Resistance phenotype and clinical molecular epidemiology of carbapenem-resistant <em>Klebsiella pneumoniae</em> among pediatric patients in Shanghai

Abstract

BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) has caused wide global disseminations and serious clinical outcomes in pediatric patients, and the purpose of this study was to analyze drug resistance, molecular epidemiology, and clinical characteristics of CRKP from children in Shanghai, China.MethodsA retrospective study was conducted from January 2016 to December 2017, and a total of 170 CRKP isolates were collected. Antimicrobial susceptibility was determined by the broth microdilution method. MAST D73C and polymerase chain reaction were used for the analysis of carbapenemase types. Multilocus sequence typing of K. pneumoniae was performed for genetic relationship. Clinical data were also reviewed.ResultsOf the 170 CRKP isolates, blaOXA-232 was mainly detected with a proportion of 42.35%, followed by blaNDM-1 (20.59%), blaKPC-2 (17.65%), blaNDM-5 (16.47%), and blaIMP-4 (1.18%). The predominant gene was blaOXA-232 in 2016 (54.46%; 55/101) and blaNDM-1 in 2017 (31.88%; 22/69). All these 170 CRKP isolates showed high resistance to cephalosporins and carbapenems (>95%), except for tigecycline and colistin. Sixteen distinct sequence types were observed with ST15 being mostly identified (41.76%). Most CRKP harboring OXA-232 type carbapenemase belonged to ST15, while NDM-1 type belonged to ST37 and KPC-2 type belonged to ST11. Furthermore, other β-lactamase genes including blaTEM, blaCTX-M, and DHA-1 were also found in this study. Clinical data reviewed that more than half of the patients produced clinical infections (112/170), mainly lower respiratory tract (58/112) and bloodstream (21/112) infections. A majority of these children had received therapy of antibiotics before CRKP isolation, especially for carbapenems (76/170) and β-lactam/β-lactamase inhibitor combinations (91/170).ConclusionsOur data revealed the increasing incidence of OXA-232-producing K. pneumoniae from pediatric patients in Shanghai, and infection control measures should be conducted to limit the spread of CRKP strains.

Dissemination of Carbapenemases (KPC, NDM, OXA-48, IMP, and VIM) Among Carbapenem-Resistant Enterobacteriaceae Isolated From Adult and Children Patients in China

“…These findings described the different patterns of carbapenemases among CRE strains from adults and children. In contrast to the previous finding that NDM-1 was the most common carbapenemase among children patients, we have found that NDM-5-producers (32.9%) were most frequently detected CRE strains from children (Tian et al, 2018;Yin et al, 2018;Zhang et al, 2018). The outbreak of NDM-5-producing ST48 K. pneumoniae was first reported in Shanghai (Tian et al, 2018).…”

“…In contrast to the previous finding that NDM-1 was the most common carbapenemase among children patients, we have found that NDM-5-producers (32.9%) were most frequently detected CRE strains from children (Tian et al, 2018;Yin et al, 2018;Zhang et al, 2018). The outbreak of NDM-5-producing ST48 K. pneumoniae was first reported in Shanghai (Tian et al, 2018). We speculated that outbreak of NDM-5-producers accounted for the spread of NDM-5 among children patients in this study (Tian et al, 2018;Li et al, 2020).…”

Characterization of carbapenem‐resistant Klebsiella pneumoniae in a tertiary hospital in Fuzhou, China

“…Galani et al (2019) detected 300 CRKP strains in hospitals across Greece and found KPC-2 (66Á7%), NDM (16Á7 %), VIM (7%) and OXA-48 (4Á0%); 14 strains carried both KPC and VIM (4Á7%), two strains carried both NDM and OXA (0Á7%) and one strain carried both KPC and OXA (0Á3%) resistance genes. Tian et al (2018) retrospectively analysed the drug-resistant phenotypes and clinical molecular epidemiology of 170 CRKP strains in Shanghai from January 2016 to December 2017 and found that the most abundant gene was bla OXA-232 (42Á35%), followed by bla NDM-1 (20Á59%), bla KPC-2 (17Á65%), bla NDM-5 (16Á47%) and bla IMP-4 (1Á18%). Furthermore, they found that the genes present were related to different ages and epidemic strains in different regions.…”

Dissemination of the bla NDM-5 Gene via IncX3-Type Plasmid among Enterobacteriaceae in Children

“…Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry (Bruker Daltonics GmBH, Bremen, Germany) was used for bacterial identification, and disc diffusion assays (for imipenem and meropenem) were used to identify carbapenem resistance. Common carbapenemase genes (bla KPC , bla NDM , bla IMP , bla OXA-48 , bla VIM , bla AIM , bla GIM , and bla SIM ) were amplified for all strains using primers from the previous study, and the positive products were sequenced (2). Twenty-two bla NDM-5 -positive strains were finally selected for further study.…”

“…KEYWORDS NDM-5, Enterobacteriaceae, ST48, IncX3-type plasmid, carbapenemase, children, Enterobacterales C arbapenemase-producing Enterobacteriaceae (CRE) have become a serious challenge to clinical therapy owing to the rapid worldwide dissemination of multidrug resistance (MDR) (1). New Delhi metallo-␤-lactamase (NDM) is the main carbapenemase detected in children (2), which is capable of hydrolyzing almost all ␤-lactams and has the potential to cause a global health crisis. Since the first report of NDM-1, 21 variants of NDM enzymes (NDM-1 to NDM-21) have been identified worldwide (3).…”