Small wards in the ICU: a favorable measure for controlling the transmission of carbapenem-resistant Klebsiella pneumoniae

Chi, Xiaohui; Meng, Xuan; Xiong, Luying; Chen, Tao; Zhou, Yanzi; Ji, Jinru; Zheng, Beiwen; Xiao, Yonghong

doi:10.1007/s00134-022-06881-0

Cited by 14 publications

(9 citation statements)

References 41 publications

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“…The bla KPC -harboring plasmids in obtaining groups were IncF types and shared the similar gene context of bla KPC with persisting groups. Our work previously confirmed that the pathogenic microorganisms could either being cross-regional transmitted between the environment and humans [ 21 ], or being limited to a specific area [ 22 ]. Above all, we supposed that the bla KPC gene was more likely being transferred from other strains rather than a new clone replacement.…”

Section: Discussionsupporting

confidence: 78%

A preliminary exploration on the mechanism of the carbapenem-resistance transformation of Serratia marcescens in vivo

Xu,

Zheng,

et al. 2024

BMC Genomics

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Background The infection of carbapenem-resistant organisms was a huge threat to human health due to their global spread. Dealing with a carbapenem-resistant Serratia marcescens (CRSM) infection poses a significant challenge in clinical settings. This study aims to provide insights into strategies for controlling CRSM infection by exploring the transformation mechanism of carbapenem-resistance. Methods We used whole genome sequencing (WGS) to investigate the mechanism of carbapenem resistance in 14 S. marcescens isolates in vivo. The expression level of related genes and the minimum inhibitory concentration of meropenem (MICMEM) were also evaluated to confirm the mechanism of carbapenem resistance. Results Seven groups of S. marcescens, each consisting of two strains, were collected from a hospital and displayed a shift in MICMEM from low to high levels. Homology analysis revealed that the isolates in five groups were significantly different from the remaining two. WGS and experimental evidence indicated that four groups of strains developed carbapenem resistance by acquiring the blaKPC (obtaining group), while two groups (persisting group) increased the expression level of the blaKPC. In contrast, isolates in the last group (missing group) did not carry the blaKPC. All strains possessed multiple β-lactamase genes, including blaCTX−M−14, blaSRT−1, and blaSRT−2. However, only in the missing group, the carbapenem-resistant strain lost an outer membrane protein-encoding gene, leading to increased blaCTX−M−14 expression compared to the carbapenem-susceptible strain. Conclusion The study findings suggest that S. marcescens strains developed diverse carbapenem resistance in vivo through the evolution of drug resistance, rather than through clone replacement. We hypothesize that carbapenem resistance in S. marcescens was due to certain clonal types with a distinct mechanism.

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Section: Discussionsupporting

confidence: 78%

A preliminary exploration on the mechanism of the carbapenem-resistance transformation of Serratia marcescens in vivo

Xu,

Zheng,

et al. 2024

BMC Genomics

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“…CRKP represents a devastating threat to global public health and clinical settings. [18][19][20] The prevalence of meropenemresistant K. pneumoniae has increased rapidly in China, from 2.9% in 2005 to 24.2% in 2022, according to the China Antimicrobial Surveillance Network (CHINET, http://www.chinets.com/). According to an antimicrobial resistance surveillance study from the Swiss ICU, carbapenem-resistant Enterobacterales (CRE) have been steadily increasing from 1% to 5% between 2008 and 2019.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Molecular Characteristics of Patients with Bloodstream Infections Caused by KPC and NDM Co-Producing Carbapenem-Resistant Klebsiella pneumoniae

