scholarly journals Clonal Dissemination of Clinical Carbapenem-Resistant Klebsiella pneumoniae Isolates Carrying fosA3 and blaKPC–2 Coharboring Plasmids in Shandong, China

2021 ◽  
Vol 12 ◽  
Author(s):  
Yingying Hao ◽  
Xuguang Zhao ◽  
Cui Zhang ◽  
Yuanyuan Bai ◽  
Zhen Song ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Gel Electrophoresis ◽  
Bioinformatics Analysis ◽  
Treatment Strategies ◽  
Pulsed Field Gel Electrophoresis ◽  
Molecular Characteristics ◽  
Broad Spectrum Antibiotic ◽  
Aminoglycoside Resistance ◽  
Carbapenem Resistant ◽  
Class B

Treatment strategies of infection by carbapenem-resistant Klebsiella pneumoniae (CRKP) are limited. Fosfomycin, a broad-spectrum antibiotic, has attracted renewed interest in combination therapy to fight K. pneumoniae infections. However, reports on fosfomycin-resistant K. pneumoniae are increasing. Among the 57 CRKP strains, 40 (70.2%) were resistant to fosfomycin. Thus, whole-genome sequencing and bioinformatics analysis were conducted to reveal molecular characteristics of fosfomycin-resistant K. pneumoniae. Twenty-three isolates coharbored fosAkp and fosA3, with K. pneumoniae carbapenemase (KPC)-producing ST11-KL64-wzi64-O2 (n = 13) and ST11-KL47-wzi209-OL101 (n = 8), the predominating clonal groups, while fosA3 was not detected in isolates carrying class B carbapenemase genes. Twenty-two (out of 26) ST11-KL64 strains were positive for rmpA2, of which 12 carried fosA3. Four of the 23 fosA3-positive isolates could successfully transfer their fosfomycin-resistant determinants to Escherichia coli J53AziR. All four strains belonged to ST11-KL47 with the same pulsed-field gel electrophoresis profile, and their transconjugants acquired fosfomycin, carbapenem, and aminoglycoside resistance. A 127-kb conjugative pCT-KPC-like hybrid plasmid (pJNKPN52_KPC_fosA) coharboring fosA3, blaKPC–2, blaCTX–M–65, blaSHV–12, rmtB, and blaTEM–1 was identified. ST11-KL64 and ST11-KL47 K. pneumoniae, with higher resistance and virulence, should be critically monitored to prevent the future dissemination of resistance.

scholarly journals Emergence of OXA-48-Type Carbapenemase-Producing Enterobacteriaceae in German Hospitals

2012 ◽  
Vol 56 (4) ◽  
pp. 2125-2128 ◽  
Author(s):  
Yvonne Pfeifer ◽  
Kathrin Schlatterer ◽  
Elisabeth Engelmann ◽  
Reinhold A. Schiller ◽  
Hans Reiner Frangenberg ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Gel Electrophoresis ◽  
Insertion Sequence ◽  
Pulsed Field Gel Electrophoresis ◽  
Mutant Form ◽  
Content Type ◽  
Point Mutant ◽  
Pulsed Field ◽  
Conjugative Plasmids ◽  
Carbapenem Resistant

ABSTRACTNine carbapenem-resistantEnterobacteriaceaeisolates collected from eight patients in five German hospitals were investigated. Six isolates produced the OXA-48 carbapenemase, and three isolates produced OXA-162, which is a point mutant form of OXA-48. Both carbapenemase genes were located on IncL/M-type conjugative plasmids. Insertion sequence IS1999(truncated or not by IS1R) was located upstream of theblaOXA-48andblaOXA-162genes in all of the isolates. Pulsed-field gel electrophoresis typing indicated the clonal transmission of an OXA-48-producingKlebsiella pneumoniaestrain in two hospitals.

scholarly journals 632. Genetic Diversity of Carbapenem-Resistant Klebsiella pneumoniae Causing Late-Onset Neonatal Sepsis in Intensive Care Unit of Caro University Hospital, Cairo, Egypt

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S293-S293
Author(s):  
Doaa Ghaith ◽  
Halaa Mufeed ◽  
Sherif Elanwary ◽  
Mai Zafer ◽  
Mohamed Alagamy ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Neonatal Sepsis ◽  
Gel Electrophoresis ◽  
Genetic Relatedness ◽  
Late Onset ◽  
Pulsed Field Gel Electrophoresis ◽  
University Hospital ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Carbapenem Resistant

