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Yang C, Jiang S, Wei C, Li C, Wang J, Li X, Zeng L, Hu K, Yang Y, Zhang J, Zhang X. Mechanism for transmission and pathogenesis of carbapenem-resistant Enterobacterales harboring the carbapenemase IMP and clinical countermeasures. Microbiol Spectr 2024; 12:e0231823. [PMID: 38197660 PMCID: PMC10846200 DOI: 10.1128/spectrum.02318-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024] Open
Abstract
Carbapenem-resistant Enterobacterales (CRE) are some of the most important pathogens causing infections, which can be challenging to treat. We identified four blaIMP-carrying CRE isolates and collected clinical data. The transferability and stability of the plasmid were verified by conjugation, successive passaging, and plasmid elimination assays. The IncC blaIMP-4-carrying pIMP4-ECL42 plasmid was successfully transferred into the recipient strain, and the high expression of traD may have facilitated the conjugation transfer of the plasmid. Interestingly, the plasmid showed strong stability in clinical isolates. Whole-genome sequencing was performed on all isolates. We assessed the sequence similarity of blaIMP -harboring plasmid from our institution and compared it to plasmids for which sequence data are publicly available. We found that four blaIMP-carrying CRE belonged to four different sequence types. The checkerboard technique and time-kill assays were used to investigate the best antimicrobial therapies for blaIMP-carrying CRE. The time-kill assay showed that the imipenem of 1× minimum inhibitory concentration (MIC) alone had the bactericidal or bacteriostatic effect against IMP-producing strains at 4-12 h in vitro. Moreover, the combination of tigecycline (0.5/1/2 × MIC) and imipenem (0.5/1 × MIC) showed a bactericidal effect against the blaIMP-26-carrying CRECL60 strain.IMPORTANCECarbapenem-resistant Enterobacterales (CRE) are an urgent public health threat, and infections caused by these microorganisms are often associated with high mortality and limited treatment options. This study aimed to determine the clinical features, molecular characteristics, and plasmid transmissible mechanisms of blaIMP carriage as well as to provide a potential treatment option. Here, we demonstrated that conjugated transfer of the IncC blaIMP-4-carrying plasmid promotes plasmid stability, so inhibition of conjugated transfer and enhanced plasmid loss may be potential ways to suppress the persistence of this plasmid. The imipenem alone or tigecycline-imipenem combination showed a good bactericidal effect against IMP-producing strains. In particular, our study revealed that imipenem alone or tigecycline-imipenem combination may be a potential therapeutic option for patients who are infected with IMP-producing strains. Our study supports further trials of appropriate antibiotics to determine optimal treatment and emphasizes the importance of continued monitoring of IMP-producing strains in the future.
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Affiliation(s)
- Chengru Yang
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Department of Microbiology, The First Affiliated Hospital of Jiamusi University, Jiamusi, China
| | - Shan Jiang
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Department of Microbiology, Jiangyou People’s Hospital, Jiangyou, China
| | - Chunli Wei
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Chunjiang Li
- Department of Life Science and Technology, Mudanjiang Normal University, Mudanjiang, China
| | - Jianmin Wang
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xinhui Li
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Lingyi Zeng
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Department of Microbiology, Hangzhou Center for Disease Control and Prevention, Hangzhou, China
| | - Kewang Hu
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
- Department of Microbiology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Yang Yang
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Jisheng Zhang
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
| | - Xiaoli Zhang
- Department of Microbiology, Yongchuan Hospital of Chongqing Medical University, Chongqing, China
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Hu Y, Yang Y, Feng Y, Fang Q, Wang C, Zhao F, McNally A, Zong Z. Prevalence and clonal diversity of carbapenem-resistant Klebsiella pneumoniae causing neonatal infections: A systematic review of 128 articles across 30 countries. PLoS Med 2023; 20:e1004233. [PMID: 37339120 DOI: 10.1371/journal.pmed.1004233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 04/04/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Klebsiella pneumoniae is the most common pathogen causing neonatal infections, leading to high mortality worldwide. Along with increasing antimicrobial use in neonates, carbapenem-resistant K. pneumoniae (CRKP) has emerged as a severe challenge for infection control and treatment. However, no comprehensive systematic review is available to describe the global epidemiology of neonatal CRKP infections. We therefore performed a systematic review of available data worldwide and combined a genome-based analysis to address the prevalence, clonal diversity, and carbapenem resistance genes of CRKP causing neonatal infections. METHODS AND FINDINGS We performed a systematic review of studies reporting population-based neonatal infections caused by CRKP in combination with a genome-based analysis of all publicly available CRKP genomes with neonatal origins. We searched multiple databases (PubMed, Web of Science, Embase, Ovid MEDLINE, Cochrane, bioRxiv, and medRxiv) to identify studies that have reported data of neonatal CRKP infections up to June 30, 2022. We included studies addressing the prevalence of CRKP infections and colonization in neonates but excluded studies lacking the numbers of neonates, the geographical location, or independent data on Klebsiella or CRKP isolates. We used narrative synthesis for pooling data with JMP statistical software. We identified 8,558 articles and excluding those that did not meet inclusion criteria. We included 128 studies, none of which were preprints, comprising 127,583 neonates in 30 countries including 21 low- and middle-income countries (LMICs) for analysis. We found that bloodstream infection is the most common infection type in reported data. We estimated that the pooled global prevalence of CRKP infections in hospitalized neonates was 0.3% (95% confidence interval [CI], 0.2% to 0.3%). Based on 21 studies reporting patient outcomes, we found that the pooled mortality of neonatal CRKP infections was 22.9% (95% CI, 13.0% to 32.9%). A total of 535 neonatal CRKP genomes were identified from GenBank including Sequence Read Archive, of which 204 were not linked to any publications. We incorporated the 204 genomes with a literature review for understanding the species distribution, clonal diversity, and carbapenemase types. We identified 146 sequence types (STs) for neonatal CRKP strains and found that ST17, ST11, and ST15 were the 3 most common lineages. In particular, ST17 CRKP has been seen in neonates in 8 countries across 4 continents. The vast majority (75.3%) of the 1,592 neonatal CRKP strains available for analyzing carbapenemase have genes encoding metallo-β-lactamases and NDM (New Delhi metallo-β-lactamase) appeared to be the most common carbapenemase (64.3%). The main limitation of this study is the absence or scarcity of data from North America, South America, and Oceania. CONCLUSIONS CRKP contributes to a considerable number of neonatal infections and leads to significant neonatal mortality. Neonatal CRKP strains are highly diverse, while ST17 is globally prevalent and merits early detection for treatment and prevention. The dominance of blaNDM carbapenemase genes imposes challenges on therapeutic options in neonates and supports the continued inhibitor-related drug discovery.
