IMP-38-Producing High-Risk Sequence Type 307 Klebsiella pneumoniae Strains from a Neonatal Unit in China

Wang, Siyi; Zhao, Juan; Liu, Ning; Fang, Yang; Zhong, Yiming; Gu, Xiumei; Jian, Zijuan; Yan, Qun; Liu, Qingxia; Li, Hongling; Liu, Yanming; Liu, Jing; Li, Hui; Chen, Liang; Liu, Wenen

doi:10.1128/msphere.00407-20

Cited by 7 publications

(5 citation statements)

References 30 publications

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“…bla IMP−38 was a novel allele and differed by a single mutation from IMP-4 which was found in the other wards of the same hospital (84). In another recent study from China, fourteen bla IMP−38 -possessing K. pneumoniae ST307 were recovered from neonates suffering from sepsis (88). Another variant, IMP-4 has also been reported from China causing neonatal infections (69,77,87).…”

Section: Drug-resistant Bug and The Newbornmentioning

confidence: 85%

Neonatal Sepsis: The Impact of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae

et al. 2021

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The convergence of a vulnerable population and a notorious pathogen is devastating, as seen in the case of sepsis occurring during the first 28 days of life (neonatal period). Sepsis leads to mortality, particularly in low-income countries (LICs) and lower-middle-income countries (LMICs). Klebsiella pneumoniae, an opportunistic pathogen is a leading cause of neonatal sepsis. The success of K. pneumoniae as a pathogen can be attributed to its multidrug-resistance and hypervirulent-pathotype. Though the WHO still recommends ampicillin and gentamicin for the treatment of neonatal sepsis, K. pneumoniae is rapidly becoming untreatable in this susceptible population. With escalating rates of cephalosporin use in health-care settings, the increasing dependency on carbapenems, a “last resort antibiotic,” has led to the emergence of carbapenem-resistant K. pneumoniae (CRKP). CRKP is reported from around the world causing outbreaks of neonatal infections. Carbapenem resistance in CRKP is largely mediated by highly transmissible plasmid-encoded carbapenemase enzymes, including KPC, NDM, and OXA-48-like enzymes. Further, the emergence of a more invasive and highly pathogenic hypervirulent K. pneumoniae (hvKP) pathotype in the clinical context poses an additional challenge to the clinicians. The deadly package of resistance and virulence has already limited therapeutic options in neonates with a compromised defense system. Although there are reports of CRKP infections, a review on neonatal sepsis due to CRKP/ hvKP is scarce. Here, we discuss the current understanding of neonatal sepsis with a focus on the global impact of the CRKP, provide a perspective regarding the possible acquisition and transmission of the CRKP and/or hvKP in neonates, and present strategies to effectively identify and combat these organisms.

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Section: Drug-resistant Bug and The Newbornmentioning

confidence: 85%

Neonatal Sepsis: The Impact of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae

et al. 2021

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“…ST307 has been reported as an emerging MDR clone replacing ST11 (ST258) by the acquisition of bla KPC , and bla OXA-48 -like in the United States, Southern Africa, Europe, and Germany ( 13 , 14 ). In China, ST307 has been reported carrying bla CTX-M-15 in the northern communities, and bla IMP-38 in the hospital of this study ( 22 , 23 ). Our results confirm the finding of bla IMP-38 -carrying ST307 in the hospital and specify the high-risk isolates belonging to ST307-neo.…”

Section: Discussionmentioning

confidence: 52%

Large-Scale Genomic Epidemiology of Klebsiella pneumoniae Identified Clone Divergence with Hypervirulent Plus Antimicrobial-Resistant Characteristics Causing Within-Ward Strain Transmissions

