An Outbreak of Infections Caused by a Klebsiella pneumoniae ST11 Clone Coproducing Klebsiella pneumoniae Carbapenemase-2 and RmtB in a Chinese Teaching Hospital

Abstract

Background:Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae bacteria, which cause serious disease outbreaks worldwide, was rarely detected in Xiangya Hospital, prior to an outbreak that occurred from August 4, 2014, to March 17, 2015. The aim of this study was to analyze the epidemiology and molecular characteristics of the K. pneumoniae strains isolated during the outbreak.Methods:Nonduplicate carbapenem-resistant K. pneumoniae isolates were screened for blaKPC-2 and multiple other resistance determinants using polymerase chain reaction. Subsequent studies included pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, analysis of plasmids, and genetic organization of blaKPC-2 locus.Results:Seventeen blaKPC-2-positive K. pneumoniae were identified. A wide range of resistant determinants was detected. Most isolates (88.2%) coharbored blaKPC-2 and rmtB in addition to other resistance genes, including blaSHV-1, blaTEM-1, and aac(3)-IIa. The blaKPC-2 and rmtB genes were located on the conjugative IncFIB-type plasmid. Genetic organization of blaKPC-2 locusin most strains was consistent with that of the plasmid pKP048. Four types (A1, A2, A3, and B) were detected by PFGE, and Type A1, an ST11, was the predominant PFGE type. A novel K. pneumoniae sequence type (ST1883) related to ST11 was discovered.Conclusions:These isolates in our study appeared to be clonal and ST11 K. pneumoniae was the predominant clone attributed to the outbreak. Coharbing of blaKPC-2 and rmtB, which were located on a transferable plasmid, in clinical K. pneumoniae isolates may lead to the emergence of a new pattern of drug resistance.

<p>Risk Factors for Subsequential Carbapenem-Resistant <em>Klebsiella pneumoniae</em> Clinical Infection Among Rectal Carriers with Carbapenem-Resistant <em>Klebsiella pneumoniae</em></p>

“…It is worth noting that all the subsequential infection CRKP isolates were also ST11 type, which is accordance with that ST11 is the most frequently reported ST type in China, contributing to the spread of antimicrobial resistance. 6,28 The limitation of this study is that it is a single-center study and the limitation of patient populations may result in the conclusion lacking of generalization. However, our hospital is a 3,500-beds hospital, one of the largest hospitals in Southern China with more than 130,000 annual admission from all over the region.…”

Molecular characterization and epidemiology of carbapenem non-susceptible Enterobacteriaceae isolated from the Eastern region of Heilongjiang Province, China

“…Isolates with the bla KPC gene are spread in many regions such as North America, Latin America and Asia with ST11 and ST258 being the common types [ 42 – 44 ]. The epidemiological information on CRKP in the eastern region of Heilongjiang Province is unknown.…”

Characterization of carbapenem-resistant hypervirulent Acinetobacter baumannii strains isolated from hospitalized patients in the mid-south region of China

“…The seven CR-hvAB isolates also harbored multiple drug resistance genes against the most commonly used antibiotics in the clinic, which made it difficult to treat. Notably, AB22 not only carried the bla OXA-23 gene, but also the bla KPC-2 gene, which is predominantly found in Klebsiella pneumoniae and clonally distributed in China [ 26 – 28 ]. To the best of our knowledge, only three cases of A. baumannii containing bla KPC-2 genes have been reported [ 29 – 31 ], making our study the first report on the detection of biofilm-producing Klebsiella pneumoniae carbapenemase-producing A. baumannii isolate in China.…”