; and resistance and virulence determinants were characterized. By in silico protein modeling (and validation), protein backbone stability analysis, and coarse dynamics study, the fitness of RmpA, RmpA2, and aerobactin-associated proteins-IucA and IutA, were determined to establish a reliable marker for clinical identification of CR-hvKp.ResultsThe CR-hvKp belonged to multidrug-resistant (MDR) high-risk clones such as CG11, CG43, ST15, and ST231 and carried OXA-232 as the predominant carbapenemase followed by NDM. The virulence plasmid belonged to IncHI1B replicon type and carried frameshifted and truncated rmpA and rmpA2. This resulted in a lack of hypermucoviscous phenotype. However, functional aerobactin was expressed in all high-risk clones. In silico analysis portrayed that IucA and IutA were more stable than classical RmpA. Furthermore, IucA and IutA had lower conformational fluctuations in the functional domains than the non-functional RmpA2, which increases the fitness cost of the latter for its maintenance and expression among CR-hvKp. Hence, RmpA and RmpA2 are likely to be lost among CR-hvKp owing to the increased fitness cost while coding for essential antimicrobial resistance and virulence factors.ConclusionIncreasing incidence of convergence of AMR and virulence is observed among K. pneumoniae globally, which warrants the need for reliable markers for identifying CR-hvKp. The presence of non-functional RmpA2 among high-risk clones highlights the significance of molecular identification of CR-hvKp. The negative string test due to non-functional RmpA2 among CR-hvKp isolates challenges phenotypic screening and faster identification of this pathotype. This can potentially be counteracted by projecting aerobactin as a stable, constitutively expressed, and functional marker for rapidly evolving CR-hvKp.

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Mobilization of the nonconjugative virulence plasmid from hypervirulent Klebsiella pneumoniae

Genome Medicine ◽

10.1186/s13073-021-00936-5 ◽

2021 ◽

Vol 13 (1) ◽

Author(s):

Yanping Xu ◽

Jianfeng Zhang ◽

Meng Wang ◽

Meng Liu ◽

Guitian Liu ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

In Silico ◽

In Silico Analysis ◽

Conjugative Plasmid ◽

Virulence Plasmid ◽

E Coli ◽

Virulence Plasmids ◽

Carbapenem Resistant ◽

Helper Plasmids ◽

Silico Analysis

Abstract Background Klebsiella pneumoniae, as a global priority pathogen, is well known for its capability of acquiring mobile genetic elements that carry resistance and/or virulence genes. Its virulence plasmid, previously deemed nonconjugative and restricted within hypervirulent K. pneumoniae (hvKP), has disseminated into classic K. pneumoniae (cKP), particularly carbapenem-resistant K. pneumoniae (CRKP), which poses alarming challenges to public health. However, the mechanism underlying its transfer from hvKP to CRKP is unclear. Methods A total of 28 sequence type (ST) 11 bloodstream infection-causing CRKP strains were collected from Ruijin Hospital in Shanghai, China, and used as recipients in conjugation assays. Transconjugants obtained from conjugation assays were confirmed by XbaI and S1 nuclease pulsed-field gel electrophoresis, PCR detection and/or whole-genome sequencing. The plasmid stability of the transconjugants was evaluated by serial culture. Genetically modified strains and constructed mimic virulence plasmids were employed to investigate the mechanisms underlying mobilization. The level of extracellular polysaccharides was measured by mucoviscosity assays and uronic acid quantification. An in silico analysis of 2608 plasmids derived from 814 completely sequenced K. pneumoniae strains available in GenBank was performed to investigate the distribution of putative helper plasmids and mobilizable virulence plasmids. Results A nonconjugative virulence plasmid was mobilized by the conjugative plasmid belonging to incompatibility group F (IncF) from the hvKP strain into ST11 CRKP strains under low extracellular polysaccharide-producing conditions or by employing intermediate E. coli strains. The virulence plasmid was mobilized via four modes: transfer alone, cotransfer with the conjugative IncF plasmid, hybrid plasmid formation due to two rounds of single-strand exchanges at specific 28-bp fusion sites or homologous recombination. According to the in silico analysis, 31.8% (242) of the putative helper plasmids and 98.8% (84/85) of the virulence plasmids carry the 28-bp fusion site. All virulence plasmids carry the origin of the transfer site. Conclusions The nonconjugative virulence plasmid in ST11 CRKP strains is putatively mobilized from hvKP or E. coli intermediates with the help of conjugative IncF plasmids. Our findings emphasize the importance of raising public awareness of the rapid dissemination of virulence plasmids and the consistent emergence of hypervirulent carbapenem-resistant K. pneumoniae (hv-CRKP) strains.

