Characterization of Carbapenem-Resistant Klebsiella pneumoniae ST15 Clone Coproducing KPC-2, CTX-M-15 and SHV-28 Spread in an Intensive Care Unit of a Tertiary Hospital

Abstract

Objective Nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is a great threat to severely ill patients. Here we report an outbreak of K. pneumoniae ST15 isolates co-producing KPC-2, CTX-M-15, and SHV-28 in the cardiac surgery intensive care unit (CSICU) of a tertiary hospital. Materials and Methods From November 2019 to August 2020, all non-duplicated CRKP isolates were collected from the CSICU. The VITEK-2 compact system was used for bacterial identification and antimicrobial susceptibility testing. Clinical data were retrieved from electronic case records. All strains were also subjected to antibiotic resistance genes detection. Clonal relationships were analyzed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Results A total of 28 non-duplicated CRKP isolates were collected, including 23 strains belonging to ST15 and 5 strains belonging to ST11. All ST15 isolates were susceptible to amikacin, tigecycline, polymyxin B and ceftazidime/avibactam, but resistant to carbapenems, cephalosporins, quinolones, tobramycin and gentamicin. The detection of resistant determinants showed that 21 strains of ST15 CRKP co-harboured bla KPC-2 , bla CTX-M-15 , bla SHV-28 , bla TEM-1 , bla OXA-1 and aac(6ʹ)-Ib-cr . All the 28 CRKP isolates were classified into five PFGE patterns (A, B, C, D and E), of which type A and B belonged to ST15 and type C, D and E belonged to ST11. PFGE type A was the predominant clonotype of this nosocomial infection and belonged to ST15. Conclusion K. pneumoniae ST15 co-producing KPC-2, CTX-M-15, SHV-28, TEM-1, OXA-1 and aac(6ʹ)-Ib-cr is the predominant clone spread in the CSICU. Surveillance and comprehensive infection control measures should be strengthened in clinical practice.

Expansion of KPC-producing Enterobacterales in four large hospitals in Hanoi, Vietnam

“…The predominance of ST15 in the four hospitals was similar to other published data in Vietnam and Asian countries including China, which shares a >1000 km border and trading and tourism activities with Vietnam [ 6 , 8 , 19 , 20 ]. ST15 K. pneumoniae has been reported worldwide as a clone carrying multiple carbapenemase genes, which was also observed in other studies in Vietnam [ 8 , 21 ].…”

Shift in the Dominant Sequence Type of Carbapenem-Resistant Klebsiella pneumoniae Bloodstream Infection from ST11 to ST15 at a Medical Center in Northeast China, 2015–2020

“…7 Consistently, another study also showed lower amikacin resistance rates for ST15 CRKP isolates. 18 Based on these findings, different treatment options should be selected for ST11 and ST15 CRKP strains.…”

Extended-Spectrum β-Lactam Resistant Klebsiella pneumoniae and Escherichia coli in Wild European Hedgehogs (Erinaceus europeus) Living in Populated Areas

“…The combination of CTX-M-15 with SHV-28 was the most repeated association, found principally in K. pneumoniae isolates. This association, when located in Klebsiella species, has been related with the high risk clone ST15, which is an emerging cause of nosocomial infections [44].…”

“…The AmpC β-lactamase genes CMY-1 and CMY-2 were detected in the tested hedgehogs. As these genes can be either acquired by plasmids or can be chromosomally selected [44], it is difficult to attribute the presence of CMY-1 and -2 in these animals as a result of direct environmental contamination. Similarly, the genetic resistance of C. freundii isolates found in three animals is usually originated at a chromosomal level.…”