Clinical and Molecular Characteristics of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae Isolates in a Tertiary Hospital in Shanghai, China

Zhou, Cong; Wu, Qiang; He, Leqi; Zhang, Hui; Xu, Maosuo; Yuan, Baoyu; Jin, Zhi; Shen, Fang

doi:10.2147/idr.s321704

Cited by 27 publications

(16 citation statements)

References 38 publications

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“…The carbapenemase genes of isolates with reduced susceptibility to carbapenems were tested by PCR, including class A ( blaKPC , blaNMC , blaGES , blaIMI and blaSME ), class B ( blaVIM , blaIMP , blaNDM , blaSIM , blaSPM and blaGIM ) and class D ( blaOXA-48 ) [ 47 , 48 ]. Virulence-associated genes ( magA , kfu , allS , iutA , rmpA , rmpA2 , iucA , aerobactin and iroN ) were identified as described previously [ 49 , 50 ]. Bacterial typing was carried out by multilocus sequence typing (MLST) using primers listed in the online databases ( https://bigsdb.pasteur.fr/klebsiella/klebsiella.html for KP and https://bigsdb.pasteur.fr/ecoli/primers_used.html for EC).…”

Section: Methodsmentioning

confidence: 99%

Epidemiology and clinical characteristics of infection/colonization due to carbapenemase-producing Enterobacterales in neonatal patients

Wang

Yang

et al. 2022

BMC Microbiol

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Background The aim of this study was to elucidate the epidemiological features of carbapenemase-producing Enterobacterales (CPE) in the pediatric and neonatal patients, to describe clinical characteristics of neonatal patients with CPE infections, and to assess risk factors for neonatal rectal colonization with CPE. Results A total of 439 carbapenem-resistant Enterobacterales (CRE) isolates recovered from 367 infant patients were characterised, including 397 isolates of Klebsiella pneumoniae (KP) and 42 isolates of Escherichia coli (EC). Carbapenemase gene blaNDM-1 was the most commonly detected, accounting for 86.56% (n = 380), followed by blaKPC-2 (9.11%, 40) and blaIMP-4 (4.33%, 19). MLST analysis showed 17 different STs detected within CPKP isolates, with ST20, ST2068, ST36 and ST17 being the most frequently isolated types. Eleven STs were identified within CPEC isolates, with ST325 being the dominant types. Eight isolates of NDM-1 producing KP, belonging to ST23, were identified as having hypervirulent traits. The main infections caused by CPE were pneumonia (n = 90) and sepsis (n = 16). All infected patients received monotherapy, with meropenem and ciprofloxacin being the most commonly used antibiotics. All pneumonia patients were cured or improved after treatment. Of the 16 patients with sepsis, 9 were cured or improved, 3 died, and 4 abandoned treatment without any clinical improvement. The rectal prevalences of CPE in the 0–3 days old (DO), the 4–28 DO, and the 29 DO-1 year old groups were decreased from 15.31%, 27.37% and 14.29% in the first stool screening period to 11.78%, 19.59% and 4.07% in the second stool screening period, respectively. Multivariate analysis showed that cesarean section, acidosis, respiration failure, gastric lavage and enema were independent risk factors for rectal colonization in the 0–3 DO group, whereas cesarean section, cephalosporins, gastric lavage and residence in rural area were independently associated with rectal colonization in the 4–28 DO group. The implementation of a series of evidence-based control measures eventually contained the CPE transmission. Conclusions Continued vigilance, epidemiological studies, and multimodal infection prevention strategies are urgently needed due to frequent importations.

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Section: Methodsmentioning

confidence: 99%

Epidemiology and clinical characteristics of infection/colonization due to carbapenemase-producing Enterobacterales in neonatal patients

Wang

Yang

et al. 2022

BMC Microbiol

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“…Klebsiella pneumoniae ( K. pneumoniae ), an opportunistic infecting microbe, frequently causes pneumonia, bacteremia, liver abscess, and urinary tract infection. 1 , 2 Multidrug-resistant strains of K. pneumoniae are common, thus leading to failure of antibiotics therapy against different infections. Although most medicines are effective against nonclassical hypervirulent K. pneumoniae strains, they can induce meddlesome infections in both immunocompromised and healthy patients within the community.…”

Section: Introductionmentioning

confidence: 99%

Virulence Genotype and Correlation of Clinical Severeness with Presence of the Type VI Secretion System in Klebsiella pneumoniae Isolates Causing Bloodstream Infections

