Outbreak of OXA-232-producing carbapenem-resistant Klebsiella pneumoniae ST15 in a Chinese teaching hospital: a molecular epidemiological study

Abstract

Background and AimsThe incidence of OXA-232-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) has been on the rise in China over the past five years, potentially leading to nosocomial epidemics. This study investigates the first outbreak of CRKP in the Second Affiliated Hospital of Jiaxing University.MethodsBetween February 2021 and March 2022, 21 clinical isolates of OXA-232-producing CRKP were recovered from 16 patients in the Second Affiliated Hospital of Jiaxing University. We conducted antimicrobial susceptibility tests, whole genome sequencing, and bioinformatics to determine the drug resistance profile of these clinical isolates.ResultsWhole-genome sequencing revealed that all 21 OXA-232-producing CRKP strains belonged to the sequence type 15 (ST15) and shared similar resistance, virulence genes, and plasmid types, suggesting clonal transmission between the environment and patients. Integrated genomic and epidemiological analysis traced the outbreak to two clonal transmission clusters, cluster 1 and cluster 2, including 14 and 2 patients. It was speculated that the CRKP transmission mainly occurred in the ICU, followed by brain surgery, neurosurgery, and rehabilitation department. Phylogenetic analysis indicated that the earliest outbreak might have started at least a year before the admission of the index patient, and these strains were closely related to those previously isolated from two major adjacent cities, Shanghai and Hangzhou. Comparative genomics showed that the IncFII-type and IncHI1B-type plasmids of cluster 2 had homologous recombination at the insertion sequence sites compared with the same type of plasmids in cluster 1, resulting in the insertion of 4 new drug resistance genes, including TEM-1, APH(6)-Id, APH(3’’)-Ib and sul2.ConclusionsOur study observed the clonal spread of ST15 OXA-232-producing between patients and the hospital environment. The integration of genomic and epidemiological data offers valuable insights and facilitate the control of nosocomial transmission.

Genomic insights and antimicrobial resistance profiles of CRKP and non-CRKP isolates in a Beijing geriatric medical center: emphasizing the blaKPC-2 carrying high-risk clones and their spread

“…Although previous studies have commonly found the clonal spread of CRKP in neurology and intensive care units (ICU) (Wu et al, 2023), our research findings indicates that the primary distribution of CRKP is within respiratory medicine. This finding highlights the importance of the use of invasive devices, whether tracheal intubation or other forms, in the transmission of CRKP.…”

Population genomic analysis of clinical ST15 Klebsiella pneumoniae strains in China

“…C1 and C4 displayed higher virulence, likely contributing to the severity of infections they cause. Recently, numerous nosocomial outbreaks of ST15 Kpn were reported in the YRD region including Hangzhou, Lishui, Wenzhou, Yancheng, Jiaxing and Shanghai ( Li et al, 2019 ; Jia et al, 2021 ; Zhu Z. et al, 2021 ; Huang et al, 2022 ; Wu et al, 2023 ; Zhang et al, 2023 ). The YRD region is one of the most economically active regions in China and attracts a large number of migrant workers from Yunnan, Sichuan, and Anhui provinces every year.…”