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Emergence of a KPC Variant Conferring Resistance to Ceftazidime-Avibactam in a Widespread ST11 Carbapenem-Resistant Klebsiella pneumoniae Clone in China

Frontiers in Microbiology ◽

10.3389/fmicb.2021.724272 ◽

2021 ◽

Vol 12 ◽

Author(s):

Xi Li ◽

Jingjing Quan ◽

Huanhuan Ke ◽

Wenhao Wu ◽

Yu Feng ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Tertiary Structure ◽

Hydrolytic Activity ◽

Clinical Settings ◽

The Novel ◽

S1 Nuclease ◽

Carbapenem Resistant ◽

Loop Region ◽

Cloning Assay ◽

Omega Loop

Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection poses a great threat to public health worldwide, and KPC-2-producing strains are the main factors responsible for resistance to carbapenems in China. Ceftazidime/avibactam (CZA) is a novel β-lactam/β-lactamase inhibitor combination with good activity against KPC-2 carbapenemase and is becoming the most important option for treating KPC-producing CRKP infection. Here, we report the emergence of a novel KPC-2 variant, designated KPC-74, produced by K. pneumoniae strain KP55, that conferred CZA resistance in a patient after CZA exposure. The novel blaKPC–74 variant showed a deletion of 6 nucleotides at positions 712–717 compared with blaKPC–2, and this deletion resulted in the consequent deletion of glycine and valine at positions 239 and 240. Antimicrobial susceptibility testing showed that KP55 presents multidrug resistance, including resistance to CZA and ertapenem, but is susceptible to imipenem, meropenem, and colistin. The blaKPC–74 gene was located on a plasmid, as determined by S1-nuclease pulsed-field gel electrophoresis followed by southern blotting, and confirmed to be 133,766 bp in length by whole-genome sequencing on both the Illumina and MinION platforms. The CZA resistance phenotype of the novel KPC variant was confirmed by both transformation of the blaKPC–74-harboring plasmid and a blaKPC–74 gene cloning assay, showing a 64-fold higher CZA minimum inhibitory concentration (MIC) than the recipient strains. The G239_V240del observed in KPC-74 was outside the omega-loop region but was still close to the active site Ser70 and omega-loop in the protein tertiary structure. The enzyme kinetic parameters and IC50 values further indicated that the hydrolytic activity of the KPC-74 enzyme against ceftazidime was potentiated twofold and that the affinity between KPC-74 and avibactam was alleviated 17-fold compared with that of the KPC-2 allele. This CZA resistance mediated by KPC-74 could be selected after CZA therapy and evolved to be more diverse and heterogeneous. Surveillance of CZA resistance is urgently needed in clinical settings.

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Detection of Carbapenemase producing Klebsiella pneumoniae isolated from Environmental Sources in a Tertiary Health Institution in Nigeria.

10.21203/rs.3.rs-42624/v1 ◽

2020 ◽

Author(s):

Iloduba Nnaemeka Aghanya ◽

Comfort Nne Akujobi ◽

Simon Nkpeh Ushie ◽

Chika Florence Ubajaka ◽

Ijeoma Maryrose Ajuba ◽

...

Keyword(s):

Public Health ◽

Klebsiella Pneumoniae ◽

Detection Method ◽

Multi Drug Resistance ◽

Health Institution ◽

Major Threat ◽

Maximum Resistance ◽

Healthcare Settings ◽

Carbapenem Resistant ◽

Hospital Wards

Abstract Objective: The acquisition of carbapenemase-producing organisms in healthcare settings is a major threat and has serious implications for public health. This study aimed at determining the occurrence of carbapenemase-producing Klebsiella pneumoniae in the ward environments of a tertiary health institution in Nigeria.Results: A total of 142 bacteria were isolated from 534 formites in the hospital wards, and of the 142 isolates, 15(10.6%) were confirmed to be Klebsiella pneumoniae. The prevalence of Klebsiella pneumoniae in all the 534 samples was 15/534(2.8%), while the prevalence of carbapenemase-producing Klebsiella pneumoniae was 8/534(1.5%). Multi-drug Resistance was detected in 15/15(100%) of the Klebsiella pneumoniae isolated. Although no Klebsiella pneumoniae Carbapenemase (blaKPC) gene was expressed in any of these isolates, 8/15(53.3%) of these isolates were confirmed positive for cabapenemase production using a phenotypic detection method- Modified Hodge Test. The commonest sites that harboured carbapenem-resistant Klebsiella pneumoniae were the beds 6/15(40%). The organisms showed maximum resistance (100%) to ampicillin, trimethoprim-sulfamethoxazole, cefuroxime and tetracycline, while the highest sensitivities were seen in the carbapenems especially imipenem (73.3%). It was concluded that carbapenemase-producing Klebsiella pneumoniae were present in the study site, thus, buttressing the need for reinforcements of infection control policies in hospital settings.