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Affiliation(s)
- Ya Hu
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China
| | - Yongqiang Yang
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China
- Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China
| | - Yu Feng
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China
- Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China
| | - Qingqing Fang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China
| | - Chengcheng Wang
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China
| | - Feifei Zhao
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China
| | - Alan McNally
- Institute of Microbiology and Infection, College of Medical and Dental Sciences, University of Birmingham, Birmingham, United Kingdom
| | - Zhiyong Zong
- Center of Infectious Diseases, West China Hospital, Sichuan University, Chengdu, China
- Division of Infectious Diseases, State Key Laboratory of Biotherapy, Chengdu, China
- Center for Pathogen Research, West China Hospital, Sichuan University, Chengdu, China
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3
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Luo H, Hang Y, Zhu H, Zhong Q, Peng S, Gu S, Fang X, Hu L. Rapid Identification of Carbapenemase-Producing Klebsiella pneumoniae Using Headspace Solid-Phase Microextraction Combined with Gas Chromatography-Mass Spectrometry. Infect Drug Resist 2023; 16:2601-2609. [PMID: 37152404 PMCID: PMC10162101 DOI: 10.2147/idr.s404742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 04/14/2023] [Indexed: 05/09/2023] Open
Abstract
Background Carbapenemase-producing Klebsiella pneumoniae is an unprecedented threat to public health, and its detection remains challenging. Analysis of microbial volatile organic compounds (VOCs) may offer a rapid way to determine bacterial antibiotic susceptibility. Purpose The aim of this study was to explore the VOCs released by carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) using headspace solid-phase microextraction/gas chromatography-mass spectrometry (HS-SPME/GC-MS). Methods Test bacteria were incubated in trypticase soy broth to the end of exponential growth phase, and imipenem was added in the middle time. Headspace VOCs were concentrated and analyzed using HS-SPME/GC-MS. Results The compound 3-methyl-1-butanol was found to be a biomarker among the 26 bacterial isolates (10 KPC-positive, 10 NDM-positive, 2 IMP-positive, 2 carbapenemase-negative CRKP, and 2 carbapenem-susceptible K. pneumonoiae). Conclusion This study explored a promising new strategy for the screening of carbapenemase-producing CRKP strains. Further research with larger sample sizes will potentially accelerate the application of biomarkers in routine microbiology.
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Affiliation(s)
- Hong Luo
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Yaping Hang
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Hongying Zhu
- Clinical Laboratory of Ganzhou People’s Hospital, Ganzhou, Jiangxi, People’s Republic of China
| | - Qiaoshi Zhong
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Suqin Peng
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Shumin Gu
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Xueyao Fang
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
| | - Longhua Hu
- Jiangxi Provincial Key Laboratory of Medicine, Clinical Laboratory of the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People’s Republic of China
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Wang Z, Yu F, Shen X, Li M. A Polyclonal Spread Emerged: Characteristics of Carbapenem-Resistant Klebsiella pneumoniae Isolates from the Intensive Care Unit in a Chinese Tertiary Hospital. Pol J Microbiol 2021; 69:311-319. [PMID: 33574860 PMCID: PMC7810120 DOI: 10.33073/pjm-2020-034] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 07/08/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022] Open
Abstract
Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates often cause nosocomial infections with limited therapeutic options and spread rapidly worldwide. In this study, we revealed a polyclonal emergence of CRKP isolates from the intensive care unit in a Chinese tertiary hospital. We applied a series of methods including automated screening, antimicrobial susceptibility testing, the modified carbapenem inacti vation method (mCIM), PCR amplification, DNA sequencing, and multilocus sequence typing (MLST) to characterize 30 non-duplicated CRKP isolates along with the collection of the related medical records. The results showed the polyclonal spread of CRKP isolates belonged to ST722, ST1446, ST111, ST896, ST290, and ST11. Among them, ST722 and ST1446 were two novel types of K. pneumoniae, and ST896 isolate harboring blaKPC-2 was also found for the first time. Since the polyclonal spread of CRKP in the same ward is rare, the silent clonal evolution with the switching genotypes prompts us to stay alert for outbreaks caused by novel subclones.
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Affiliation(s)
- Zhengzheng Wang
- Department of Clinical Laboratory, Hwa Mei Hospital, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China.,Ningbo Institute of Life and Health, University of Chinese Academy of Sciences, Ningbo, Zhejiang, China
| | - Fangyou Yu
- Department of Laboratory Medicine, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.,Shanghai Key Laboratory of Tuberculosis, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Xiaofei Shen
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Meilan Li
- Emergency Intensive Care Unit, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
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Zhu Y, Zhang W, Schwarz S, Wang C, Liu W, Chen F, Luan T, Liu S. Characterization of a blaIMP-4-carrying plasmid from Enterobacter cloacae of swine origin. J Antimicrob Chemother 2020; 74:1799-1806. [PMID: 30879063 DOI: 10.1093/jac/dkz107] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Revised: 01/28/2019] [Accepted: 02/25/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To characterize an MDR blaIMP-4-harbouring plasmid from Enterobacter cloacae EC62 of swine origin in China. METHODS Plasmid pIMP-4-EC62 from E. cloacae EC62 was transferred by conjugation via filter mating into Escherichia coli J53. Plasmid DNA was extracted from an E. coli J53 transconjugant and sequenced using single-molecule real-time (SMRT) technology. MIC values for both the isolate EC62 and the transconjugant were determined using the broth microdilution and agar dilution methods. Plasmid stability in both the isolate EC62 and the transconjugant was assessed through a series of passages on antibiotic-free media. RESULTS Plasmid pIMP-4-EC62 is 314351 bp in length, encodes 369 predicted proteins and harbours a novel class 1 integron carrying blaIMP-4 and a group II intron. The blaIMP-4-bearing plasmid belongs to the IncHI2/ST1 incompatibility group. Sequence analysis showed that pIMP-4-EC62 carries four MDR regions and several gene clusters encoding heavy metal resistance. Plasmid pIMP-4-EC62 was stably maintained in both the E. cloacae EC62 isolate and the transconjugant E. coli J53-pIMP-4-EC62 in the absence of selective pressure. Analysis of the evolutionary relatedness of selected IncHI2 plasmids indicates that ST1-type plasmids are key carriers of carbapenemase genes among IncHI2 plasmids. CONCLUSIONS pIMP-4-EC62 represents the first fully sequenced IncHI2-type blaIMP-4-harbouring plasmid from E. cloacae in China. Co-location of blaIMP-4 with other resistance genes on an MDR plasmid is likely to further accelerate the dissemination of blaIMP-4 by co-selection among bacteria from humans, animals and the environment under the selective pressure of other antimicrobial agents, heavy metals and disinfectants.
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Affiliation(s)
- Yao Zhu
- State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, China
| | - Wanjiang Zhang
- State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, China
| | - Stefan Schwarz
- Department of Veterinary Medicine, Centre for Infection Medicine, Institute of Microbiology and Epizootics, Freie Universität Berlin, Berlin, Germany
| | - Changzhen Wang
- State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, China
| | - Wenyu Liu
- State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, China
| | - Fuguang Chen
- State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, China
| | - Tian Luan
- State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, China
| | - Siguo Liu
- State Key Laboratory of Veterinary Biotechnology, Harbin Veterinary Research Institute, Chinese Academy of Agricultural Sciences, Harbin, China
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Jin C, Shi R, Jiang X, Zhou F, Qiang J, An C. Epidemic Characteristics of Carbapenem-Resistant Klebsiella pneumoniae in the Pediatric Intensive Care Unit of Yanbian University Hospital, China. Infect Drug Resist 2020; 13:1439-1446. [PMID: 32547112 PMCID: PMC7244351 DOI: 10.2147/idr.s245397] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Accepted: 04/07/2020] [Indexed: 12/25/2022] Open
Abstract
Introduction Carbapenem-resistant Enterobacteriaceae (CRE) pose a serious threat to clinical patient management and public health, as they are generally resistant to most antibiotics and cause infections with high mortality rates. Klebsiella pneumoniae ranks second among Enterobacteriaceae species that cause nosocomial infections. In this study, we investigated the epidemic characteristics of carbapenem-resistant K. pneumoniae (CRKP) in the pediatric intensive care unit (PICU) of Yanbian University Hospital. Materials and Methods A total of 14 non-duplicate CRKP strains, collected from March 2015 to November 2019, were subjected to automated microbial identification and antimicrobial susceptibility tests using the Phoenix-100 ID/AST system. The strains were also subjected to genotypic resistance testing, polymerase chain reaction assays to detect genes encoding carbapenemases and other β-lactamases, multi-locus sequence typing (MLST), and pulsed-field gel electrophoresis (PFGE)-based homology analysis. Results Two carbapenemase genes, KPC-2 and NDM-1 (in eight and six strains, respectively), were detected. MLST enabled the division of the strains into two sequence types, ST11 and ST1224 (containing eight and six strains, respectively). PFGE results classified the 14 strains into clonotypes A–D, of which clonotypes A and B belonged to ST11, while clonotypes C and D belonged to ST1224. Conclusion Our study reveals that epidemics of the KPC-2-ST11 and NDM-1-ST1224 strains occurred in the PICU of Yanbian University Hospital. Surveillance and strict implementation of prevention and control measures are crucial to prevent the occurrence and rapid spread of nosocomial infections.
