In China, Klebsiella pneumoniae carbapenemase (KPC) -producing K. pneumoniae isolates have been identified. However, little is known about the spread and outbreak of KPC-producing enterobacterial pathogens. In this study, 48 non-duplicated KPC-producing isolates were analysed for genetic relatedness by pulsed-field gel electrophoresis (PFGE), antimicrobial susceptibility by E-test, and sequence type (ST) by multilocus sequence typing. S1-PFGE and Southern blot were used for plasmid profiling, and PCR and subsequent sequencing were performed to determine the effects of genetic background on the blaKPC gene. From December 2011 to June 2012, an outbreak of the KPC-2-producing K. pneumoniae was observed. The 48 isolates of K. pneumoniae are categorized into eight PFGE types (A1, A2, A3, A4, B, C, D and E). The predominant pathogens of the outbreak were strains with PFGE types A1, A2 and A3, which all belong to ST11. Furthermore, ST37, ST392 and ST395 KPC-2-producing K. pneumoniae isolates have also been sporadically identified. The blaKPC-2 -carrying plasmids vary in size from 30 to 220 kb. The genetic environments of the blaKPC-2 gene for most strains were consistent with the genetic structure of blaKPC-2 on the plasmid pKP048. In conclusion, the dissemination and outbreak of KPC-2-producing K. pneumoniae isolates in this study appeared to be clonal, and ST11 K. pneumoniae was the predominant clone attributed to the outbreak. This is the first study to report the emergence and spread of KPC-producing K. pneumoniae ST392 and ST395 worldwide. Our findings suggest that horizontal transfer of Tn3-based transposons might mediate the spread of blaKPC-2 gene between different K. pneumoniae clones in China.
The sporadic emergence of New Delhi metallo-β-lactamase-1 (NDM-1)-producing Acinetobacter spp. has been reported in China; however, NDM-1-positive bacteria epidemics are rarely reported in intensive care units (ICUs) in China, or even in the world. During 15 months' surveillance Acinetobacter spp. isolated from patients, heathcare workers and surfaces of a Chinese ICU were screened for the bla(NDM-1) gene. A total of 27 of 3114 Acinetobacter spp. strains were NDM-1 positive and identified as A. pittii with sequence type 63 (ST63) by multilocus sequence typing. Of the 27 NDM-1-positive A. pittii strains, 22 were isolated from the ICU surfaces and grouped into a major clone A using pulsed-field gel electrophoresis typing, while the other five strains isolated from the patients were classified into three clones (A, B and C). The bla(NDM-1) gene was located on a 45-kb plasmid for all three A. pittii clones. The plasmid could be transferred to A. pittii and A. baumannii recipients at both 30 and 37°C but not to Escherichia coli J53. The plasmid could not be classified into any of the known plasmid incompatibility groups. The bla(NDM-1) region in the plasmid was flanked by two insertion sequence elements, ISAba125 and ISAba11, and no other carbapenemase gene was present in this NDM-1-positive A. pittii isolate. Thus, we present the first report on the transmission and characterization of NDM-1-producing A. pittii in an ICU in China as well as a novel bla(NDM-1) gene-bearing plasmid.
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