c Fifty-seven carbapenem-resistant Klebsiella pneumoniae isolates belonging to ST11 (50 isolates), ST423 (5 isolates), and two other sequence types were studied. All were positive for bla KPC-2 , bla TEM-1 , and bla CTX-M-14 . SDS-PAGE analysis of six representative isolates demonstrated varied porin expression. Nevertheless, when bla KPC-2 was deleted, carbapenem resistance was markedly reduced. Additionally, SHV-12, DHA-1, and/or VIM-1 appeared to contribute to accessory carbapenemase activity. In contrast, OmpK35 and/or OmpK36 deficiency seemed to serve only as a minor cooperative factor. Table S1 in the supplemental material for primer details). Standard multilocus sequence typing (MLST) protocols were utilized, with alternative primers for gapA, mdh, rpoB, and tonB used as required. Fifty isolates belonged to ST11, five belonged to ST423, and one each belonged to ST65 and a novel MLST type, ST977. The first carbapenem-resistant isolate, derived from a urine specimen obtained in August 2006, belonged to ST423. However, only four other ST423 isolates were detected over the study period. In contrast, ST11 remained endemic throughout this period. Intriguingly, isolates belonging to ST65 and ST977 appeared only once. Except for XJ-2 and XJ-4, which exhibited lower carbapenem MICs, all 57 isolates showed high-level resistance to ampicillin, cefotaxime, ceftazidime, imipenem, meropenem, and ertapenem. PCR analysis suggested that all but two isolates produced TEM-1, KPC-2, CTX-M-14, and SHV-12; bla was not detected in XJ-1 and XJ-4. In addition, all five ST423 isolates encoded DHA-1, and the XJ-5 (ST11) isolate uniquely produced VIM-1.
CIsolates XJ-1, XJ-2, and XJ-3, representative of ST977, ST65, and ST423, respectively, were chosen for further analysis together with three ST11 isolates: XJ-4 because it had relatively low carbapenem MICs, XJ-5 because it had a supplementary bla VIM-1 gene, and XJ-6 because it was typical of most ST11 isolates. SDS-PAGE analysis of outer membrane proteins extracted as described previously (10) from cells grown overnight with shaking at 37°C in nutrient broth with or without 10 g/liter NaCl showed that XJ-1 expressed smaller quantities of OmpK36, while OmpK35 production was not detected for XJ-1, XJ-4, and XJ-5 (Fig. 1). Furthermore, as the likely OmpK36 protein bands of XJ-3 and XJ-6 were shifted upwards (see below for details), the status of OmpK35 bands in these strains could not be determined (Fig. 1).Although DNA mutations relative to that of NTUH-K2044 were detected in the ompK35 sequences of XJ-4, XJ-5, and XJ-6, no amino acid changes were predicted (Fig. 2). In contrast, the predicted OmpK35 of XJ-1 exhibited 25 amino acid substitutions and a single insertion, while the corresponding sequence of XJ-2 varied by a single amino acid substitution only. The OmpK35 protein of XJ-3 lacked a five-amino-acid string (EIYNK), which mapped to the B1 -sheet. This string of amino acids was strictly conserved in the OmpK35 sequences of the remaining five clinical isolates, NTUH-K2044, a...