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Affiliation(s)
- Chunmei Jin
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji, People's Republic of China
| | - Rong Shi
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji, People's Republic of China
| | - Xue Jiang
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji, People's Republic of China
| | - Fuxian Zhou
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji, People's Republic of China
| | - Jixiang Qiang
- Department of Clinical Laboratory, Yanbian University Hospital, Yanji, People's Republic of China
| | - Changshan An
- Department of Respiratory Medicine, Yanbian University Hospital, Yanji, People's Republic of China
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Li L, Yu T, Ma Y, Yang Z, Wang W, Song X, Shen Y, Guo T, Kong J, Wang M, Xu H. The Genetic Structures of an Extensively Drug Resistant (XDR) Klebsiella pneumoniae and Its Plasmids. Front Cell Infect Microbiol 2019; 8:446. [PMID: 30662878 PMCID: PMC6328971 DOI: 10.3389/fcimb.2018.00446] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 12/13/2018] [Indexed: 12/18/2022] Open
Abstract
Multi-, extensively-, and pan-drug resistant bacteria are a threat to our health today, because their wide resistance spectra make their infections difficult to cure. In this work, we isolated an extensively drug resistant (XDR) Klebsiella pneumoniae 2-1 strain from the stool sample of a patient diagnosed of colorectal cancer. K. pneumoniae 2-1 was found to be resistant to all the antibiotics tested except for cefepime, tigecycline, and ceftazidime-avibactam. By sequencing the complete genome of K. pneumoniae 2-1, we found it contains a chromosome of 5.23 Mb and two circular plasmids with the size of 246 and 90 kb. The larger plasmid, pKP21HI1 was found to be a new conjugation-defective plasmid belonging to incompatibility group HI1B and a new sequence type. Further comparative genomics analysis and antimicrobial resistance gene analysis showed that although a great deal of changes took place on the chromosome of K. pneumoniae 2-1 in comparison with the reference genome, the extensively drug resistance phenotype of K. pneumoniae 2-1 is primarily due to the two multidrug resistant plasmids it contains. This work explains the genetic and mechanistic basis of the extensive drug resistance of K. pneumoniae 2-1, and found that plasmids play key roles in the strong antibiotic resistance of bacteria.
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Affiliation(s)
- Ling Li
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Tao Yu
- Department of Gastroenterology, Qilu Hospital of Shandong University, Jinan, China
| | - Yanan Ma
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Zhongjun Yang
- Department of Stomatology, Qilu Hospital of Shandong University, Qingdao, China
| | - Wenjia Wang
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Xiaobo Song
- Department of Medical Biology, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway
| | - Yu Shen
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Tingting Guo
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Jian Kong
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Mingyu Wang
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
| | - Hai Xu
- State Key Laboratory of Microbial Technology, Microbial Technology Institute, Shandong University, Qingdao, China
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Chen D, Hu X, Chen F, Li H, Wang D, Li X, Wu C, Li N, Wu S, Li Z, Chen L, Chen Y. Co-outbreak of multidrug resistance and a novel ST3006 Klebsiella pneumoniae in a neonatal intensive care unit: A retrospective study. Medicine (Baltimore) 2019; 98:e14285. [PMID: 30681632 PMCID: PMC6358387 DOI: 10.1097/md.0000000000014285] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
The outbreak of carbapenem-resistant Klebsiella pneumoniae is a serious public health problem, especially in the neonatal intensive care unit (NICU).Fifteen K. pneumoniae strains were isolated from 7 neonates during June 3 to 28, 2017 in an NICU. Antimicrobial susceptibility was determined by the Vitek 2 system and microbroth dilution method. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were used to analyze the genetic relatedness of the isolates. Whole-genome sequencing and gene function analysis were performed to investigate pathogenicity and drug resistance and screen genomic islands.Three clones of K. pneumoniae were identified from 7 neonates: 7 strains of ST37, 7 of novel ST3006, and 1 of ST1224. Gene sequencing showed that the kpn1343 (ST37) strain harbored 12 resistance genes (OXA-33, TEM-1, SHV-11, AAC (6')-IId, AAC (3)-IIa, AAC (6')-Ib-cr, catB3, arr-3, sul1, oqxB, oqxA, CRP, and catB3) and included 15 genomic islands and 205 reduced virulence genes. The kpn1344 (ST3006) strain harbored 4 antibiotic-resistant genes (TEM-1, CTX-M-3, vgaC, and CRP) and included 19 genomic islands and 209 reduced virulence genes. MLST and PFGE showed that 15 strains of K. pneumoniae were divided into 3 groups with a high level of homology. ST1224 (kpn1362) was isolated on June 28, 2017, which was 10 days after the last isolate (kpn1359, June 18, 2017); thus, we speculated that ST1224 was not the clone that caused the outbreak.This co-outbreak of K. pneumoniae involved 2 clones: ST37 and ST3006. ST37 carried the multidrug-resistant genes, such as OXA-33, TEM-1, and SHV-11, and ST3006 was a novel K. pneumoniae ST typing. Whole-genome sequencing may be an effective method for screening bacterial-resistant genes and their functions.
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Affiliation(s)
- Dongjie Chen
- Shengli Clinical Medical College of Fujian Medical University
| | - Xinlan Hu
- Clinical Microbiology Laboratory, Fujian Provincial Hospital
| | - Falin Chen
- Clinical Microbiology Laboratory, Fujian Provincial Hospital
| | - Hongru Li
- Department of Respiratory Medicine and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Daxuan Wang
- Department of Respiratory Medicine and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Xiaoqin Li
- Department of Respiratory Medicine and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
| | - Changsheng Wu
- Clinical Microbiology Laboratory, Fujian Provincial Hospital
| | - Ning Li
- Clinical Microbiology Laboratory, Fujian Provincial Hospital
| | - Shaolian Wu
- Clinical Microbiology Laboratory, Fujian Provincial Hospital
| | - Zhen Li
- Clinical Microbiology Laboratory, Fujian Provincial Hospital
| | - Liqing Chen
- Clinical Microbiology Laboratory, Fujian Provincial Hospital
| | - Yusheng Chen
- Shengli Clinical Medical College of Fujian Medical University
- Department of Respiratory Medicine and Critical Care Medicine, Fujian Provincial Hospital, Fuzhou, China
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Ciccia M, Ambretti S, Guerra L, Sandri F. Verona integron-encoded metallo- β-lactamase-producing Klebsiella pneumoniae sepsis in an extremely premature infant. CASE REPORTS IN PERINATAL MEDICINE 2018. [DOI: 10.1515/crpm-2018-0011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
During the course of an outbreak due to Verona integron-encoded Metallo-β-lactamase (VIM)-producing Klebsiella pneumonia (KP) in the neonatal intensive care unit (NICU) of Maggiore Hospital in Bologna (Italy), an 8-day-old extremely low birth weight (ELBW) infant developed a severe ventilator-associated pneumonia (VAP) with concomitant bacteraemia. Although the microorganism was susceptible only to colistin and tigecycline, the patient was successfully treated with a combination of antibiotics including high-dosage, prolonged infusion of meropenem (MEM) and intravenous plus aerosolised gentamicin (GEN). This report highlights that, even when the microorganism is considered non-susceptible to MEM and GEN, the combination of these two agents could have a significant survival benefit.
