Carbapenem and Colistin Resistant Klebsiella Pneumoniae ST14 and ST2096 Dominated in Two Hospitals in Turkey

Hoşbul, Tuğrul; Guney-Kaya, Kubra; Güney, Mustafa; Sakarya, Serhan; Bozdoğan, Bülent; Oryaşin, Erman

doi:10.7754/clin.lab.2021.201226

Cited by 9 publications

(7 citation statements)

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“…The phylogenetic tree of K. pneumoniae in the KSA also revealed a diverse population composed of distinct lineages and expanding STs (Figure 2). The largest clone population belonged to the CC14 strains, i.e., the ST14 and ST2096 clades, similar to recent reports from hospitals in the Middle East [34,35] and from a single hospital analysis in Jeddah [16]. Moreover, clinical strains from various sources, i.e., body sites, and regions show an even phylogenetic distribution across lineages (Figure 2).…”

Section: Resultssupporting

confidence: 86%

“…Consistent with our findings, carbapenemase-carrying plasmids have been shown to occur in diverse lineages and are associated with previously reported high-risk clones that frequently spread across healthcare networks [43]. In addition to the global high-risk clones, our results highlight the significance of ST2096, which appears to be currently limited to Saudi Arabia, the Middle East, and South Asia [16,[44][45][46]. An expanding ST2096 clone was reported in a single-hospital study over an 8-year period in Jeddah and was proposed to be an emerging clone, with pervasive transmission within the hospital wards and links to sepsis and adverse clinical manifestations [16].…”

Section: Discussionsupporting

confidence: 91%

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The Dissemination of Multidrug-Resistant and HypervirulentKlebsiella pneumoniaeClones Across the Kingdom of Saudi Arabia

Huang,

Alhejaili,

Alkherd

et al. 2024

Preprint

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The Gram-negative bacterium Klebsiella pneumoniae is a major human health threat underlying a broad range of community- and hospital-associated infections. The emergence of clonal hypervirulent strains often resistant to last-resort antimicrobial agents has become a global burden as treatment options are limited. The Kingdom of Saudi Arabia (KSA) has a dynamic and diverse population and serves as a major global tourist hub facilitating the dissemination of multidrug-resistant (MDR) strains of K. pneumoniae. To examine the spread of clinically relevant Klebsiella pneumoniae strains, we characterized the population structure and dynamics of multidrug-resistant K. pneumoniae across the KSA hospitals. Methods We conducted a large genomic survey on a Saudi Arabian collection of multidrug-resistant K. pneumoniae isolates from bloodstream and urinary tract infections. The isolates were collected from 32 hospitals located in 15 major cities across the country in 2022 and 2023. We subjected 352 K. pneumoniae isolates to whole-genome sequencing and employed a broad range of genomic epidemiological and phylodynamic methods to analyse population structure and dynamics at high resolution. We employed an integrated short- and long-read sequencing approach to fully characterize multiple plasmids carrying resistance and virulence genes. Results Our results indicate that, despite a diverse K. pneumoniae population underlying hospital infections, the population is characterized by the rapid expansion of a few dominant clones, including ST096 (n=115), ST147 (n=75), ST231 (n=35), ST101 (n=30), ST11 (n=18), ST16 (n=15) and ST14 (n=12). ST2096, ST231, and ST147 clones were estimated to have formed within the past two decades and spread between hospitals across the country on an epidemiological time scale. All STs were genetically linked with globally circulating clones, particularly strains from the Middle East and South Asia. All of the major clones harboured plasmid-borne ESBLs and a range of carbapenemase genes. Plasmidome analysis revealed multiple mosaic plasmids with resistance and virulence gene cassettes, some of which were shared between the major clades and account for multidrug resistant hypervirulent (MDR/hv) phenotype, especially in the ST2096 strains. Integration of phylodynamic data and resistance plasmid profiles showed that the acquisition of plasmids occurred on the same time scales as did the expansion of major clones across the country. Conclusion Taken together, these results indicate the dissemination of MDR and MDR-hv K. pneumoniae strains across the kingdom and provide evidence for pervasive plasmid sharing and horizontal gene transfer of resistance genes. The results demonstrate the independent introduction of endemic ST147, ST231, and ST101 clones into the country and highlight the clinical significance of ST2096 as an emerging clone with dual resistance and virulence risks. These results highlight the need for continuous surveillance of circulating and newly emergent strains (STs) and of their plasmidome footprints carrying MDR determinants.

