scholarly journals Clonal Spread and Intra- and Inter-Species Plasmid Dissemination Associated With Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales During a Hospital Outbreak in Barcelona, Spain

2021 ◽  
Vol 12 ◽  
Author(s):  
Marta Marí-Almirall ◽  
Núria Ferrando ◽  
Mariana José Fernández ◽  
Clara Cosgaya ◽  
Joaquim Viñes ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Tertiary Hospital ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Flight Mass Spectrometry ◽  
Hospital Outbreak ◽  
Resistance Plasmids ◽  
Long Read ◽  
Clonal Spread

Objectives: The study aimed to characterize the clonal spread of resistant bacteria and dissemination of resistance plasmids among carbapenem-resistant Enterobacterales at a tertiary hospital in Catalonia, Spain.Methods: Isolates were recovered from surveillance rectal swabs and diagnostic samples. Species identification was by matrix-assisted laser desorption ionization-time time of flight mass spectrometry (MALDI-TOF MS). Molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing (MLST). Antimicrobial susceptibility was assessed by gradient-diffusion and carriage of bla genes was detected by PCR. Plasmid typing, conjugation assays, S1-PFGE studies and long-read sequencing were used to characterize resistance plasmids.Results: From July 2018 to February 2019, 125 Klebsiella pneumoniae carbapenemase (KPC)-producing Enterobacterales were recovered from 101 inpatients from surveillance (74.4%) or clinical samples (25.6%), in a tertiary hospital in Barcelona. Clonality studies identified a major clone of Klebsiella pneumoniae belonging to sequence type ST15 and additional isolates of K. pneumoniae, Escherichia coli and Enterobacter sp. from different STs. All isolates but one carried the blaKPC–2 allelic variant. The blaKPC–2 gene was located in an IncFIIk plasmid of circa 106 Kb in a non-classical Tn4401 element designated NTEKPC-pMC-2-1. Whole-genome sequencing revealed different rearrangements of the 106 Kb plasmid while the NTEKPC-pMC-2-1 module was highly conserved.Conclusion: We report a hospital outbreak caused by the clonal dissemination of KPC-producing ST15 K. pneumoniae but also the intra- and inter-species transmission of the blaKPC–2 gene associated with plasmid conjugation and/or transposon dissemination. To our knowledge, this is the first report of an outbreak caused by KPC-producing Enterobacterales isolated from human patients in Catalonia and highlights the relevance of surveillance studies in the early detection and control of antibiotic resistant high-risk clones.

scholarly journals Prevalence of blaKPC-2, blaKPC-3 and blaKPC-30—Carrying Plasmids in Klebsiella pneumoniae Isolated in a Brazilian Hospital

Pathogens ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 332
Author(s):  
Letícia B. Migliorini ◽  
Romário O. de Sales ◽  
Paula C. M. Koga ◽  
Andre M. Doi ◽  
Anja Poehlein ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Tertiary Hospital ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Genomic Context ◽  
Multidrug Resistant Bacteria ◽  
Klebsiella Pneumoniae Carbapenemase ◽  
Carbapenem Resistant ◽  
Horizontal Spread ◽  
Widespread Dissemination

Klebsiella pneumoniae carbapenemase (KPC) actively hydrolyzes carbapenems, antibiotics often used a last-line treatment for multidrug-resistant bacteria. KPC clinical relevance resides in its widespread dissemination. In this work, we report the genomic context of KPC coding genes blaKPC-2, blaKPC-3 and blaKPC-30 in multidrug-resistant Klebsiellapneumoniae isolates from Brazil. Plasmids harboring blaKPC-3 and blaKPC-30 were identified. Fifteen additional carbapenem-resistant K. pneumoniae isolates were selected from the same tertiary hospital, collected over a period of 8 years. Their genomes were sequenced in order to evaluate the prevalence and dissemination of blaKPC–harboring plasmids. We found that blaKPC genes were mostly carried by one of two isoforms of transposon Tn4401 (Tn4401a or Tn4401b) that were predominantly located on plasmids highly similar to the previously described plasmid pKPC_FCF3SP (IncN). The identified pKPC_FCF3SP-like plasmids carried either blaKPC-2 or blaKPC-30. Two K. pneumoniae isolates harbored pKpQIL-like (IncFII) plasmids, only recently identified in Brazil; one of them harbored blaKPC-3 in a Tn4401a transposon. Underlining the risk of horizontal spread of KPC coding genes, this study reports the prevalence of blaKPC-2 and the recent spread of blaKPC-3, and blaKPC-30, in association with different isoforms of Tn4401, together with high synteny of plasmid backbones among isolates studied here and in comparison with previous reports.

