Outbreak of NDM-1-Producing Klebsiella pneumoniae Causing Neonatal Infection in a Teaching Hospital in Mainland China

Zhang, Xiaoyu; Li, XianPing; Wang, Min; Yue, HeJia; Li, Pengling; Liu, Ya Ping; Cao, Wei; Yao, Dongmei; Liu, Li; Xiao-lan, Zhou; Zheng, Ruisheng; Tao, Bo

doi:10.1128/aac.03868-14

Cited by 46 publications

(28 citation statements)

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“…16 isolates were carbapenem resistant and six were carbapenem sensitive. We found the same ST in patient 11 and patient 15, but reversed drug susceptibility to carbapenem in isolates In this study, there are 15 non-ST37 bla OXA-1 negative K. pneumoniae isolates, the other eight isolates which were bla OXA-1 negative and resistant to carbapenem were presented in our previous study [16]. R: Resistant; S: Susceptible.…”

Section: Rasmussen Et Al and Andres Opazo Et Alsupporting

confidence: 68%

“…However, all carbapenem-resistant isolates were KPC-2 negative, and only two isolates harbored NDM-1 in our study. This outcome leads to a lower positive rate compared with previous studies in our hospital neonatal department [16]. We speculate that different genotypes of K. pneumoniae may be expressing different resistant genes at different time.…”

Section: Discussionmentioning

confidence: 47%

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ST37 Klebsiella Pneumoniae : Development of Carbapenem Resistance in Vivo During Antimicrobial Therapy in Neonates

Wang

et al. 2017

Future Microbiol.

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Aim:To investigate the mechanism leading to in vivo carbapenem resistance development in Klebsiella pneumoniae. Methods: Carbapenemase was detected using the modified carbapenem inactivation method. β-lactamases resistant genes were identified by PCR and sequencing. Clonal relatedness was evaluated by random amplified polymorphic DNA and multiple locus sequence typing. The relationship between sequence typing and resistant genes was analyzed by using the chi-squared test. Results: All ST37 carbapenem-resistant isolates were bla OXA-1 positive and all ST37 carbapenem-sensitive isolates were bla OXA-1 negative at Stage I. A significant relationship between carbapenem resistance and bla OXA-1 was observed. The bla OXA-1 -positive rate was significantly higher in ST37 K. pneumoniae than others. Conclusion: This is the first study about the development of carbapenem resistance in vivo potentially mediated by bla OXA-1 in ST37 K. pneumoniae among neonates.

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Section: Rasmussen Et Al and Andres Opazo Et Alsupporting

confidence: 68%

Section: Discussionmentioning

confidence: 47%

ST37 Klebsiella Pneumoniae : Development of Carbapenem Resistance in Vivo During Antimicrobial Therapy in Neonates

Wang

et al. 2017

Future Microbiol.

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“…This circumstance was possibly owing to the fact that pks + isolates possessed high percentages of hypervirulent serotypes and virulence genes as the acquisition of virulence is usually accompanied by reduced drug resistance. Currently, the emergence of multidrug‐, extremely drug‐, or pan‐drug‐resistant cKP has already become a tough situation in clinical studies . Nonetheless, multidrug‐resistant hvKP strains producing extended spectrum β‐lactamase (ESBL) or carbapenemase have also been described .…”

Section: Discussionmentioning

confidence: 99%

Prevalence of pks gene cluster and characteristics of Klebsiella pneumoniae‐induced bloodstream infections

Lan

Zhou

Jian

et al. 2019

Clinical Laboratory Analysis

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BackgroundThe emerging pks‐positive (pks+) strains have aroused great public concern recently. Colibactin, encoded by pks gene cluster, has been reported to be involved in DNA damage and increased virulence. Little is known about its prevalence among Klebsiella pneumoniae‐induced bloodstream infections (BSIs). Therefore, the aim of this study was to investigate the prevalence of pks gene cluster, and molecular and clinical characteristics of K pneumoniae‐induced BSIs.MethodsA total of 190 non‐duplicate K pneumoniae bloodstream isolates were collected at a university hospital in China from March 2016 to March 2018. Molecular characteristics including capsular types, virulence, and pks genes were detected by polymerase chain reaction (PCR). Clinical characteristics and antimicrobial susceptibility were also investigated.ResultsOverall, 21.6% (41/190) of K pneumoniae bloodstream isolates were hypervirulent K pneumoniae(hvKP). The prevalence of pks gene cluster was 26.8% (51/190). The positive rates of K1, K57, and genes associated with hypervirulence, that is, rmpA, wcaG, mrkD, allS, ybtS, kfu,and iucA, were significantly higher in the pks+isolates than the pks‐negative (pks −) isolates (P < 0.05), while the pks+ isolates were significantly less resistant to 11 antimicrobial agents than the pks − isolates. Multivariate analysis showed diabetes mellitus, and K1 and K20 capsular types as independent risk factors for pks + K pneumoniaebloodstream infections.ConclusionsThe pks + K pneumoniae was prevalent in individuals with bloodstream infections in mainland China. The high rates of hypervirulent determinants among pks + K pneumoniaerevealed the potential pathogenicity of this emerging gene cluster. Diabetes mellitus, and K1 and K20 capsular types were identified as independent risk factors associated with pks+ K pneumoniaebloodstream infections. This study highlights the significance of clinical awareness and epidemic surveillance of pks+strains.