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Clinical evolution of ST11 carbapenem resistant and hypervirulent Klebsiella pneumoniae

Communications Biology ◽

10.1038/s42003-021-02148-4 ◽

2021 ◽

Vol 4 (1) ◽

Author(s):

Miaomiao Xie ◽

Xuemei Yang ◽

Qi Xu ◽

Lianwei Ye ◽

Kaichao Chen ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

High Mortality ◽

Genome Analysis ◽

Direct Evidence ◽

Carbapenem Resistance ◽

Conjugative Plasmid ◽

Evolutionary Mechanisms ◽

Clinical Evolution ◽

Carbapenem Resistant

AbstractCarbapenem-resistant and hypervirulent K. pneumoniae (CR-HvKP) strains that have emerged recently have caused infections of extremely high mortality in various countries. In this study, we discovered a conjugative plasmid that encodes carbapenem resistance and hypervirulence in a clinical ST86 K2 CR-HvKP, namely 17ZR-91. The conjugative plasmid (p17ZR-91-Vir-KPC) was formed by fusion of a non-conjugative pLVPK-like plasmid and a conjugative blaKPC-2-bearing plasmid and is present dynamically with two other non-fusion plasmids. Conjugation of p17ZR-91-Vir-KPC to other K. pneumoniae enabled them to rapidly express the carbapenem resistance and hypervirulence phenotypes. More importantly, genome analysis provided direct evidence that p17ZR-91-Vir-KPC could be directly transmitted from K2 CR-HvKP strain, 17ZR-91, to ST11 clinical K. pneumoniae strains to convert them into ST11 CR-HvKP strains, which explains the evolutionary mechanisms of recently emerged ST11 CR-HvKP strains.

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Acquisition of the Conjugative Virulence Plasmid From a CG23 Hypervirulent Klebsiella pneumoniae Strain Enhances Bacterial Virulence

Frontiers in Cellular and Infection Microbiology ◽

10.3389/fcimb.2021.752011 ◽

2021 ◽

Vol 11 ◽

Author(s):

Dongxing Tian ◽

Weiwen Wang ◽

Meng Li ◽

Wenjie Chen ◽

Ying Zhou ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Biofilm Formation ◽

Evidence Base ◽

Serum Resistance ◽

Virulence Plasmid ◽

E Coli ◽

Virulence Plasmids ◽

Carbapenem Resistant ◽

High Level

The emergence of hypervirulent and carbapenem-resistant Klebsiella pneumoniae (hv-CRKP) has become a hot topic and confounding problem for clinicians and researchers alike. Conjugative virulence plasmids have the potential to cause more threatening dissemination of hv-CRKP strains. We previously identified K2606, a CG23 clinical hypervirulent strain of Klebsiella pneumoniae harboring a conjugative virulence plasmid designated pK2606. In this study we examined hypervirulence levels using assays of biofilm formation, serum resistance, and wax larvae and mouse in vivo infection models. Moreover, to define the transfer ability of pK2606 and whether this confers hypervirulence to other strains we performed plasmid transconjugation experiments between K2606 and the ST11 CRKP strain HS11286 along with E. coli J53. We found that although biofilm formation and serum resistance were not significantly increased, the transconjugants acquired the ability of produce high level of siderophores and also caused high mortality of wax larvae and mice. Furthermore, we identified pK2606-like conjugative virulence plasmids in GenBank, providing evidence that such plasmids may have begun to spread throughout China. These findings provide an evidence base for the possible mechanisms of the emergence of hv-CRKP strains and highlight the potential of pK2606-like conjugative virulence plasmids to spread worldwide.

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Epidemiology and Clinical Significance of pLVPK-Like Virulence Plasmid in KPC-2-Producing Klebsiella Pneumoniae Infections in A Tertiary Hospital in Eastern China

10.21203/rs.3.rs-80150/v1 ◽

2020 ◽

Author(s):

Min Xu ◽

Qing Yang ◽

Yanchao Liu ◽

Xiao Chen ◽

Haishen Kong ◽

...