Spread of NDM-producing Klebsiella pneumoniae in a tertiary Greek hospital

2021 ◽  
Author(s):  
Κonstantina Kontopoulou ◽  
Georgios Meletis ◽  
Styliani Pappa ◽  
Sofia Zotou ◽  
Katerina Tsioka ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Rapd Analysis ◽  
Random Amplified Polymorphic Dna ◽  
Hospital Setting ◽  
Tertiary Hospital ◽  
Whole Genome Sequence ◽  
Health Concern ◽  
Resistant Bacteria ◽  
New Delhi ◽  
Whole Genome

AbstractBacterial carbapenem resistance, especially when mediated by transferable carbapenemases, is of important public health concern. An increased number of metallo-β-lactamase (MBL)-producing Klebsiella pneumoniae strains isolated in a tertiary hospital in Thessaloniki, Greece, called for further genetic investigation.The study included 29 non-repetitive carbapenem resistant K. pneumoniae isolates phenotypically characterized as MBL-producers collected in a tertiary hospital in Greece. The isolates were screened for the detection of carbapenemase genes (K. pneumoniae carbapenemase (blaKPC), Verona-integron-encoded MBL-1 (blaVIM-1), imipenemase (blaIMP), oxacillinase-48 (blaOXA-48) and New Delhi MBL (blaNDM)). The genetic relationship of the isolates was determined by Random Amplified Polymorphic DNA (RAPD) analysis. The whole genome sequences (WGS) from two NDM-positive K. pneumoniae isolates were further characterized.The presence of New Delhi MBL (blaNDM) gene was confirmed in all K. pneumoniae isolates, while blaKPC and blaVIM-1 genes were co-detected in one and two isolates, respectively. The RAPD analysis showed that the isolates were clustered into two groups. The whole genome sequence analysis of two K. pneumoniae isolates revealed that they belonged to the sequence type 11, they carried the blaNDM-1 gene, and exhibited differences in the number and type of the plasmids and the resistant genes.All MBL-producing K. pneumoniae isolates of the study harbored a blaNDM gene, while WGS analysis revealed genetic diversity in resistance genes. Continuous surveillance is needed to detect the emergence of new clones in a hospital setting, while application of antimicrobial stewardship is the only way to reduce the spread of multi-resistant bacteria.

scholarly journals AmpC β-Lactamase Variable Expression in Common Multidrug-Resistant Nosocomial Bacterial Pathogens from a Tertiary Hospital in Cairo, Egypt

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
Aliaa ELshamy ◽  
Zainab Zakaria ◽  
Mahmoud M. Tolba ◽  
Nermeen Salah Eldin ◽  
Al-Taher Rabea ◽  
...  
Keyword(s):  
Tract Infection ◽  
Bacterial Species ◽  
Expression Patterns ◽  
Tertiary Hospital ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Variable Expression ◽  
Wound Swab ◽  
Significant Difference ◽  
Lactamase Gene

The emergence of AmpC (pAmpC) β-lactamases conferring resistance to the third-generation cephalosporins has become a major clinical concern worldwide. In this study, we aimed to evaluate the expression of AmpC β-lactamase encoding gene among the pathogenic Gram-positive and Gram-negative resistant bacteria screened from clinical samples of Egyptian patients enrolled into El-Qasr El-Ainy Tertiary Hospital in Cairo, Egypt. A total of 153 bacterial isolates of the species Pseudomonas aeruginosa, Klebsiella pneumoniae, and Enterococcus faecium were isolated from patients diagnosed with urinary tract infection (UTI), respiratory tract infection (RTI), and wound infections. The total number of E. faecium isolates was 53, comprising 29 urine isolates, 5 sputum isolates, and 19 wound swab isolates, whereas the total number of P. aeruginosa isolates was 49, comprising 27 urine isolates, 7 sputum isolates, and 15 wound swab isolates, and that of the K. pneumoniae isolates was 51, comprising 20 urine isolates, 25 sputum isolates, and 6 wound swab isolates. Our results indicated that there is no significant difference in the expression of AmpC β-lactamase gene among the tested bacterial species with respect to the type of infection and/or clinical specimen. However, the expression patterns of AmpC β-lactamase gene markedly differed according to the antibacterial resistance characteristics of the tested isolates.