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Section: Resultssupporting

confidence: 86%

Section: Discussionsupporting

confidence: 91%

The Dissemination of Multidrug-Resistant and HypervirulentKlebsiella pneumoniaeClones Across the Kingdom of Saudi Arabia

Huang,

Alhejaili,

Alkherd

et al. 2024

Preprint

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“…In this study, mcr-1 and mcr-2 genes were not detected. Similar to the present research, Sari et al and Hosbul et al could not detect mcr-1 and mcr-2 genes in clinical isolates (8,40).…”

Section: Discussionsupporting

confidence: 91%

Evaluation of Plasmid Mediated Colistin Resistance in Colistin Resistant Gram-negative Bacilli

Çaycı¹,

Ülker²,

Vural³

et al. 2023

J Kermanshah Univ Med Sci

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Background: Infections caused by carbapenem-resistant gram-negative bacteria are treated with colonistin as a last resort. However, the increased resistance in recent years is significant for treating multiple drug-resistant infections. Objectives: This study aimed to determine the resistance genes mobile colistin resistance (mcr)-1 and mcr-2 in the colistin-resistant isolates, understand the resistance mechanism, and help with treatment. Methods: Isolates were identified in the Vitek MS automated system. The antibiotic susceptibility was tested with the Vitek 2 Compact automated system. Enteric gram-negative bacilli isolates were stored at -20°C until the molecular study. DNA extraction of colistin-resistant isolates was performed by boiling method. Then, polymerase chain reaction (PCR) optimization was performed using the specific primers, and mcr-1 and mcr-2 genes were investigated by the multiplex PCR method. Results: About 170 enteric gram-negative bacilli isolate were mainly sent from internal medicine (44.7%) and neurology (13.5%) services. According to the species identification, 37.6% of the isolates were Klebsiella pneumonia, and 31.7% were Serratia marcescens. Based on PCR results, mcr-1 and mcr-2 genes were not detected in the isolates. Conclusions: Increased colistin resistance and the worrying discovery of mcr genes require urgent precautions, even though the study did not detect mcr-1 and mcr-2. New studies investigating mcr genes in new isolates are needed to understand the mechanism of resistance and identify resistant isolates.

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“…This might explain its high prevalence (13.7%) in this study, considering the endemicity of ESBL-producing Enterobacterales in our region. Carbapenem resistance has emerged in this clonal complex and has been described in isolates producing the OXA-48-type with or without NDM carbapenemases in Tanzania, South Korea, the United Arab Emirates, and Turkey ( 19 , 39 – 42 ). While some of the earliest cases of ST14 carbapenemase producers (observed in 2001) were reported to have been isolated from patients with travel history to Bangladesh, where OXA-181-producing Enterobacterales are endemic ( 43 ), it is likely that circulating CG14 strains that have established a successful foothold in the local setting have also acquired different carbapenemases (including KPC, IMP, OXA-48, and and NDM) over multiple independent events, as exemplified by the large pairwise SNP differences observed with the ST14 isolates.…”

Section: Discussionmentioning

confidence: 99%

Genomic Surveillance of Carbapenem-Resistant Klebsiella pneumoniae from a Major Public Health Hospital in Singapore

et al. 2022

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In this study, we characterized carbapenem-resistant Klebsiella pneumoniae clinical isolates collected over a 12-year period in the largest public acute-care hospital in Singapore using whole-genome sequencing. The results of this study demonstrate significant genomic diversity with the presence of well-known epidemic, multidrug-resistant clones amid a diverse pool of nonepidemic lineages.

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Carbapenem and Colistin Resistant Klebsiella Pneumoniae ST14 and ST2096 Dominated in Two Hospitals in Turkey

Cited by 9 publications

References 0 publications

The Dissemination of Multidrug-Resistant and HypervirulentKlebsiella pneumoniaeClones Across the Kingdom of Saudi Arabia

The Dissemination of Multidrug-Resistant and HypervirulentKlebsiella pneumoniaeClones Across the Kingdom of Saudi Arabia

Evaluation of Plasmid Mediated Colistin Resistance in Colistin Resistant Gram-negative Bacilli

Genomic Surveillance of Carbapenem-Resistant Klebsiella pneumoniae from a Major Public Health Hospital in Singapore

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