Spread of Klebsiella pneumoniae ST45 Producing GES-5 Carbapenemase or GES-1 Extended-Spectrum β-Lactamase in Newborns and Infants

Literacka, Elżbieta; Izdebski, Radosław; Urbanowicz, P; Żabicka, Dorota; Klepacka, Joanna; Sowa-Sierant, Iwona; Żak, Iwona; Garus-Jakubowska, A; Hryniewicz, Waleria; Gniadkowski, Marek

doi:10.1128/aac.00595-20

Cited by 15 publications

(25 citation statements)

References 18 publications

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“…These genes have been described on a variety of plasmid families. Noticeably, this gene family is increasingly reported with, for instance, two recent reports of GES-5-producing K. pneumoniae in Poland and GES-5-producing K. oxytoca, E. coli , and E. cloacae in UK ( 62 , 63 ).…”

Section: Minor Class a Carbapenemasesmentioning

confidence: 94%

Genetic Diversity, Biochemical Properties, and Detection Methods of Minor Carbapenemases in Enterobacterales

et al. 2021

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Gram-negative bacteria, especially Enterobacterales, have emerged as major players in antimicrobial resistance worldwide. Resistance may affect all major classes of anti-gram-negative agents, becoming multidrug resistant or even pan-drug resistant. Currently, β-lactamase-mediated resistance does not spare even the most powerful β-lactams (carbapenems), whose activity is challenged by carbapenemases. The dissemination of carbapenemases-encoding genes among Enterobacterales is a matter of concern, given the importance of carbapenems to treat nosocomial infections. Based on their amino acid sequences, carbapenemases are grouped into three major classes. Classes A and D use an active-site serine to catalyze hydrolysis, while class B (MBLs) require one or two zinc ions for their activity. The most important and clinically relevant carbapenemases are KPC, IMP/VIM/NDM, and OXA-48. However, several carbapenemases belonging to the different classes are less frequently detected. They correspond to class A (SME-, Nmc-A/IMI-, SFC-, GES-, BIC-like…), to class B (GIM, TMB, LMB…), class C (CMY-10 and ACT-28), and to class D (OXA-372). This review will address the genetic diversity, biochemical properties, and detection methods of minor acquired carbapenemases in Enterobacterales.

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Section: Minor Class a Carbapenemasesmentioning

confidence: 94%

Genetic Diversity, Biochemical Properties, and Detection Methods of Minor Carbapenemases in Enterobacterales

et al. 2021

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“…E. coli neonatal infections and outbreaks were reported in Japan with an IMP-11 carbapenemase 37 , in China with nine NDM-5-producing ST410 strains 45 and NDM-5positive ST167 33 , in Turkey with an OXA-48-producing strain 43 , and in India with NDM-1positive clonal strains from the body of infants and the ward environment 42 . Comparatively, outbreaks in NICUs involving K. pneumoniae were globally reported, involving NICUs infections, colonizations, mobile plasmid-borne bla NDM , bla KPC , bla OXA-48 , bla IMP, bla VIM and bla GES-5 carbapenemases, and very high mortalities, making K. pneumoniae the most deadly and common neonatal MDR pathogen 13,18,25,27,28,31,36,40,41,43,44,49,50,[57][58][59][60][61][62][63] .…”

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…Whereas several studies have reported on pregnant women colonized with CR-GNB than infected by it, there is a risk of colonized pregnant women transferring these CR-GNB to their new borns 19,21–24 . It is therefore not surprising that numerous studies report on CR-GNB- and polymyxin-resistant Gram-negative bacteria (PR-GNB)-infected neonates than colonized ones 20,23,25,26 . Further, there have been abundant reports of clonal and polyclonal CR-GNB outbreaks in neonatal intensive care units (NICUs) globally, claiming the lives of several neonates as a result 18,27–29 .…”