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Affiliation(s)
- Matilde Ciccia
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health , Maggiore Hospital , via dell’Ospedale 2 , 40131 Bologna , Italy , Tel.: 0039 051 3172424, Fax: 0039 051 3172419
| | - Simone Ambretti
- Institute of Microbiology , University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Luca Guerra
- Division of Infectious Diseases , University of Bologna, S. Orsola-Malpighi Hospital , Bologna , Italy
| | - Fabrizio Sandri
- Neonatal Intensive Care Unit, Department of Women’s and Children’s Health , Maggiore Hospital , Bologna , Italy
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Pang F, Jia XQ, Zhao QG, Zhang Y. Factors associated to prevalence and treatment of carbapenem-resistant Enterobacteriaceae infections: a seven years retrospective study in three tertiary care hospitals. Ann Clin Microbiol Antimicrob 2018; 17:13. [PMID: 29571291 PMCID: PMC5865290 DOI: 10.1186/s12941-018-0267-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 03/17/2018] [Indexed: 12/26/2022] Open
Abstract
Background The increasing incidence of carbapenem-resistant Enterobacteriaceae (CRE), has resulted in a difficult problem in the current clinical anti-infective treatment. We performed a retrospective analysis of prevalence and treatment for CRE infections patients. Methods This study was conducted in three tertiary care hospitals from January 1, 2010 to December 30, 2016. Baseline data, treatment, and outcomes were collected in patients with ventilator-associated bacterial pneumonia (VABP), bacteremia, complicated urinary tract infection (cUTI)/acute pyelonephritis (AP), hospital-acquired bacterial pneumonia (HABP), superficial wound infection (SWI), biliary tract infection (BTI), deep wound infection (DWI) and sterile body fluids infection (SBFI) due to CRE. Results One hundred twenty-four cases of CRE infection were identified: 31 VABP, 22 bacteremia, 18 cUTI/AP, 16 HABP, 16 SWI, 9 BTI, 7 DWI and 5 SBFI. The patient population had significant immunocompromised (33 of 124, 26.6%) and severe sepsis (43 of 124, 34.7%). The most common CRE pathogens were Klebsiella pneumoniae (84 of 124, 67.7%) and Enterobacter cloacae (24 of 124, 19.4%). And the production of IMP-type carbapenemase was the main antibiotic resistance mechanism. The majority of patients to take monotherapy for empiric therapy and dual therapy for direct treatment. Outcomes were universally poor (28-day mortality was 22.6%, 28 of 124) across all sites of infection. Conclusions We identified a large number of cases of CRE infection in 7 years from different parts, most of these pathogens have been confirmed to produce IMP-type carbapenemases. The retrospective analysis of cases of such bacterial infections will help to control future infections of these pathogens. Despite the high mortality rate, we still found that the selection of quinolone antibiotics can be effective in the treatment of CRE producing IMP type enzymes.
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Affiliation(s)
- Feng Pang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China.,Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Xiu-Qin Jia
- Department of Clinical Pharmacy, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China.
| | - Qi-Gang Zhao
- Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Yi Zhang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, 250012, Shandong, People's Republic of China
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11
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van Loon K, Voor In 't Holt AF, Vos MC. A Systematic Review and Meta-analyses of the Clinical Epidemiology of Carbapenem-Resistant Enterobacteriaceae. Antimicrob Agents Chemother 2018; 62:e01730-17. [PMID: 29038269 PMCID: PMC5740327 DOI: 10.1128/aac.01730-17] [Citation(s) in RCA: 143] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 09/29/2017] [Indexed: 01/23/2023] Open
Abstract
Carbapenem-resistant Enterobacteriaceae (CRE) are major health care-associated pathogens and responsible for hospital outbreaks worldwide. To prevent a further increase in CRE infections and to improve infection prevention strategies, it is important to summarize the current knowledge about CRE infection prevention in hospital settings. This systematic review aimed to identify risk factors for CRE acquisition among hospitalized patients. In addition, we summarized the environmental sources/reservoirs and the most successful infection prevention strategies related to CRE. A total of 3,983 potentially relevant articles were identified and screened. Finally, we included 162 studies in the systematic review, of which 69 studies regarding risk factors for CRE acquisition were included in the random-effects meta-analysis studies. The meta-analyses regarding risk factors for CRE acquisition showed that the use of medical devices generated the highest pooled estimate (odds ratio [OR] = 5.09; 95% confidence interval [CI] = 3.38 to 7.67), followed by carbapenem use (OR = 4.71; 95% CI = 3.54 to 6.26). To control hospital outbreaks, bundled interventions, including the use of barrier/contact precautions for patients colonized or infected with CRE, are needed. In addition, it is necessary to optimize the therapeutic approach, which is an important message to infectious disease specialists, who need to be actively involved in a timely manner in the treatment of patients with known CRE infections or suspected carriers of CRE.
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Affiliation(s)
- Karlijn van Loon
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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12
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Zhou K, Yu W, Shen P, Lu H, Wang B, Rossen JWA, Xiao Y. A novel Tn1696-like composite transposon (Tn6404) harboring bla IMP-4 in a Klebsiella pneumoniae isolate carrying a rare ESBL gene bla SFO-1. Sci Rep 2017; 7:17321. [PMID: 29229976 PMCID: PMC5725488 DOI: 10.1038/s41598-017-17641-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/29/2017] [Indexed: 11/29/2022] Open
Abstract
Genetic determinants of a clinical Klebsiella pneumoniae isolate (KP1814) coproducing IMP-4 and a rare ESBL gene SFO-1 was investigated. KP1814 belongs to a novel sequence type (ST) assigned to ST2270. WGS identified four circular DNA sequences in KP1814, including two multidrug-resistance (MDR) plasmids, one virulence plasmid, and one circular form. The MDR plasmid pKP1814-1 (299.9 Kb) is untypeable, and carries two large mosaic multiresistance regions (MRRs). blaSFO-1 and blaIMP-4 co-exists on MRR1, and blaSFO-1 is associated with an IS/Tn-independent genetic context. blaIMP-4 is carried by a novel In804-like integron (intlI-blaIMP-4-Kl.pn.I3-qacG2-aacA4-catB3∆) associated with a novel Tn1696-like transposon (designed Tn6404) flanked by IS5075. The other MDR plasmid pKP1814-3 is a 95,701-bp IncFII plasmid, and is a hybrid of a Shigella flexneri plasmid pSF07201 and an E. coli plasmid pCA08. All resistance genes of pKP1814-3 were detected in a ~16-kb IS26-flanked composite transposon carried by a Tn5396 transposon. The circular form (18.3 Kb) was composed of two parts belonging to pKP1814-1 and pKP1814-3, respectively. The plasmid pKP1814-2, carrying multiple virulence factors, encodes IncFIBK and IncFIIK replicons with a size of 187,349 bp. The coexistence of MDR and virulence plasmids largely enhances the bacterial fitness in the host and environment.
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Affiliation(s)
- Kai Zhou
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Wei Yu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China.,Department of Infectious Diseases, Zhejiang Provincial People's Hospital, Hangzhou, China
| | - Ping Shen
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Haifeng Lu
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - Baohong Wang
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China
| | - John W A Rossen
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Yonghong Xiao
- State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, the First Affiliated Hospital of Medicine School, Zhejiang University, Hangzhou, China.