A 7-year surveillance for ESBL-producing Escherichia coli and Klebsiella pneumoniae at a university hospital in Taiwan: the increase of CTX-M-15 in the ICU

2009 ◽  
Vol 138 (2) ◽  
pp. 253-263 ◽  
Author(s):  
J. C. SHU ◽  
J. H. CHIA ◽  
A. J. KUO ◽  
L. H. SU ◽  
T. L. WU
Keyword(s):  
Escherichia Coli ◽  
Klebsiella Pneumoniae ◽  
Genetic Relatedness ◽  
Horizontal Transmission ◽  
Clonal Expansion ◽  
Tertiary Hospital ◽  
University Hospital ◽  
Molecular Investigation ◽  
Resistance Plasmids ◽  
Changing Trend

SUMMARYTo monitor the changing trend of extended-spectrum β-lactamase (ESBL)-producing bacteria, a 7-year continuous study was launched in 2001 at the largest tertiary hospital in Taiwan. A significant increase over the study period was evident for ESBL-producing isolates of Escherichia coli (4·8–10·0%) and Klebsiella pneumoniae (15·0–23·4%). Molecular investigation conducted in three separate periods revealed the prevalent ESBL types and their genetic relatedness. CTX-M-producing isolates (73·8%) were more prevalent than SHV-type ESBLs (37·0%), the most frequent being CTX-M-14 (34·3%), CTX-M-3 (25·9%), and SHV-12 (25·7%). However, a marked increase of CTX-M-15-producing isolates from 2·1% in 2002 to 29·6% in 2007 was also noted. The increase of ESBL-producing isolates in both species may be mainly due to the horizontal transmission of resistance plasmids, while clonal expansion of some epidemic strains further added to the dispersion of ESBL-producing K. pneumoniae.

scholarly journals Epidemiology of Carbapenemase-Producing Klebsiella pneumoniae in a Portuguese Tertiary Hospital

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
D Peres ◽  
N Pereira-Rocha ◽  
C Alves ◽  
S Correia
Keyword(s):  
Klebsiella Pneumoniae ◽  
Urinary Catheter ◽  
Fatal Outcome ◽  
Previous History ◽  
Public Health Problem ◽  
Tertiary Hospital ◽  
Clinical Samples ◽  
High Risk Population ◽  
Male Patients ◽  
Containment Strategy

Abstract Background Carbapenemase-producing Klebsiella pneumoniae (CPKp) are considered a public health problem. To manage this multidrug-resistant organism (MDRO), it is important to identify individuals at higher risk. We describe risk factors for CPKp among a population who acquired this MDRO, in a tertiary hospital Center (THC), from 2017 to 2019. Methods Descriptive study, with data from medical record, in a 1100 bed THC, with active surveillance (high risk population at admission and CPKp direct contacts). Participants: patients > =18 years old, with length of stay (LOS) >48 hours, in which CPKp was identified in clinical samples > =48 h after admission and without previous history of this MDRO. Results Incidence rate increased from 0.031 (2017) to 0.090 (2018) cases per 1000 patient-days and was 0.081 in 2019 (p = 0.004). Evolution of CPKp proportion was 1.6%, 3.9% and 4.1%, respectively. In 2019, 12 patients (40.0%) were at intensive care when this MDRO was detected. During these 3 years, CPKp was more frequently identified in urine (31.3 - 54.5%) and respiratory products (13.3 - 36.4%). The median LOS until CPKp isolation was 10.0 to 24.0 days and, until discharge, 15.0 to 25.5 days. Fatal outcome occurred in 8 (25.0%) and 7 (23.3%) patients in 2018 and 2019, respectively. Most cases were exposed to antibiotics (81.8 - 90.6%), had a urinary catheter (63.6 - 75.0%) and were dependent for hygiene activities (63.6 - 66.7%). Many had a central line (21.9 - 43.3%), previous surgery (45.5 - 63.3%) and hospital admission in the previous 6 months (27.3 - 40.6%). Along these 3 years, none of these variations was statistically significant. Conclusions In this THC, CPKp increased from 2017 to 2018 and remained stable afterwards. It affected mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO. Key messages CPKp increased from 2017 to 2018 and remained stable afterwards, affecting mostly male patients, exposed to antibiotics, with urinary catheter and dependent in their hygiene activities. In order to have an adequate CPKp containment strategy it is essential to know the population who acquired this MDRO during their stay.

scholarly journals Molecular Epidemiological Surveillance of CTX-M-15-producing Klebsiella pneumoniae from the patients of a teaching hospital in Sindh, Pakistan.