Keyword(s):

Klebsiella Pneumoniae ◽

Clinical Outcomes ◽

Susceptibility Testing ◽

Eastern China ◽

Multivariable Analysis ◽

Tertiary Hospital ◽

Sequence Type ◽

Virulence Plasmid ◽

Carbapenem Resistant ◽

Wide Dissemination

Abstract Background: By acquiring a pLVPK-like virulence plasmid (pVir), Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-kp) evolves to a hypervirulent variant, however, controversies exist. The aim of present study was to determine the prevalence, risk factors and clinical outcomes of patients infected with pVir+-KPC-kp.Methods: Between 2014 and 2018, 662 carbapenem-resistant K. pneumoniae (CRKP) were collected from a tertiary hospital in eastern China. The isolates were subjected to antimicrobial susceptibility testing, multilocus sequence typing and detection of blaKPC, pLVPK-related genetic loci (rmpA, rmpA2, iucA and iroN) to identify pVir+-KPC-kp. The clinical characteristics of pVir+-KPC-kp were retrospectively evaluated.Results: Of the 662 CRKP, 86.6% (573/662) were KPC-kp including 285 (49.7%) pVir+-KPC-kp and 288 (50.3%) pVir--KPC-kp. Notably, the prevalence of pVir+-KPC-kp by year increased remarkably from 2014 (19.5%, 8/41) to 2018 (60.0%, 90/150). Sequence type (ST) 11 was the most predominant ST, accounting for 88.9% of all pVir+-KPC-kp. For the 352 KPC-kp infection cases (186 with pVir+-KPC-kp and 166 with pVir--KPC-kp), multivariable analysis indicated neurosurgery (P =0.002) was independently associated with pVir+-KPC-kp infections. Although patients with pVir+-KPC-kp infections had higher incidence of septic shock (P =0.03), the two groups showed no significant differences in 7-day mortality (P =0.24) or 28-day mortality (P =0.75). Conclusions: A wide dissemination of pVir in ST11 KPC-kp has emerged in our region. Neurosurgery is an independent risk factor for acquisition of pVir+-KPC-kp infections. The mortality rates were similar between patients infected with pVir+-KPC-kp or pVir--KPC-kp, suggesting uncertain impact of pVir in clinical outcomes.

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Detection of Carbapenemase-producing Klebsiella pneumoniae isolated from Environmental Sources in a Tertiary Health Institution in Nigeria.

10.21203/rs.3.rs-42624/v3 ◽

2021 ◽

Author(s):

Iloduba Nnaemeka Aghanya ◽

Comfort Nne Akujobi ◽

Simon Nkpeh Ushie ◽

Chika Florence Ubajaka ◽

Ijeoma Maryrose Ajuba ◽

...

Keyword(s):

Public Health ◽

Drug Resistance ◽

Klebsiella Pneumoniae ◽

Multi Drug Resistance ◽

Health Institution ◽

Healthcare Settings ◽

Carbapenem Resistant ◽

Carbapenemase Gene ◽

Resistance Patterns ◽

Hospital Wards

Abstract ObjectiveThe acquisition of carbapenemase-producing organisms in healthcare settings is a significant threat and has dire implications for public health. Previous reports regarding carbapenemase-producing Enterobacteriaceae from fomites are limited. This study aimed to analyse the antimicrobial resistance patterns and prevalence of carbapenemase-producing Klebsiella pneumoniae in the ward environments of a tertiary health institution in Nigeria.Results One hundred and forty-two bacteria were isolated from 534 fomites in the hospital wards, and out of these, 15(10.6%) were K. pneumoniae. Therefore, the prevalence of K. pneumoniae in all the samples was 15/534(2.8%), while that of carbapenemase-producing K. pneumoniae was 8/534(1.5%). Multi-drug resistance was detected in 15/15(100%) of the K. pneumoniae isolated. All the K. pneumoniae isolates were resistant to ampicillin, trimethoprim-sulfamethoxazole, cefuroxime, and tetracycline. Although 8/15(53.3%) of the isolates were confirmed positive for carbapenemase production using the modified Hodge test, no Klebsiella pneumoniae carbapenemase gene (blaKPC) was detected. The most frequent sites that harboured carbapenem-resistant K. pneumoniae were the beds 6/15(40%). Hence, the prevalence of carbapenemase-producing K. pneumoniae fomite colonisation in the NAUTH ward environment was low.

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