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13
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Molecular Epidemiology of Clonally Related Metallo-β-Lactamase-Producing Klebsiella pneumoniae Isolated from Newborns in a Hospital in Shandong, China. Jundishapur J Microbiol 2017. [DOI: 10.5812/jjm.14046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Lai K, Ma Y, Guo L, An J, Ye L, Yang J. Molecular characterization of clinical IMP-producing Klebsiella pneumoniae isolates from a Chinese Tertiary Hospital. Ann Clin Microbiol Antimicrob 2017; 16:42. [PMID: 28629366 PMCID: PMC5474851 DOI: 10.1186/s12941-017-0218-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Accepted: 05/23/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND IMP-producing Klebsiella pneumoniae (IMPKpn) exhibits sporadic prevalence in China. The mechanisms related to the spread of IMPKpn remain unclear. METHODS Carbapenem non-susceptible K. pneumoniae isolates were collected from our hospital. The genetic relatedness, antimicrobial susceptibility, as well as sequence types (ST) were analyzed by pulsed-field gel electrophoresis (PFGE), VITEK 2 AST test Kit, and multilocus sequence typing (MLST), respectively. S1-PFGE, Southern blot analysis and multiple PCR amplification were used for plasmid profiling. RESULTS Between October 2009 and June 2016, 25 non-repetitive IMPKpn isolates were identified. PFGE results showed that these isolates belonged to 20 genetically unrelated IMPKpn strains. Diverse STs were identified by MLST. Most strains carried bla IMP-4, followed by bla IMP-1. Four incompatibility types of bla IMP-carrying plasmids were identified, which included A/C (n = 2), B/O (n = 2), L/M (n = 1) and N (n = 14), while type of other one plasmid failed to be determined. CONCLUSIONS The IMPKpn isolates exhibited sporadic prevalence in our hospital. IncN types of plasmids with various sizes have emerged as the main platform mediating the spread of the bla IMP genes in our hospital.
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Affiliation(s)
- Kaisheng Lai
- Department of Microbiology, Chinese PLA General Hospital, 301 Hospital, 28# Fuxing Road, Beijing, 100853 China
| | - Yanning Ma
- Department of Microbiology, Chinese PLA General Hospital, 301 Hospital, 28# Fuxing Road, Beijing, 100853 China
| | - Ling Guo
- Department of Microbiology, Chinese PLA General Hospital, 301 Hospital, 28# Fuxing Road, Beijing, 100853 China
| | - Jingna An
- Department of Microbiology, Chinese PLA General Hospital, 301 Hospital, 28# Fuxing Road, Beijing, 100853 China
| | - Liyan Ye
- Department of Microbiology, Chinese PLA General Hospital, 301 Hospital, 28# Fuxing Road, Beijing, 100853 China
| | - Jiyong Yang
- Department of Microbiology, Chinese PLA General Hospital, 301 Hospital, 28# Fuxing Road, Beijing, 100853 China
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15
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Mohamed ER, Aly SA, Halby HM, Ahmed SH, Zakaria AM, El-Asheer OM. Epidemiological typing of multidrug-resistant Klebsiella pneumoniae, which causes paediatric ventilator-associated pneumonia in Egypt. J Med Microbiol 2017; 66:628-634. [PMID: 28485710 DOI: 10.1099/jmm.0.000473] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE Multidrug-resistant Klebsiella pneumoniae is a common nosocomial pathogen that plays an important role in ventilator-associated pneumonia (VAP). This study aimed to define the clonal relatedness of K. pneumoniae strains isolated from paediatric VAP in addition to those isolated from environmental samples. METHODOLOGY This study included 19 clinical and 4 environmental K. pneumoniae isolates recovered from the paediatric intensive care unit (PICU) in Assiut University Children's Hospital. The K. pneumoniae isolates were confirmed by biotyping using API strips and subjected to antimicrobial susceptibility testing. The genes coding K1 and K2 capsular types were detected by PCR. The clonal relationships between the K. pneumoniae isolates were determined by pulsed-field gel electrophoresis (PFGE). RESULTS Ten resistotypes were detected among all the K. pneumoniae isolates, while PFGE identified seventeen K. pneumoniae pulsotypes. Similar PFGE patterns were found between environmental and clinical isolates and between isolates recovered from different patients, suggesting the circulation of K. pneumoniae pathogens in the PICU and the role of the environment in the spread of infection. No correlation was found between the resistotypes and pulsotypes of the K. pneumoniae isolates. PFGE showed higher discriminatory power for the typing of nosocomial K. pneumoniae [Simpson's diversity index (DI)=0.96] than resistotyping (DI=0.72). CONCLUSION As far as we know, this is the first report of the isolation of the same multidrug-resistant (MDR) K. pneumoniae pulsotype from patients and environmental samples in the same hospital ward in Egypt. This study provides a step on the way to understanding the genotyping and epidemiology of MDR K. pneumoniae for enhanced prevention of bacterial transmission.
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Affiliation(s)
- Eman R Mohamed
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Egypt
| | - Sherine A Aly
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
| | - Hamada M Halby
- Department of Microbiology and Immunology, Faculty of Pharmacy, Al-Azhar University, Egypt
| | - Shabaan H Ahmed
- Department of Microbiology and Immunology, Faculty of Medicine, Assiut University, Egypt
| | - Amira M Zakaria
- Biotechnology Research Institute, Suez Canal University, Ismailia, Egypt
| | - Osama M El-Asheer
- Department of Pediatric Medicine, Faculty of Medicine, Assiut University, Egypt
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16
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Ruiz J, Ramirez P, Villarreal E, Gordon M, Cuesta S, Piñol M, Frasquet J, Castellanos Á. Silver-embedded screens in the intensive care unit. A new tool to control multi-drug resistant bacterial cross-transmission. Eur J Clin Microbiol Infect Dis 2017; 36:1505-1509. [PMID: 28321578 DOI: 10.1007/s10096-017-2959-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2017] [Accepted: 03/03/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to assess the effectiveness of silver-embedded surfaces (BactiBlock®) to prevent surface colonization by multi-resistant bacteria (MRB) and to reduce the incidence of MRB colonization and infection in patients admitted to an intensive care unit (ICU). A 6-month prospective observational study in a 24-bed mixed ICU divided into two identical subunits (12 beds each) was designed. Seven solid mobile screens were placed in one of the subunits while in the other cloth screens remained. Solid screens were constructed with high-density polyethylene embedded in Bactiblock®. To evaluate the effectiveness of screens coated with Bactiblock®, number of MRB isolates on screens were compared for 6 months. Likewise, numbers of new patients and ICU-stays with MRB colonization in the two subunits were compared. One hundred forty screen samples were collected in 10-point prevalent days. MRB were detected on 28 (20.0%) samples. Over the 70 samples taken on cloth folding screens, MRB were detected in 25 (35.7%), while only 3 (4.3%) of the 70 samples taken on Bactiblock® screens were positive for MRB (p < 0.001). The unit with Bactiblock® screens presented fewer number of ICU stays with MRB colonization (27.8% vs 47.1%; p < 0.001). No significant differences were found in the global incidence of MRB nosocomial infection. The presence of Bactiblock® embedded in solid folding screens avoided MRB surface colonization and reduced MRB transmission to patients admitted to critical care units, proving to be an useful tool in the control of MRB.