Pei

Liu

et al. 2022

Microbiol Spectr

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“…Unfortunately, there are no large-scale studies exploring the association of plasmid replicon types and carbapenemase genes for neonatal CRKP. Nonetheless, we found a few common associations (seen in ≥10 strains) of certain carbapenemases with certain plasmid replicon types including KPC-2 with IncN [ 154 ], IMP-38 with IncHI5 [ 155 ], NDM-1 with IncC [ 156 ], IncFI [ 85 ], IncFIIK [ 103 ], IncHI1B/IncFIB [ 117 ], or IncX3 [ 57 , 157 ], NDM-5 with IncX3 [ 67 , 76 , 158 ], OXA-48 with IncL/M [ 27 , 156 ], OXA-232 with ColKP3 [ 30 , 96 , 159 , 160 ], and VIM-1 with IncC [ 132 ] ( S8 Table ). All of these carbapenemase-encoding plasmids except IMP-38-encoding IncHI5, NDM-1-encoding IncHI1B/IncFIB, and VIM-1-encoding IncC were present in neonatal CRKP strains of multiple STs ( S8 Table ).…”

Section: Resultsmentioning

confidence: 99%

Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries

Yang

Feng

et al. 2023

PLoS Med

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Background Klebsiella pneumoniae is the most common pathogen causing neonatal infections, leading to high mortality worldwide. Along with increasing antimicrobial use in neonates, carbapenem-resistant K. pneumoniae (CRKP) has emerged as a severe challenge for infection control and treatment. However, no comprehensive systematic review is available to describe the global epidemiology of neonatal CRKP infections. We therefore performed a systematic review of available data worldwide and combined a genome-based analysis to address the prevalence, clonal diversity, and carbapenem resistance genes of CRKP causing neonatal infections. Methods and findings We performed a systematic review of studies reporting population-based neonatal infections caused by CRKP in combination with a genome-based analysis of all publicly available CRKP genomes with neonatal origins. We searched multiple databases (PubMed, Web of Science, Embase, Ovid MEDLINE, Cochrane, bioRxiv, and medRxiv) to identify studies that have reported data of neonatal CRKP infections up to June 30, 2022. We included studies addressing the prevalence of CRKP infections and colonization in neonates but excluded studies lacking the numbers of neonates, the geographical location, or independent data on Klebsiella or CRKP isolates. We used narrative synthesis for pooling data with JMP statistical software. We identified 8,558 articles and excluding those that did not meet inclusion criteria. We included 128 studies, none of which were preprints, comprising 127,583 neonates in 30 countries including 21 low- and middle-income countries (LMICs) for analysis. We found that bloodstream infection is the most common infection type in reported data. We estimated that the pooled global prevalence of CRKP infections in hospitalized neonates was 0.3% (95% confidence interval [CI], 0.2% to 0.3%). Based on 21 studies reporting patient outcomes, we found that the pooled mortality of neonatal CRKP infections was 22.9% (95% CI, 13.0% to 32.9%). A total of 535 neonatal CRKP genomes were identified from GenBank including Sequence Read Archive, of which 204 were not linked to any publications. We incorporated the 204 genomes with a literature review for understanding the species distribution, clonal diversity, and carbapenemase types. We identified 146 sequence types (STs) for neonatal CRKP strains and found that ST17, ST11, and ST15 were the 3 most common lineages. In particular, ST17 CRKP has been seen in neonates in 8 countries across 4 continents. The vast majority (75.3%) of the 1,592 neonatal CRKP strains available for analyzing carbapenemase have genes encoding metallo-β-lactamases and NDM (New Delhi metallo-β-lactamase) appeared to be the most common carbapenemase (64.3%). The main limitation of this study is the absence or scarcity of data from North America, South America, and Oceania. Conclusions CRKP contributes to a considerable number of neonatal infections and leads to significant neonatal mortality. Neonatal CRKP strains are highly diverse, while ST17 is globally prevalent and merits early detection for treatment and prevention. The dominance of blaNDM carbapenemase genes imposes challenges on therapeutic options in neonates and supports the continued inhibitor-related drug discovery.

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IMP-38-Producing High-Risk Sequence Type 307 Klebsiella pneumoniae Strains from a Neonatal Unit in China

Cited by 7 publications

References 30 publications

Neonatal Sepsis: The Impact of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae

Neonatal Sepsis: The Impact of Carbapenem-Resistant and Hypervirulent Klebsiella pneumoniae

Large-Scale Genomic Epidemiology of Klebsiella pneumoniae Identified Clone Divergence with Hypervirulent Plus Antimicrobial-Resistant Characteristics Causing Within-Ward Strain Transmissions

Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries

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