Colistin resistance emerges in pandrug-resistant Klebsiella pneumoniae epidemic clones in Rio de Janeiro, Brazil

Longo, Luís G.A.; Sousa, Viviane Santos de; Kraychete, Gabriela Bergiante; Justo-da-Silva, Lívia Helena; Rocha, Jaqueline; Superti, Silvana; Bonelli, Raquel Regina; Martins, Ianick Souto; Moreira, Beatriz Meurer

doi:10.1016/j.ijantimicag.2019.08.017

Cited by 36 publications

(27 citation statements)

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“…CRISPR spacers are derived from foreign genetic elements, such as viruses and plasmids, and provide immunity to reinfection based on the recognition of the cognate sequence. Although the characteristics of CRISPR/Cas systems in Kp are still not fully understood, they are mainly distributed mainly in ST15 isolates [23], including in Brazil [3], suggesting that this is a clonal feature. Additionally, CRISPR/Cas sequence analyses have been used as a complementary bacterial typing tool, and for evolutionary and epidemiological studies [24].…”

Section: Resultsmentioning

confidence: 99%

“…Despite the emergence of mobile colistin resistance ( mcr ) gene variants among other Enterobacterales , colistin resistance in Kp is predominantly driven by chromosomal point mutations, mainly in the two-component signalling system PhoP/PhoQ, or through the disruption of the mgrB by insertion sequences [2]. Although such modifications in the PhoP/PhoQ negative regulator mgrB have recently been described as an emerging mechanism of colistin resistance among healthcare-associated Kp isolates from Brazil [3], deletion of the mgrB gene has not yet been described in this region. In addition, a serious concern has been raised concerning the dissemination of KPC-producing Kp isolates among animals, the environment and humans, with this comprising a One Health issue [4].…”

Section: Introductionmentioning

confidence: 99%

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Emergence of mgrB locus deletion mediating polymyxin resistance in pandemic KPC-producing Klebsiella pneumoniae ST15 lineage

Longo

Fontana

Sousa

et al. 2021

Journal of Medical Microbiology

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Klebsiella pneumoniae causes a diversity of infections in both healthcare and community settings. This pathogen is showing an increased ability to accumulate antimicrobial resistance and virulence genes, making it a public health concern. Here we describe the whole-genome sequence characteristics of an ST15 colistin-resistant K. pneumoniae isolate obtained from a blood culture of a 79-year-old female patient admitted to a university hospital in Brazil. Kp14U04 was resistant to most clinically useful antimicrobial agents, remaining susceptible only to aminoglycosides and fosfomycin. The colistin resistance in this isolate was due to a ~1.3 kb deletion containing four genes, namely mgrB, yebO, yobH and the transcriptional regulator kdgR. The study isolate presented a variety of antimicrobial resistance genes, including the carbapenemase-encoding gene bla KPC-2, the extended-spectrum beta-lactamase (ESBL)-encoding gene bla SHV-28 and the beta-lactamase-encoding gene bla OXA-1. Additionally, Kp14U04 harboured a multiple stress resistance protein, efflux systems and regulators, heavy metal resistance and virulence genes, plasmids, prophage-related sequences and genomic islands. These features revealed the high potential of this isolate to resist antimicrobial therapy, survive in adverse environments, cause infections and overcome host defence mechanisms.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergence of mgrB locus deletion mediating polymyxin resistance in pandemic KPC-producing Klebsiella pneumoniae ST15 lineage

Longo

Fontana

Sousa

et al. 2021

Journal of Medical Microbiology

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“…Nowadays, all known mcr genes have been detected in various K. pneumoniae isolates, whereas a small number of studies have shown the presence of mcr genes in clinical K. pneumoniae isolates [49]. Several studies suggested that chromosomal mutations rather than mcr genes positivity might have an important role in colistin resistance [47,44,50]. Different STs such as ST274, ST461, ST15, ST16, ST416, ST1890, ST37, ST1942, ST101, ST147, ST258, ST152, and ST15 were detected in carbapenem and colistin resistant K. pneumoniae [42,50,51].…”

Section: Discussionmentioning

confidence: 99%

“…Several studies suggested that chromosomal mutations rather than mcr genes positivity might have an important role in colistin resistance [47,44,50]. Different STs such as ST274, ST461, ST15, ST16, ST416, ST1890, ST37, ST1942, ST101, ST147, ST258, ST152, and ST15 were detected in carbapenem and colistin resistant K. pneumoniae [42,50,51]. We detected two ST types, ST101 (95.6%) and ST147 (4.4%) in carbapenem and colistin resistant K. pneumoniae.…”

Section: Discussionmentioning

confidence: 99%

Emergence of carbapenemase-producing and colistin resistant Klebsiella pneumoniae ST101 high-risk clone in Turkey