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Affiliation(s)
- J Ruiz
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - P Ramirez
- Hospital Universitario y Politécnico la Fe, Valencia, Spain.
| | - E Villarreal
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Gordon
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - S Cuesta
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - M Piñol
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - J Frasquet
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
| | - Á Castellanos
- Hospital Universitario y Politécnico la Fe, Valencia, Spain
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17
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Ying Q, Qun L, Qinzhong L, Mingliang C, Hong C, Ni Z. Investigation and control of a suspected nosocomial outbreak of pan-drug resistant Acinetobacter baumannii in an intensive care unit. Open Med (Wars) 2016; 11:587-592. [PMID: 28352851 PMCID: PMC5329883 DOI: 10.1515/med-2016-0096] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Accepted: 12/11/2016] [Indexed: 11/16/2022] Open
Abstract
Acinetobacter baumannii, a non-fermenting Gram-negative bacterium, is a common pathogen in intensive care units (ICU) that is easily spread through contact and can cause nosocomial outbreaks. This study investigated the risk factors associated with outbreaks of pan-drug resistant Acinetobacter baumannii (PDR-Ab) infection by studying a suspected nosocomial outbreak in a comprehensive ICU in a teaching hospital in China, and discusses the effectiveness of current prevention and control measures. Pathogen detection methods involving pulsed field gel electrophoresis (PFGE) were employed to survey patients infected or colonized with PDR-Ab. An epidemiological investigation was conducted to determine the risk factors for infection or colonization with PDR-Ab between 1 October 2014 and 16 January 2015. The rate of PDR-Ab infection in the ICU was higher during the period from 1 October 2014 to 16 January 2015 than it was between 1 October 2013 and 16 January 2014. Only two cases were confirmed to have the same genotype. Risk factors were explored and the rate of infection was found to be controlled by interventions targeting these risk factors. A decrease in the number of infections was observed after multiple prevention and control measures were implemented, preventing the outbreak of a nosocomial infection.
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Affiliation(s)
- Qian Ying
- Shanghai First People’s Hospital, Shanghai 201620, China
| | - Li Qun
- Shanghai First People’s Hospital, Shanghai 201620, China
| | - Liu Qinzhong
- Shanghai First People’s Hospital, Shanghai 201620, China
| | - Chen Mingliang
- Shanghai Municipal Center for Disease Control & Prevention, Shanghai, China
| | - Chen Hong
- Shanghai First People’s Hospital, Shanghai 201620, China
| | - Zou Ni
- Shanghai First People’s Hospital, Shanghai, China
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18
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Hu L, Liu Y, Deng L, Zhong Q, Hang Y, Wang Z, Zhan L, Wang L, Yu F. Outbreak by Ventilator-Associated ST11 K. pneumoniae with Co-production of CTX-M-24 and KPC-2 in a SICU of a Tertiary Teaching Hospital in Central China. Front Microbiol 2016; 7:1190. [PMID: 27531996 PMCID: PMC4970487 DOI: 10.3389/fmicb.2016.01190] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2016] [Accepted: 07/19/2016] [Indexed: 12/15/2022] Open
Abstract
The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) often responsible for numerous hospital-associated outbreaks has become an important public health problem. From January 2013 to February 2014, a total of 41 non-duplicate K. pneumoniae isolates with carbapenem resistance, were collected at a tertiary teaching hospital in Nanchang, central China. Among 41 K. pneumoniae isolates, 28 were isolated from hospitalized patients including 19 from the patients in surgery intensive care unit (SICU) and 13 were isolated from ventilators. Twenty-four of 28 patients infected by CRKP have been submitted to mechanical ventilation using ventilator. More than 95% of the CRKP isolates were resistant to 13 antimicrobials tested. All CRKP isolates were confirmed as carbapenemase producer and were positive for bla KPC-2, with one positive for both blaKPC-2 and bla NDM-1. All carbapenemase-producing isolates harbored at least one of extended spectrum β-lactamase genes tested, among which 95.1% (39/41) of the tested isolates were found to harbor both bla CTX-M-24 and bla KPC-2, Of note, one isolate harbored simultaneously two carbapenemase genes (bla KPC-2 and bla NDM-1) and two ESBL genes (bla CTX-M-3 and bla TEM-104). To the best of our knowledge, coexistence of bla KPC-2 and bla CTX-M-24 in one isolate is first reported. MLST results showed that 41 CRKP isolates belonged to four sequence types (STs) including ST11, novel ST1854, novel ST1855, and ST1224. PFGE results displayed three PFGE clusters. Thirty-eight ST11 CRKP isolates (92.7%, 38/41) including all 13 isolates from ventilators and 25 isolates from patients from seven wards (18 from SICU) belonged to same PFGE cluster, indicating these isolates were clonally related. Fifteen isolates have an identical undistinguished pattern (100% similarity) forming a single clonal population. Moreover, this clone was exclusively linked to the cases attended in SICU and linked to the Ventilators. Additionally, the other SICU cases were linked to closely related clones (similarity greater than 95%). These data indicated that the occurrence of a clonal outbreak associated with ventilators has been found. In conclusion, outbreak by ventilator-associated ST11 K. pneumoniae with co-production of CTX-M-24 and KPC-2 is found in a SICU of a tertiary teaching hospital in central China.
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Affiliation(s)
- Longhua Hu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang China
| | - Yanling Liu
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang China
| | - Linqiang Deng
- Department of Clinical Laboratory, Jiangxi Provincial People's Hospital, Nanchang China
| | - Qiaoshi Zhong
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang China
| | - Yaping Hang
- Department of Clinical Laboratory, The Second Affiliated Hospital of Nanchang University, Nanchang China
| | - Zengzeng Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou China
| | - Lingling Zhan
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou China
| | - Liangxing Wang
- Department of Respiratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou China
| | - Fangyou Yu
- Department of Laboratory Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou China
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Pang F, Jia XQ, Song ZZ, Li YH, Wang B, Zhao QG, Wang CX, Zhang Y, Wang LX. Characteristics and management of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in a tertiary hospital. Afr Health Sci 2016; 16:153-61. [PMID: 27358627 DOI: 10.4314/ahs.v16i1.21] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The emergence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases is rare. We report an occurrence of Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemases in a Chinese tertiary care hospital from November 2010 to December 2012. METHODS The clinical characteristics of 30 patients were described. The genetic relationship of isolates was determined by pulsed-field gel electrophoresis (PFGE). Carbapenemases were detected by modified Hodge test (MHT) and polymerase chain reactions (PCRs). Amplicons were sequenced and blasted to determine the genotype. RESULTS Most infected patients were from intensive care unit and had complex and serious underlying illnesses requiring mechanical ventilation. PFGE revealed that Klebsiella pneumoniae showed two major PFGE types. Two Klebsiella oxytoca had an indistinguishable PFGE pattern, while four Enterobacter cloacae were different strains. The sequencing studies showed Enterobacteriaceae harboring IMP-4 or IMP-8 carbapenemase in the 23 infected patients. The majority of patients had infections with the carbapenemase-producing Enterobacteriaceae (CPE) strain, most were successfully treated with a range of antibiotics and discharged. CONCLUSION It is important to maintain a high index of suspicion to screen for carbapenemase-producing Enterobacteriaceae strains. Rapid identification of these strains and implementation of stringent procedures are the key to prevent major outbreaks in a hospital setting.