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“…Resistant genes including β-lactamase genes ( bla TEM , bla SHV , bla CTX-M-1 , bla CTX-M-2 , bla CTX-M-8 , bla CTX-M-9 , bla PER , bla VEB , bla CIT , bla MOX , bla DHA , bla ACC , bla EBC , bla FOX , bla KPC , bla IMP , bla VIM , bla NDM , bla OXA-10 , bla OXA-23 , bla OXA-24 , and bla OXA-48 ) [9,10], fluoroquinolone-resistant genes ( qepA , aac(6 ′ )-Ib , qnrA , qnrB , qnrC , qnrD , qnrS , oqxA , and oqxB ), and 16S rRNA methylase genes ( armA , rmtA , rmtB , rmtC , rmtD , rmtE , and npmA ) were detected by polymerase chain reaction (PCR), and the positive amplicons were determined by DNA sequencing [9,11,12]. The amplification of these genes was performed in cycles with initial denaturation at 95°C for 5 min followed by 35 cycles, each cycle consisting of 30 s at 95°C for denaturation, 30 s for primer annealing, and 1 min at 72°C for elongation.…”

Section: Methodsmentioning

confidence: 99%

An Uncommon ST1224 NDM-1-Producing <b><i>Klebsiella pneumoniae</i></b> Isolated from the Bloodstream of a Leukemia Patient in China

Zhang

Du²,

Zhou³

et al. 2017

Chemotherapy

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Aims: This study aimed to analyze the clinical data and characteristics of an NDM-1 (New Delhi metallo-β-lactamase-1)-producing Klebsiella pneumoniae isolated from the bloodstream of a leukemia patient. Materials and Methods: A retrospective analysis was used for the clinical data of the patient. The modified Hodge test (MHT) and ethylenediaminetetraacetic acid (EDTA)-disk synergy test were used for detecting metallo-β-lactamase. Antibiotic resistance was determined using the agar dilution method. PCR was used to identify resistance genes. S1-PFGE (S1 nuclease/pulsed-field gel electrophoresis) and Southern blot hybridization were performed to determine the location of bla_NDM-1. A conjugation experiment was used to confirm the transferable characteristics of the resistant genes. Multilocus sequence typing (MLST) was also performed. Results: The patient developed bloodstream infections caused by this NDM-1-producing strain and died due to worsening of the condition. The strain was highly resistant to β-lactam antibiotics and coharbored bla_NDM-1, qnrB, and bla_CTX-M-9 genes. Southern blot confirmed that bla_NDM-1 was located on a plasmid of approximately 55 kb and could be transferred to Escherichia coli J53. MLST analysis showed that this strain belonged to an uncommon sequence type ST1224. Conclusion: The coexistence of various resistant genes is the mechanism for resistance to most antibiotics. Additionally, infections caused by multi-drug resistant bacteria increase the mortality of patients with immunodeficiency, which alerts clinicians to establish a rational and effective combination drug therapy.

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Outbreak of NDM-1-Producing Klebsiella pneumoniae Causing Neonatal Infection in a Teaching Hospital in Mainland China

Cited by 46 publications

References 12 publications

ST37 Klebsiella Pneumoniae : Development of Carbapenem Resistance in Vivo During Antimicrobial Therapy in Neonates

ST37 Klebsiella Pneumoniae : Development of Carbapenem Resistance in Vivo During Antimicrobial Therapy in Neonates

Prevalence of pks gene cluster and characteristics of Klebsiella pneumoniae‐induced bloodstream infections

An Uncommon ST1224 NDM-1-Producing <b><i>Klebsiella pneumoniae</i></b> Isolated from the Bloodstream of a Leukemia Patient in China

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