Abstract Background Neonatal sepsis poses a great challenge for clinicians and infection control practitioners. Carbapenem-resistant Klebsiella pneumoniae (CRKP) is rapidly increasing and poses a major threat to neonates. Our research aim was to examine the phenotypes, genotypes, and genetic relatedness of CRKP in late-onset neonatal sepsis in the neonatal intensive care unit (NICU) at Cairo University Hospital. Methods Our study included 88 neonates diagnosed with sepsis; 58 with late-onset sepsis (LOS) and 30 with early-onset sepsis (EOS) admitted to the NICU between November 2015 and April 2016. Laboratory investigations included (vomplete blood count, C-reactive protein, serum interleukin-6 level by ELISA technique and blood culture). bacterial identification and antibiotic susceptibility testing were done by automated VITEK 2 compact system (BioMérieux, France). Detection of carbapenemases (OXA-48, NDM, IMP, KPC, and VIM) by multiplex PCR and pulsed-field gel electrophoresis (PFGE). Results K. pneumoniae was the most common encountered pathogen in the LOS group (37.9%) with a mean sepsis score of 6.39 when compared with the 33 EOS group (P < 0.005). The interleukin ratio, C-reactive protein, and interleukin-6 levels were significantly high in the K. group (P ˂ 0.001). The most prevalent 35 carbapenemase gene in the NICU, OXA-48, was identified in 14/23 (60.8%) 36 isolates followed by NDM-1 in 12/23 (52.2%) isolates as detected by multiplex 37 PCR. Coexistence of both carbapenemases was found in 52.2% (12/23). By investigating the genetic relatedness of CRKP by pulsed-field gel electrophoresis, 23 isolates of K. pneumoniae revealed various PFGE patterns, demonstrating that 40 the isolates were nonclonal. Conclusion In conclusion, carbapenam-resistant Klebsiella pneumoniae remains the most frequent organism detected in neonatal sepsis. Our results revealed that CRKP isolates were not clonal. Extra data are required on the rates of birth asphyxia and microbiology of neonatal infection since reduced records of diseases sets gaps in understanding how to improve existing practices. Infection control actions including antibiotic stewardship programs with continuous surveillance to trace emerging CRKP infections in the early hours as possible particularly in units at risk as NICUs. Disclosures All authors: No reported disclosures.

scholarly journals Detection of the novel IMP-38 among carbapenemase-producing Enterobacteriaceae in a university hospital, China

2014 ◽  
Vol 8 (08) ◽  
pp. 1044-1048 ◽  
Author(s):  
Zijuan Jian ◽  
Yanming Li ◽  
Wenen Liu ◽  
Hongling Li ◽  
Yunli Zhang ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Molecular Epidemiology ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
University Hospital ◽  
The Novel ◽  
Pulsed Field ◽  
Carbapenem Resistant ◽  
Neonatal Ward ◽  
Carbapenem Resistant Enterobacteriaceae

Introduction: This study set out to investigate the molecular epidemiology of carbapenemase-producing Enterobacteriaceae isolates collected from Xiang Ya Hospital, Hunan, China. Methodology: The carbapenemase genes from Enterobacteriaceae isolates were determined by PCR and sequencing. Relatedness of Klebsiella pneumoniae isolates was evaluated by pulsed-field gel electrophoresis. Results: Twenty-four out of 738 non-repetitive Enterobacteriaceae isolates harbored carbapenemase genes including IMP-38, a novel IMP-type metallo-enzyme. Nine IMP-38-producing isolates were shown to originate from the same clone and caused a small outbreak in the neonatal ward. Conclusions: IMP-38, a novel IMP-type metallo-enzyme, was one of the predominant types of carbapenemase in the clinical carbapenem-resistant Enterobacteriaceae isolates in our hospital.

scholarly journals First Report ofblaIMP-8in Raoultella planticola

2013 ◽  
Vol 58 (1) ◽  
pp. 593-595 ◽  
Author(s):  
Sung-Pin Tseng ◽  
Jann-Tay Wang ◽  
Chih-Yuan Liang ◽  
Pei-Shan Lee ◽  
Yee-Chun Chen ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Gel Electrophoresis ◽  
Pulsed Field Gel Electrophoresis ◽  
Protein Loss ◽  
Class 1 Integron ◽  
Raoultella Planticola ◽  
Content Type ◽  
First Report ◽  
Carbapenem Resistant ◽  
Class 1