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Affiliation(s)
- Feng Pang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China; Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Xiu-Qin Jia
- Department of Clinical Pharmacy, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Zhen-Zhu Song
- Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Yan-Hua Li
- Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Bin Wang
- Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Qi-Gang Zhao
- Department of Clinical Laboratory, Liaocheng People's Hospital, Liaocheng, Shandong 252000, P.R. China
| | - Chuan-Xin Wang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Yi Zhang
- Department of Clinical Laboratory, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Le-Xin Wang
- School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, Australia
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20
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Abstract
Real-time PCR is the traditional face of nucleic acid detection in the diagnostic microbiology laboratory and is now generally regarded as robust enough to be widely adopted. Methods based on nucleic acid detection of this type are bringing increased accuracy to diagnosis in areas where culture is difficult and/or expensive, and these methods are often effective partners to other rapid molecular diagnostic tools such as matrix-assisted laser desorption ionisation-time of flight mass spectrometry (MALDI-TOF MS). This change in practice has particularly affected the recognition of viruses and fastidious or antibiotic-exposed bacteria, but has been also shown to be effective in the recognition of troublesome or specialised phenotypes such as antiviral resistance and transmissible antibiotic resistance in the Enterobacteriaceae. Quantitation and high-intensity sequencing (of multiple whole genomes) has brought new opportunities as well as new challenges to the microbiology community. Diagnostic microbiologists currently training might be expected to deal less with the culture-based techniques of the last half-century than with the high-volume data and complex analyses of the next.
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Zhang J, Zhao C, Chen H, Wang X, Li H, Zhang Y, Wang H. Comparative evaluation of tigecycline susceptibility testing methods for Acinetobacter baumannii and Enterobacteriaceae. J Glob Antimicrob Resist 2015; 3:75-79. [PMID: 27873673 DOI: 10.1016/j.jgar.2015.02.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 01/29/2015] [Accepted: 02/09/2015] [Indexed: 11/26/2022] Open
Abstract
The objectives of this study were to recommend suitable susceptibility testing methods for tigecycline for clinical laboratory use and to evaluate differences in tigecycline susceptibility between carbapenem-susceptible and carbapenem-non-susceptible isolates. Broth microdilution (BMD) was used as the reference method to evaluate MIC Test Strip (MTS), agar dilution, VITEK® 2 and disk diffusion testing methods for tigecycline against Acinetobacter baumannii and Enterobacteriaceae. MIC50/90 values (minimum inhibitory concentrations for 50% and 90% of the isolates, respectively) of A. baumannii and Enterobacteriaceae were, respectively, 2/4μg/mL and 0.5/4μg/mL by BMD, 1.5/3μg/mL and 0.5/3μg/mL by MTS, 2/4μg/mL and 1/8μg/mL by agar dilution and 2/4μg/mL and 2/8μg/mL by VITEK® 2. Essential agreement for A. baumannii/Enterobacteriaceae detected by MTS, agar dilution and VITEK® 2 methods was 96.0/97.3%, 98.0/97.3% and 94.0/63.9%, respectively. Categorical agreement for A. baumannii/Enterobacteriaceae detected by MTS, agar dilution, VITEK® 2 and disk diffusion methods was 90.0/91.8%, 72.0/93.7%, 62.0/86.5% and 72.0/81.2%, respectively. No very major errors were found for all isolates by the four methods evaluated. Major error rates were produced by VITEK® 2 (for Enterobacteriaceae) and by disk diffusion (for A. baumannii and Enterobacteriaceae). Tigecycline susceptibility of carbapenem-susceptible and carbapenem-non-susceptible isolates was 85.2% and 83.6% (χ2=0.15, P>0.05) using the reference method. In conclusion, in this study MTS showed the best correlation with BMD for tigecycline MICs. Based on in vitro testing, tigecycline can be considered an equally useful choice for infections caused by carbapenem-susceptible and carbapenem-non-susceptible isolates.
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Affiliation(s)
- Jixia Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China; Department of Clinical Laboratory, Aviation General Hospital of China Medical University, Beijing, China
| | - Chunjiang Zhao
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
| | - Xiaojuan Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
| | - Henan Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
| | - Yawei Zhang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China.
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22
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Dai XT, Sun FJ, Chen ZH, Luo GM, Feng W, Xiong W, Xia PY. The Epidemiology and Resistance Mechanisms of Acinetobacter baumannii Isolates from the Respiratory Department ICU of a Hospital in China. Microb Drug Resist 2014; 20:618-22. [PMID: 24991998 DOI: 10.1089/mdr.2014.0005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Xiao-Tian Dai
- Department of Pulmonology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Feng-Jun Sun
- Department of Pharmacy, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Zhen-Hong Chen
- Department of Respiratory Diseases, Chinese PLA General Hospital, Beijing, China
| | - Guang-Ming Luo
- Department of Pulmonology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wei Feng
- Department of Pharmacy, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Wei Xiong
- Department of Pulmonology, Southwest Hospital, Third Military Medical University, Chongqing, China
| | - Pei-Yuan Xia
- Department of Pharmacy, Southwest Hospital, Third Military Medical University, Chongqing, China
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23
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High prevalence of carbapenem resistance among plasmid-mediated AmpC β-lactamase-producing Klebsiella pneumoniae during outbreaks in liver transplantation units. Int J Antimicrob Agents 2014; 45:33-40. [PMID: 25455850 DOI: 10.1016/j.ijantimicag.2014.08.015] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 08/21/2014] [Accepted: 08/22/2014] [Indexed: 01/17/2023]
Abstract
During a prospective surveillance using PCR for the detection of plasmid-mediated AmpC β-lactamase (pAmpC)-producing Enterobacteriaceae, outbreaks due to pAmpC-producing Klebsiella pneumoniae (pAmpC-Kp) occurred in an adult liver transplantation unit (aLTU) and a paediatric liver transplantation unit (pLTU), with carbapenem-resistant (CR) variants. Between April 2010 and March 2012, a total of 32 patients infected with pAmpC-Kp were found by prospective surveillance using PCR detection at a Japanese university hospital. Multilocus sequence typing, analysis of outer membrane proteins, and detection of carbapenemases were performed. Clinical courses of patients with bloodstream infection (BSI) were reviewed. Of 32 pAmpC-Kp isolates from each patient, 20 (18 from aLTU patients) were DHA-1-producing sequence type 11 (DHA-1-ST11), 9 were CMY-2-ST45/778 (all from pLTU patients) and the other 3 isolates had different sequence types. CR variants were isolated from 8 aLTU patients with DHA-1-ST11 and from 1 pLTU patient with CMY-2-ST45. All of the pAmpC-Kp isolates, including CR variants, were negative for carbapenemases. All of the DHA-1-ST11 and CMY-2-ST45 isolates lacked OmpK35, and seven CR variants also lacked OmpK36. BSIs due to DHA-1-ST11 isolates, including CR variants, occurred in six aLTU patients, four of whom died. The outbreaks were controlled after application of intensified infection control measures. During pAmpC-Kp outbreaks involving 27 liver transplants, CR variants with porin loss developed in nine patients, and DHA-1-ST11 K. pneumoniae caused BSIs with high mortality.
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24
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High incidence and endemic spread of NDM-1-positive Enterobacteriaceae in Henan Province, China. Antimicrob Agents Chemother 2014; 58:4275-82. [PMID: 24777095 DOI: 10.1128/aac.02813-13] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The emergence and spread of New Delhi metallo-β-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla(NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla(NDM-1), and the gene was found to be carried on plasmids of various sizes (∼ 55 to ∼ 360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla(NDM-1)-positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla(NDM-1)-positive CRE isolate, the bla(NDM-1) gene was downstream of an intact ISAba125 element and upstream of the bleMBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla(NDM-1)-containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.