Li,

Wu,

et al. 2024

IDR

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Purpose Klebsiella pneumoniae carbapenemase (KPC) and New Delhi metallo-β-lactamase (NDM) co-producing carbapenem-resistant Klebsiella pneumoniae (KPC-NDM-CRKP) isolates have been increasingly reported worldwide but have not yet been systematically studied. Thus, we have conducted a study to compare the risk factors, molecular characteristics, and mortality involved in clinical bloodstream infections (BSIs) caused by KPC-NDM-CRKP and KPC-CRKP strains. Methods A retrospective study was conducted on 231 patients with BSIs caused by CRKP at Jinling Hospital in China from January 2020 to December 2022. Antimicrobial susceptibility testing, carbapenemase genes detection and whole-genome sequencing were performed subsequently. Results Overall, 231 patients were included in this study: 25 patients with KPC-NDM-CRKP BSIs and 206 patients with KPC-CRKP BSIs. Multivariate analysis implicated ICU-acquired BSI, surgery within 30 days, and longer stay of hospitalization prior to CRKP isolation as independent risk factors for KPC-NDM-CRKP BSIs. The 30-day mortality rate of the KPC-NDM-CRKP BSIs group was 56% (14/25) compared with 32.5% (67/206) in the KPC-CRKP BSIs control group ( P = 0.02). The ICU-acquired BSIs, APACHE II score at BSI onset, and BSIs caused by KPC-NDM-CRKP were independent predictors for 30-day mortality in patients with CRKP bacteremia. The most prevalent ST in KPC-NDM-CRKP isolates was ST11 (23/25, 92%), followed by ST15 (2/25, 8%). Conclusion In patients with CRKP BSIs, KPC-NDM-CRKP was associated with an excess of mortality. The likelihood that KPC-NDM-CRKP will become the next “superbug” highlights the significance of epidemiologic surveillance and clinical awareness of this pathogen.

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“…13 HAI was defined as an infection occurring at least 48 hours after hospitalisation. 14 CAI was defined as an infection that occurred within 48 hours of admission. 15 The clinical outcomes of patients were divided into an improved group (patients, getting better and alive when being discharged) and a poor prognosis group (patients, death or terminal discharge).…”

Section: Antimicrobial Susceptibility Test Clinical Collecting Inform...mentioning

confidence: 99%

Clinical Characteristics and Molecular Epidemiology of ST23 Klebsiella pneumoniae in China

Liu,

Jian,

Wang

et al. 2023

IDR

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In clinical settings, CG23 Klebsiella pneumoniae (Kp) is the most virulent clonal group of Kp. Continuous fusions of hypervirulent (Hv) and highly resistant strains have been reported; however, few studies have analysed the molecular epidemiology and clinical characteristics of CG23 strains, especially MDR-sequence type ST23 strains. In this study, we investigated the molecular characteristics of ST23 Kp and analysed the clinical characteristics of ST23 Kp infections in a large teaching hospital of the third class in China. Methods: ST23 Kp isolates were screened using whole-genome sequencing data from a large single centre. We compared the clinical characteristics of ST23 strains isolated from community-acquired infections (CAI) and hospital acquired infection (HAI). In addition, the infection characteristics of MDR and poor-prognosis isolates were investigated. We analysed genetic characteristics of ST23 Kp and further investigated the evolutionary relationship based on single-nucleotide polymorphism phylogenetic trees. Results: We detected 184 ST23 strains between 2013 and July of 2018. There were no significant differences between the isolation rates of pulmonary, bloodstream, urinary tract, and cutaneous soft tissue infections in the community and hospitals, except for abscess infections. MDR strains primarily cause pulmonary infections and abscesses; infections with a poor prognosis are typically bloodstream and pulmonary infections. Fourteen MDR strains producing extended-spectrum or class C beta-lactamases, resulting in resistance to third-generation cephalosporins. In 3.8% of ST23 Kp strains, the clb locus was absent. The phylogenetic tree revealed that the isolates were primarily divided into three clades, and based on clinical data, it is inferred that three clonal transmission events have occurred, mainly in ICU causing lung infection. Conclusion:This study demonstrates that virulence and drug-resistance fusion events of ST23 strains occur gradually, and that the hypervirulent clones facilitate the widespread dissemination of CAI and HAI, particularly pulmonary. Monitoring genomics and developing antivirulence strategies are essential.

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Small wards in the ICU: a favorable measure for controlling the transmission of carbapenem-resistant Klebsiella pneumoniae

Cited by 14 publications

References 41 publications

A preliminary exploration on the mechanism of the carbapenem-resistance transformation of Serratia marcescens in vivo

A preliminary exploration on the mechanism of the carbapenem-resistance transformation of Serratia marcescens in vivo

Clinical and Molecular Characteristics of Patients with Bloodstream Infections Caused by KPC and NDM Co-Producing Carbapenem-Resistant Klebsiella pneumoniae

Clinical Characteristics and Molecular Epidemiology of ST23 Klebsiella pneumoniae in China

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