ABSTRACTTwo carbapenem-resistantRaoultella planticolaclinical isolates were isolated from patients with pneumonia and Port-A catheter-related bacteremia, respectively, in Taiwan. These isolates remained susceptible to fluoroquinolone, aminoglycoside, and colistin. Though the two isolates had the same antibiogram, plasmidic carbapenemaseblaIMP-8, class 1 integron cassette (dfrA12-orfF-aadA2), andqnrB2, they had different pulsed-field gel electrophoresis patterns, plasmid sizes, and outer membrane protein loss profiles. To our knowledge, this is the first report ofblaIMP-8found inR. planticola. Interestingly,blaIMP-8is the most common carbapenemase found inKlebsiella pneumoniaein Taiwan. In the literature, carbapenemase genes inR. planticolain each country were also found in carbapenem-resistantEnterobacteriaceaein the same country.

scholarly journals Duodenoscope-Associated Outbreak of a Carbapenem Resistant Enterobacteriaceae

2020 ◽  
Vol 41 (S1) ◽  
pp. s197-s197
Author(s):  
Sung Ran Kim ◽  
Joon Young Song ◽  
Min Hee Cho ◽  
Ji Yeon Song
Keyword(s):  
Gel Electrophoresis ◽  
Case Control ◽  
Pulsed Field Gel Electrophoresis ◽  
Control Analysis ◽  
Endoscopic Retrograde ◽  
Carbapenem Resistant ◽  
Case Control Analysis ◽  
Record Review ◽  
Carbapenem Resistant Enterobacteriaceae ◽  
Cleaning Protocol

Background: We describe and evaluate our outbreak of carbapenem-resistant K. pneumoniae transmitted by contaminated duodenoscopes during endoscopic retrograde cholangiopancreatography (ERCP) procedures. Methods: An outbreak investigation was performed when Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) were identified from bile specimens of 4 patients. The investigation included medical record review, practice audits, and surveillance cultures of duodenoscopes and environmental sites. If available, clinical specimens were obtained from patients who had undergone ERCP in the previous 3 months. Carbapenem-resistant Enterobacteriaceae (CRE) screening cultures were performed to identify additional patients until no CRE cases were detected during 2 consecutive weeks. Pulsed-field gel electrophoresis (PFGE) of KPC-KP isolates was implemented. Results: In total, 12 cases were identified with exposure to duodenoscope from February 2019 through April 2019, including 6 cases with infections and 6 asymptomatic carriers. Case-control analysis showed that 2 specific duodenoscopes would be associated with the KPC-KP outbreak. Duodenoscope reprocessing procedures did not deviate from manufacturer recommendations for reprocessing. After ethylene oxide (EO) gas sterilization, the outbreak was terminated. Conclusions: Meticulous cleaning protocol and enhanced surveillance are necessary to prevent outbreaks of CRE. Notably, enhanced cleaning measures, such as sterilization for duodenoscopes, would be required after procedures with KPC-KP carriers.Funding: NoneDisclosures: None

scholarly journals 1348. In vitro Activity of Plazomicin, a Next-Generation Aminoglycoside, Against Carbapenemase-Producing Klebsiella pneumoniae

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S412-S413
Author(s):  
Michael R Jacobs ◽  
Caryn E Good ◽  
Ayman M Abdelhamed ◽  
Daniel D Rhoads ◽  
Kristine M Hujer ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Carbapenem Resistance ◽  
Vitro Activity ◽  
In Vitro Activity ◽  
Next Generation ◽  
Aminoglycoside Resistance ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
Research Grant