Section: Introductionmentioning

confidence: 99%

“…Hence, under antibiotic selection pressure, MDR plasmids and clones proliferate, leading to outbreaks 10,27,34,35 . It is thus not surprising that most neonatal CRE infections occur in NICUs during clonal outbreaks in which the isolates harbour multiple ARGs on mobile plasmids 20,25,26,30,36,37 . Analyses of the data obtained from this study confirms this observation.…”

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Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem- and Polymyxin-Resistant Gram-negative Bacterial Infections in Pregnant Women and Infants: A Systematic Review

Sekyere

Reta

2020

Preprint

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BackgroundCarbapenems and polymyxins are last-resort antibiotics used to treat multidrug-resistant bacterial infections. However, resistance is increasing, even in vulnerable groups such as pregnant women and infants, for whom therapeutic options are limited.MethodUsing a diversity of databases, the literature was searched for studies investigating carbapenem and polymyxin resistance in pregnant women and infants (< 5 years).ResultA final set of 73 manuscripts were used. In almost all countries, carbapenem/polymyxin-resistant Klebsiella pneumoniae, Escherichia coli, and Acinetobacter baumannii infect and/or colonizes neonates and pregnant women, causing periodic outbreaks with very high infant mortalities. Plasmid-borne blaNDM, blaKPC, blaOXA-48, blaIMP,blaVIM and blaGES-5 and ompK35/36 downregulation in clonal strains accelerate the horizontal and vertical transmission of carbapenem resistance in these pathogens. High prevalence of carbapenem/polymyxin resistance and carbapenemases were present in India, China, Pakistan, Thailand, Taiwan, Turkey, Egypt, Italy, USA, South Africa, Algeria, Ghana, and Madagascar. Factors such as antibiotic therapy, prolonged hospitalization, invasive procedures, mother/infant colonization, mechanical ventilation, low-birth weight and preterm state placed infants at high risk of carbapenem/polymyxin-resistant infections. Infant mortalities ranged from 0.2% to 36.8% in different countries.ConclusionUse of polymyxins to treat carbapenem-resistant infections is selecting for resistance to both agents, restricting therapeutic options for infected infants and pregnant women. However, appropriate infection control and antibiotic therapy can contain outbreaks and clear these infections. Antibiotic stewardship, periodic rectal and vaginal screening, and strict infection control practices in neonatal ICUs are necessary to forestall future outbreaks and deaths.HighlightsCarbapenems & polymyxins are last-resort antibiotics used for multidrug-resistant infectionsResistance to these two agents are reported in infants & pregnant womenK. pneumoniae, E. coli, and A. baumannii are the most common pathogensCarbapenem & polymyxin resistance cause outbreaks with high infant mortalitiesAppropriate treatment & infection control can outbreaks & save lives

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Different virulence genetic context of multidrug-resistant CTX-M- and KPC-producing Klebsiella pneumoniae isolated from cerebrospinal fluid

Ballaben¹,

Galetti²,

Ferreira³

et al. 2022

Diagnostic Microbiology and Infectious Disease

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Spread of Klebsiella pneumoniae ST45 Producing GES-5 Carbapenemase or GES-1 Extended-Spectrum β-Lactamase in Newborns and Infants

Abstract: GES-type extended-spectrum β-lactamases (ESBLs), like GES-1, mutate by Gly170Asn/Ser substitutions into carbapenem-hydrolyzing variants, of which GES-5 is relatively more frequent (1, 2).…

Cited by 15 publications

References 18 publications

Genetic Diversity, Biochemical Properties, and Detection Methods of Minor Carbapenemases in Enterobacterales

Genetic Diversity, Biochemical Properties, and Detection Methods of Minor Carbapenemases in Enterobacterales

Molecular Epidemiology, Risk Factors and Clinical Outcomes of Carbapenem- and Polymyxin-Resistant Gram-negative Bacterial Infections in Pregnant Women and Infants: A Systematic Review

Different virulence genetic context of multidrug-resistant CTX-M- and KPC-producing Klebsiella pneumoniae isolated from cerebrospinal fluid

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