Hazırolan

Karagöz

2020

AMicr

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Carbapenemase-producing and colistin resistant Klebsiella pneumoniae has become a worldwide healthcare problem. This study describes molecular characterization of carbapenemase-producing and colistin resistant clinical K. pneumoniae isolates.A total of 93 non-replicate carbapenem and colistin resistant K. pneumoniae were recovered from clinical specimens in a university hospital during 2017–2019. Detection of blaOXA-48, blaKPC, blaNDM-1, blaIMP, blaVIM-1 and mcr-1, -2, -3, -4, -5, -6, -7, and -8 genes was performed by PCR. The bacterial isolates were assigned to clonal lineages by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).All isolates harbored blaOXA-48 and only two isolates harbored blaOXA-48, and blaNDM-1 genes together. In colistin resistant K. pneumoniae, mcr-1 was detected in two (2.1%) isolates. Ninety three isolates of K. pneumoniae were categorized into three clusters and five pulsotypes. MLST revealed two different sequence types, ST101 (89/93) and ST147 (4/93).In our study ST101 was found to be a significantly dominant clone carrying blaOXA-48 and among our strains a low frequency of mcr-1 gene was determined. The emergence of colistin resistance was observed in K. pneumoniae ST101 isolates. ST101 may become a global threat in the dissemination of carbapenem and colistin resistance.

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“…Pandrug-resistant K. pneumoniae has been reported sporadically in many countries. [9][10][11][12][13] However, pandrugresistant K. pneumoniae in China is still rare and has only been reported by a few studies. 14 In the present study, one pandrug-resistant K. pneumoniae strain, KP65, was collected from a urine specimen of an inpatient in a teaching hospital in China.…”

Section: Introductionmentioning

confidence: 99%

<p>Rapid Emergence of a Pandrug-Resistant <em>Klebsiella pneumoniae</em> ST11 Isolate in an Inpatient in a Teaching Hospital in China After Treatment with Multiple Broad-Spectrum Antibiotics</p>

Xu¹,

Zhao²,

He³

2020

IDR

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Pandrug-resistant K. pneumoniae is still rare in China, and the lack of studies limits our understanding of the emergence mechanism of pandrug-resistant K. pneumoniae. Here, we report the rapid emergence of a pandrug-resistant K. pneumoniae ST11 strain in an inpatient after treatment with multiple broad-spectrum antibiotics in China. Patients and Methods: K. pneumoniae strain KP65 was isolated from a 55-year-old male patient hospitalized in the Department of Intensive Care Unit (ICU) of a teaching hospital in China. Antimicrobial susceptibility testing was conducted according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). The complete genome sequence of the strain was determined using the Illumina NovaSeq 6000 platform and long-read MinION sequencer. Genomic features and resistance mechanisms of the strain were comprehensively analysed using various bioinformatics approaches. Results: K. pneumoniae strain KP65 was found to be resistant to all antibiotics tested, including beta-lactams, aminoglycosides, quinolones, tigecycline and colistin. Seven resistance genes were identified in the genome. The carbapenem-resistant gene bla KPC-2 and extended-spectrum β-lactamase (ESBL)-producing gene bla CTX-M-65 are located on the IncFII-type plasmid pKPC-2-KP65. No mcr genes were detected in the genome, but an IS5 insertion element was found at position 117 of the mgrB gene. Regarding the rpsJ gene, single-base substitution, G169C, leading to the amino acid substitution V57L was also identified. According to in silico MLST analysis, K. pneumoniae KP65 belongs to sequence type ST11. The closest relative of K. pneumoniae KP65 is another ST11 K. pneumoniae strain, which was isolated from a bloodstream infection in Hangzhou, differing by only 53 cgMLST loci. Conclusion: Under the selective pressure of antibiotics, the KPC-2-producing K. pneumoniae ST11 strain can easily evolve pandrug resistance through chromosomal mutations. More attention is required to monitor the prevalence of the KPC-2-producing K. pneumoniae ST11 strain in China.

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Colistin resistance emerges in pandrug-resistant Klebsiella pneumoniae epidemic clones in Rio de Janeiro, Brazil

Cited by 36 publications

References 36 publications

Emergence of mgrB locus deletion mediating polymyxin resistance in pandemic KPC-producing Klebsiella pneumoniae ST15 lineage

Emergence of mgrB locus deletion mediating polymyxin resistance in pandemic KPC-producing Klebsiella pneumoniae ST15 lineage

Emergence of carbapenemase-producing and colistin resistant Klebsiella pneumoniae ST101 high-risk clone in Turkey

<p>Rapid Emergence of a Pandrug-Resistant <em>Klebsiella pneumoniae</em> ST11 Isolate in an Inpatient in a Teaching Hospital in China After Treatment with Multiple Broad-Spectrum Antibiotics</p>

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