Zhang¹,

Xu²,

Huang³

2022

IDR

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Background Klebsiella pneumoniae ( K. pneumoniae ) causes bloodstream infection (BSI), which is responsible for a high rate of morbidity and mortality among different populations. In mainland China, data on the correlation and features of the type VI secretion system (T6SS) gene cluster in K. pneumoniae is currently scarce. As a result, we conducted a prospective investigation to determine the involvement of the T6SS in K. pneumoniae pathogenicity and antibiotic resistance. Methods In this prospective analysis, we enrolled 119 individuals who had been diagnosed with K. pneumoniae bloodstream infection between July 2019 and January 2021 and acquired demographic and clinical data from their medical records. The virulence genes rmpA, rmpA2, aerobactin, iroB, hcp, vgrG, and icmF were tested for K1 and K2, antimicrobial susceptibility. Five T6SS-positive and five T6SS-negative isolates were chosen for the competition, serum resistance, and biofilm formation experiments to further gain insights regarding the microbiological properties of T6SS-positive K. pneumoniae isolates. Results Among 119 isolates obtained from patients with BSIs, 20 (16.8%) were T6SS positive K. pneumoniae . T6SS positive strains had four virulence genes and a greater K1 capsular serotypes rate than T6SS negative bacteria. Among hvKP isolates, the T6SS positive rate was substantially greater than the T6SS negative rate (P = 0.001). T6SS-positive K. pneumoniae strains had a lower rate of antimicrobial resistance in comparison to T6SS-negative bacteria. T6SS-positive isolates may be more competitive with Escherichia coli than T6SS-negative isolates. T6SS-positive isolates, on the other hand, did not show stronger biofilm-forming activity or a higher survival rate in the presence of normal human serum in comparison to T6SS-negative isolates. Conclusion T6SS-positive K. pneumoniae was common in people who had BSIs. In T6SS‐containing K. pneumoniae , the system may play a major role in bacterial competition.

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“…Capsular polysaccharide was considered to be a virulence factor for KP, and some capsular types such as K1, K2, K5, K20, K54 and K57 were associated with invasive diseases or unique pathogenicity [ 16 – 18 ]. CPKP ST11 was increasingly becoming hypervirulent especially in China and two CPS (K64 and K47) in ST11 isolates were found to be carbapenem-resistant hypervirulent KP [ 16 , 17 ]. The hypervirulence status of the most prevalent CPKP isolates such as wzi 209 and wzi 141 in our study was also determined by polymerase chain reaction (PCR) amplification of virulence plasmid associated genes ( rmpA2 , iutA , iucA ) [ 18 ], which were identified as hypervirulent KP, but none of the isolates tested in our study carried these virulence genes.…”

Section: Discussionmentioning

confidence: 99%

Clonal spread of carbapenemase-producing Enterobacteriaceae in a region, China

Yin

Yang

et al. 2022

BMC Microbiol

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Background The increasing number of carbapenemase-producing Enterobacterales (CPE) has become a serious problem globally. This study aimed to elucidate their geographically epidemiological characteristics. Methods Resistance genes were identified by polymerase chain reaction (PCR) and sequencing. Bacterial genotyping was studied using multilocus sequence typing (MLST) and wzi typing. The transferability of carbapenemase genes was determined by a broth mating method. The relationships between the rates of antimicrobial consumption and the prevalence of CRE were performed by Pearson's or Spearman's correlation analyses. Results A total of 930 phenotypically confirmed carbapenem-resistant Enterobacterales (CRE) isolates collected from 19 hospitals were genotypically characterized. K. pneumoniae (KP) and E. coli isolates were 785 (85.14%) and 96 (10.41%) among 922 CPE isolates. Two major carbapenemase genes blaKPC-2 and blaNDM in CPE isolates accounted for 84.6% (n = 780) and 13.77% (n = 127). ST11 comprised 86.83% (633/729) of KPC-2 KP isolates. Different combinations of extended spectrum-β-lactamase (ESBL) genes of blaSHV, blaCTX, and blaTEM were found in KPC-2 producing KP isolates, and blaCTM-M-14/15, blaSHV-11/12 and blaTEM-1 were common ESBL genotypes. The wzi typing method could further subdivide ST11 KP group into at least five subgroups, among which wzi209 (69.83%, 442/633) was the most frequently isolated, followed by wzi141 (25.28%, 160/633). Conjugation assays showed that high conjugation rates were observed in CPE (15.24%, 32/210) for NDM plasmids, but relatively low (8.1%, 17/210) for KPC-2 plasmids. Different STs, different wzis and temperature could influence plasmid conjugation efficiency. No associations between the rates of antibiotics consumption and CPE prevalence were observed. The number of intra-hospital and inter-hospital transfers of CPE patients increased gradually from 18 (17.82%, 101) and 12 (11.88%, 101) in 2015 to 63 (30.73%, 205) and 51 (24.88%, 205) in 2018 (p = 0.016 and p = 0.008), respectively. Evidence-based measures could effectively reduce the prevalence of ST11-wzi209 clone but failed to control the dissemination of ST11-wzi141 KP clone. Conclusions Clonal spread of CPE, especially KPC-2 ST11 KP was the key factor contributing to the CPE increase in the region. Continued vigilance for the importations should be maintained. Coordinated regional interventions are urgently needed to reduce CPE threat.

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Clinical and Molecular Characteristics of Carbapenem-Resistant Hypervirulent Klebsiella pneumoniae Isolates in a Tertiary Hospital in Shanghai, China

Cited by 27 publications

References 38 publications

Epidemiology and clinical characteristics of infection/colonization due to carbapenemase-producing Enterobacterales in neonatal patients

Epidemiology and clinical characteristics of infection/colonization due to carbapenemase-producing Enterobacterales in neonatal patients

Virulence Genotype and Correlation of Clinical Severeness with Presence of the Type VI Secretion System in Klebsiella pneumoniae Isolates Causing Bloodstream Infections

Clonal spread of carbapenemase-producing Enterobacteriaceae in a region, China

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