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Li H, Zhang J, Liu Y, Zheng R, Chen H, Wang X, Wang Z, Cao B, Wang H. Molecular characteristics of carbapenemase-producing Enterobacteriaceae in China from 2008 to 2011: predominance of KPC-2 enzyme. Diagn Microbiol Infect Dis 2013; 78:63-5. [PMID: 24211218 DOI: 10.1016/j.diagmicrobio.2013.10.002] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2013] [Revised: 09/01/2013] [Accepted: 10/02/2013] [Indexed: 11/24/2022]
Abstract
Among 228 carbapenem-nonsusceptible Enterobacteriaceae isolated in China, 65 were carbapenemase-producing Enterobacteriaceae (CPE). Among them, 41, 22, 1, and 1 produced KPC-2, IMP-4, IMP-8, and IMP-1, respectively. KPC-2-producing CPE showed higher resistance than IMP-4-producing ones. Furthermore, the first outbreak of ST11 KPC-2-producing Klebsiella pneumoniae in a Beijing second-degree hospital was identified.
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Affiliation(s)
- Henan Li
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Jixia Zhang
- Department of Clinical Laboratory, Aviation General Hospital, Beijing, China
| | - Yingmei Liu
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Rui Zheng
- Department of Clinical Laboratory, First People's Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Hongbin Chen
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Xiaojuan Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Zhanwei Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China
| | - Bin Cao
- Department of Infectious Diseases and Clinical Microbiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Hui Wang
- Department of Clinical Laboratory, Peking University People's Hospital, Beijing, China.
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Large oligoclonal outbreak due to Klebsiella pneumoniae ST14 and ST26 producing the FOX-7 AmpC β-lactamase in a neonatal intensive care unit. J Clin Microbiol 2013; 51:4067-72. [PMID: 24088849 DOI: 10.1128/jcm.01982-13] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A large outbreak caused by expanded-spectrum cephalosporin-resistant Klebsiella pneumoniae (ESCRKP) was observed in a neonatal intensive care unit (NICU) in central Italy. The outbreak involved 127 neonates (99 colonizations and 28 infections, with seven cases of sepsis and two deaths) over a period of more than 2 years (February 2008 to April 2010). Characterization of the 92 nonredundant isolates that were available for further investigation revealed that all of them except one produced the FOX-7 AmpC-type β-lactamase and belonged to either sequence type 14 (ST14) or ST26. All of the FOX-7-positive isolates were resistant to cefotaxime, ceftazidime, and piperacillin-tazobactam, while 76% were susceptible to cefepime, 98% to ertapenem, 99% to meropenem, and 100% to imipenem. The two carbapenem-nonsusceptible isolates had alterations in the genes encoding outer membrane proteins K35 and K36, which resulted in truncated and likely nonfunctional proteins. The outbreak was eventually controlled by the reinforcement of infection control measures based on a multitiered interventional approach. This is the first report of a large NICU outbreak caused by ESCRKP producing an AmpC-type enzyme. This study demonstrates that AmpC-type enzyme-producing strains can cause large outbreaks with significant morbidity and mortality effects (the mortality rate at 14 days was 28.5% for episodes of sepsis), and it underscores the role of laboratory-based surveillance and infection control measures to contain similar episodes.
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27
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Current World Literature. Curr Opin Allergy Clin Immunol 2013. [DOI: 10.1097/aci.0b013e3283619e49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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28
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Bush K. Carbapenemases: Partners in crime. J Glob Antimicrob Resist 2013; 1:7-16. [PMID: 27873609 DOI: 10.1016/j.jgar.2013.01.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2013] [Accepted: 01/23/2013] [Indexed: 10/27/2022] Open
Abstract
Carbapenemases, β-lactamases that inactivate carbapenems and most β-lactam antibiotics, are most widely known for their ability to confer resistance to β-lactams. They include serine carbapenemases, such as the widespread KPC family of enzymes, and the metallo-β-lactamases that contain the IMP, NDM and VIM enzyme families acquired by Gram-negative bacteria on transferable elements. These enzymes are almost always produced by organisms that encode at least one other β-lactamase, with as many as eight different β-lactamase genes detected in a single isolate. This consortium of β-lactamases includes a full spectrum of molecular and biochemical characteristics, providing the producing organism with a range of catalytic activities. In addition to the variety of β-lactamases found in carbapenemase-producing Gram-negative pathogens are multiple other resistance factors, especially aminoglycoside-modifying enzymes and 16S rRNA methylases that confer resistance to aminoglycosides. Other acquired genes encode fluoroquinolone, trimethoprim, sulfonamide, rifampicin and chloramphenicol resistance determinants on mobile elements that travel together with β-lactamase genes. Thus, the recent proliferation of transferable carbapenemases serves to magnify resistance to virtually all antibiotic classes. Judicial use of current antibiotics and a quest for novel antibacterial agents are necessary, as multidrug-resistant bacteria continue to multiply.
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Affiliation(s)
- Karen Bush
- Department of Molecular and Cellular Biochemistry, Jordan Hall A311, Indiana University, 1001 E. Third Street, Bloomington, IN 47405, USA.
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29
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Emergence of blaNDM-1 among Klebsiella pneumoniae ST15 and novel ST1031 clinical isolates in China. Diagn Microbiol Infect Dis 2013; 75:373-6. [PMID: 23453788 DOI: 10.1016/j.diagmicrobio.2013.01.006] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2012] [Revised: 01/03/2013] [Accepted: 01/08/2013] [Indexed: 01/29/2023]
Abstract
The emergence of NDM-1 has become established as a major public health threat and represents a new and major challenge in the treatment of infectious diseases. A total of 39 carbapenem-resistant Enterobacteriaceae isolates collected from patients receiving care at 5 teaching hospitals in Jiangxi province, central China, were analyzed for carriage of resistance genes, including bla(NDM-1). Two carbapenem-resistant Klebsiella pneumoniae isolates (NC12 and NC18) were found to harbor bla(NDM-1). In addition to bla(NDM-1), NC12 also carried bla(SHV-1), while NC18 harbored additional resistance genes, including bla(SHV-12), bla(CTX-M-14), armA and bla(TEM-1). NC12 and NC18 belonged to ST15 and novel ST1031 and were clonally unrelated. Carbapenem resistance for NC12 could be transferred to Escherichia coli recipients through conjugation and chemical transformation, while carbapenem resistance for NC18 was only transferred to E. coli recipients by chemical transformation. The EcoR1-digested DNA pattern of plasmids from the transformants of NC12 was identical to that for NC18. Taken together, this is the first report of bla(NDM-1) carriage by K. pneumoniae clinical isolates in mainland China, indicating that bla(NDM-1) is disseminated among Enterobacteriaceae in China. Systemic surveillance should focus on the dissemination of bla(NDM-1) among Gram-negative clinical isolates, especially some major clones, such as K. pneumoniae ST15 which is a major clone among CTX-M-15-producing isolates.
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30
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Gould IM, Bal AM. New antibiotic agents in the pipeline and how they can help overcome microbial resistance. Virulence 2013; 4:185-91. [PMID: 23302792 PMCID: PMC3654619 DOI: 10.4161/viru.22507] [Citation(s) in RCA: 184] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Bacterial resistance is a growing threat and yet few new antibiotics active against multi-resistant bacteria are being explored. A combination of falling profits, regulatory mechanisms and irrational and injudicious use of antibiotics has led to an alarming situation where some infections have no cure. In this article, we summarize the new developments that have been suggested to incentivize the pharmaceutical industries toward the field of infections. We also briefly mention the new compounds on the horizon and some newly approved compounds that might help us tide over this crisis.
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31
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Complete sequence of an IncN plasmid, pIMP-HZ1, carrying blaIMP-4 in a Klebsiella pneumoniae strain associated with medical travel to China. Antimicrob Agents Chemother 2012; 57:1561-2. [PMID: 23274671 DOI: 10.1128/aac.02298-12] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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