F1000Research ◽  
2021 ◽  
Vol 10 ◽  
pp. 444
Author(s):  
Muzaheed Muzaheed ◽  
Naveed Sattar Shaikh ◽  
Saeed Sattar Shaikh ◽  
Sadananda Acharya ◽  
Shajiya Sarwar Moosa ◽  
...  
Keyword(s):  
Klebsiella Pneumoniae ◽  
Teaching Hospital ◽  
Hospital Setting ◽  
Influential Factor ◽  
Detection Methods ◽  
Epidemiological Surveillance ◽  
Clinical Samples ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Extended Spectrum

Background  The presence of Extended-spectrum β-lactamase positive bacteria in hospital setting is an aggravating influential factor for hospitalized patients, and its consequences may be hazardous. Therefore, there is a need for rapid detection methods for newly emerging drug-resistant bacteria. This study was aimed at the molecular characterization of Extended-spectrum β-lactamase -positive  Klebsiella pneumoniae isolates recovered from the patients of a teaching hospital in Sindh, Pakistan.   Methods  A total of 513  K. pneumoniae isolates were obtained from various clinical samples during June 2019 to May 2020. The collected isolates were investigated for antimicrobial susceptibility (antibiogram), and PCR and DNA sequencing were performed to analyse the ESBL genes.   Results  Among the 513 isolates, as many as 359 (69.9%) were Extended-spectrum β-lactamase producers and 87.5% were multi-drug resistant, while none had resistance to imipenem. PCR scored 3% blaTEM, 3% blaSHV, and 60% blaCTX-M-15 genes for the tested isolates.   Conclusion  The study showed that CTX-M-15 was the major prevalent Extended-spectrum β-lactamase type among the isolates. Additionally, all the isolates were susceptible to carbapenems. Screening and detection of Extended-spectrum β-lactamase tests are necessary among all isolates from the enterobacteriaceae family in routine microbiology laboratory to prevent associated nosocomial infections. A larger study is essential to understand molecular epidemiology of Extended-spectrum β-lactamase producing organisms to minimize morbidities due to these multidrug resistant organisms.

scholarly journals The evaluation of vancomycin-resistant enterococci and carbapenamase producing Klebsiella colonization among ICU-Hospitalized Patients

2021 ◽  
Vol 21 (4) ◽  
pp. 1662-8
Author(s):  
Gökhan Karaşin ◽  
Yasemin Bayram ◽  
Mehmet Parlak ◽  
Cenk Aypak ◽  
Mustafa Akgül ◽  
...  
Keyword(s):  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Intensive Care Units ◽  
Rectal Swab ◽  
Tertiary Hospital ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Vancomycin Resistant Enterococcus ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

Background: Multi-drug resistant organisms, especially Vancomycin-Resistant Enterococcus (VRE) and Carbapenam Resistant Klebsiella pneumoniae (KPC), are serious health threat. Early detection of resistant bacteria colonization amongpatients in intensive care units (ICUs) not only enables effective treatment but more importantly prevents disease and limits transmission. Therefore, we aimed to to assess the frequency of VRE and KPC colonization via rectal swab sampling. Methods: The study was carried out in ICUs of a tertiary hospital. Two rectal swab samples were collected within the first 24 hours of admission and another one was taken every subsequent 15 days to test for for VRE and KPC carriage. Results: A total 316 rectal swab samples taken from 230 patients. Forty-seven patients were screened at least 2 times. 183 patients were not further screened due to discharge, exitus or transfer to other wards. Thirty-six patients (16%) were determinedto be VRE (+). The most frequently isolated strain was E. faecium (80.5%) and its most common genotype was VanA (87.5%). Seven patients (3%) were identified as KPC (+). OXA-48 type crbapenamase was confirmed in all KPC isolates. Conclusion: This study shows that VRE and KPC colonization continues to be a serious threat in ICUs. Keywords: Carbapenam resistant klebsiella pneumoniae; vancomycin-resistant enterococci; intensive care units.

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