Abstract Background Plazomicin is a next-generation aminoglycoside with in vitro activity against multidrug-resistant Gram-negative species, including carbapenem-resistant isolates. The Consortium on Resistance Against Carbapenems in Klebsiella and other Enterobacteriaceae (CRACKLE) is a federally funded, prospective multicenter consortium of 20 hospitals from nine US healthcare systems to track carbapenem-resistant Enterobacteriaceae. Methods Minimum inhibitory concentrations (MICs) of plazomicin were determined by broth microdilution according to current CLSI guidelines against a collection of 697 carbapenem-resistant Klebsiella pneumoniae with defined carbapenem resistance mechanisms, including KPC and OXA carbapenemases. Isolates were submitted by participating CRACKLE centers. Results Carbapenemases present in study isolates included KPC-2 (n = 323), KPC-3 (n = 364), KPC-4 (n = 2), OXA-48 like (n = 7), and NDM (n = 1). Plazomicin MICs ranged from ≤0.12 to &gt;32 mg/L, with MIC50 and MIC90 values of 0.25 and 1 mg/L, respectively (figure). MICs of 689 (98.8%) isolates were ≤4 mg/L, while MICs of the remaining eight isolates were &gt;32 mg/L. Plazomicin MICs were related to specific carbapenemases present in isolates: of eight isolates with MICs &gt;32 mg/L, seven contained OXA-48 like and one contained KPC-3, suggesting that these isolates possess an aminoglycoside-resistance mechanism on the same plasmid as their carbapenemase gene, such as a 16S ribosomal RNA methyltransferase, against which plazomicin is not active. Conclusion Plazomicin has good in vitro potency against a collection of carbapenemase-producing K. pneumoniae, with MIC90 value of 1 mg/L and MICs of ≤4 mg/L for 98.9% of isolates. Disclosures M. R. Jacobs, Achaogen: Investigator, Research grant. Shionogi: Investigator, Research grant. L. Connolly, Achaogen, Inc.: Consultant, Consulting fee. K. M. Krause, Achaogen: Employee, Salary. S. S. Richter, bioMerieux: Grant Investigator, Research grant. BD Diagnostics: Grant Investigator, Research grant. Roche: Grant Investigator, Research grant. Hologic: Grant Investigator, Research grant. Diasorin: Grant Investigator, Research grant. Accelerate: Grant Investigator, Research grant. Biofire: Grant Investigator, Research grant. D. Van Duin, achaogen: Scientific Advisor, Consulting fee. shionogi: Scientific Advisor, Consulting fee. Allergan: Scientific Advisor, Consulting fee. Astellas: Scientific Advisor, Consulting fee. Neumedicine: Scientific Advisor, Consulting fee. Roche: Scientific Advisor, Consulting fee. T2 Biosystems: Scientific Advisor, Consulting fee.

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 &lt; 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 1189. A Comprehensive Characterization of the Emerging Carbapenem-Resistant Klebsiella pneumoniae Clinical Isolates From a Public Hospital in Lima, Peru

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S359-S360 ◽  
Author(s):  
Fiorella Krapp ◽  
Catherine Amaro ◽  
Karen Ocampo ◽  
Lizeth Astocondor ◽  
Noemi Hinostroza ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Dna Extraction ◽  
Antibiotic Susceptibility ◽  
Tertiary Care ◽  
Clinical Isolates ◽  
Molecular Characteristics ◽  
Care Hospital ◽  
Carbapenem Resistant ◽  
Carbapenemase Gene ◽  
String Test

Abstract Background In contrast with other countries in Latin America, Peru had been notoriously spared by the global dissemination of carbapenem-resistant Klebsiella pneumoniae (CR-Kp), until recently. Even though, isolated cases of KPC-producing K. pneumoniae had been reported since 2013, it was not until 2016 that the first outbreak of NDM- producing K. pneumoniae was described in Peru. By 2017, rapid emergence of CR-Kp took place in Hospital Cayetano Heredia (HCH), a tertiary care hospital in Lima. Here, we provide a description of clinical, microbiological and molecular characteristics of CR-Kp isolates recovered at HCH. Methods Retrospective review of all CR-Kp clinical isolates recovered at HCH until December 2017. Antibiotic susceptibility data were obtained during routine care (Vitek or disc diffusion) and was assessed using CLSI breakpoints. DNA extraction was performed by heat shock, and PCR was performed to assess carriage of blaNDM gene. String test was performed to detect hypermucoviscosity. Results The first case of CR-Kp in HCH dated from July 2015. Since then, a total of 69 CR-Kp clinical isolates, from 60 patients have been recovered until December 2017. A significant increase in the number of cases was observed during 2017 (Figure 1). The average age of patients was 55. Urinary, and respiratory sources of infection or colonization were the most common ones (35% and 30%, respectively), followed by blood stream (17%) and intraabdominal (10%) infections. Isolate recovery and DNA extraction was achieved in 40 cases. Of these, 15 (38%) had a positive PCR for blaNDM carbapenemase gene (Figure 2). Antibiotic susceptibility testing revealed that amikacin was the most effective antimicrobial with the rest of antimicrobials having extremely high rates of resistance (Figure 3). String test was positive in two of these isolates, suggesting that hypervirulent CR-KP might be emerging in this region. Conclusion An epidemic of CR-Kp has established in our hospital, representing the first one reported in Peru. The different mechanisms of carbapenem resistance found suggest a polyclonal expansion. Amikacin remains the only active antimicrobial within the routinely tested antibiotics, highlighting the need to add other antimicrobials to the routine panel. Disclosures All authors: No reported disclosures.

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