Colistin-resistant Klebsiella pneumoniae co-harboring KPC and MCR-1 in a Hematopoietic Stem Cell Transplantation Unit

Higashino, Hermes Ryoiti; Marchi, Ana Paula; Martins, Roberta Cristina Ruedas; Batista, Marjorie Vieira; Neto, Lauro Vieira Perdigão; Lima, Victor Augusto Camarinha de Castro; Rossi, Flávia; Guimarães, Thaís; Levin, Anna S.; Rocha, Vanderson; Costa, Sílvia Figueiredo

doi:10.1038/s41409-018-0416-x

Cited by 16 publications

(9 citation statements)

References 10 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In our cohort of patients undergoing HSCT we have found that overall survival on D +100 is lower among patients with CRK colonization or infection. In CRK infection patients, only 53.3 % received adequate empiric antibiotic treatment and ten patients had colistin-resistant CRK [6], which can account for the high mortality. However, we have also found a higher overall mortality in colonized patients, which is similar to findings from an Italian study, which also observed a lower survival at 3 months in haematologic cancer patients with CRE [10] and could suggest that critical and immunocompromised patients are more prone to CRK colonization.…”

Section: Discussionmentioning

confidence: 99%

“…It is of note that about 50 % of patients with CRK infection were not found to be previously colonized. This may be explained in part by the lower sensitivity of culture-based methods for screening for CRK colonization [6].…”

Section: Discussionmentioning

confidence: 99%

“…Multilocus Sequence Typing and was analysed by MLSTfinder tool and confirmed in the database PubMLST Pasteur (http://pubmlst.org). We used the Resfinder tool(https://cge.cbs.dtu.dk/services/ResFinder/) [6] and Virulence Factors of Pathogenic Bacteria Database (VFDB) tool [7] and manually curated using Artemis software for the study of resistance and virulence mechanisms. Complete genome sequences were deposited at the DDBJ/EMBL/GenBank.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Carbapenem-resistant Klebsiella pneumoniae colonization and infection is associated with lower overall survival in a cohort of haematopoietic stem-cell transplantation patients: mechanism of resistance and virulence by whole-genome sequencing

Higashino

Marchi

Martins

et al. 2021

Journal of Medical Microbiology

Self Cite

View full text Add to dashboard Cite

Carbapenem-resistant Klebsiella pneumoniae (CRK) infections are a growing concern in immunocompromised patients. The aim of the present study was to evaluate the impact of CRK colonization and infection in overall mortality for haematopoietic stem-cell transplant (HSCT) patients. We also aimed to investigate resistance and virulence profiles of CRK isolates and assess their epidemiological and genetic relatedness. Patients in the HSCT unit were screened for colonization with CRK with weekly rectal swab or stool cultures and placed under contact precautions. We defined CRK colonization as positive culture from a swab or stool sample grown in MacConkey agar with meropenem at 1 µg ml−1. Demographic and clinical data were retrieved from the patients’ charts and electronic records. According to resistance mechanisms and pulsed field gel electrophoresis profile, isolates were selected based on whole-genome sequencing (WGS) using MiSeq Illumina. Outcomes were defined as overall mortality (death up to D+100), and infection-related death (within 14 days of infection). We report a retrospective cohort of 569 haematopoietic stem-cell transplant patients with 105 (18.4 %) CRK colonizations and 30 (5.3 %) infections. blaKPC was the most frequent carbapenemase in our cohort with three isolates co-harbouring blaKPC and blaNDM. We found no difference in virulence profiles from the CRK isolates. There were also no significant differences in virulence profiles among colonization and infection isolates regarding genes encoding for type 1 and 3 fimbriae, siderophores, lipopolysaccharide and colibactin. In clonality analysis by PFGE and WGS, isolates were polyclonal and ST340 was the most prevalent. Overall survival at D+100 was 75.4 % in in CRK-colonized (P=0.02) and 35.7 % in infected patients and significantly lower than non-colonized patients (85.8 %; P<0.001). We found a higher overall mortality associated with colonization and infection; KPC was the main resistance mechanism for carbapenems. The polyclonal distribution of isolates and findings of CRK infection in patients not previously colonized suggest the need to reinforce antibiotic stewardship.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Carbapenem-resistant Klebsiella pneumoniae colonization and infection is associated with lower overall survival in a cohort of haematopoietic stem-cell transplantation patients: mechanism of resistance and virulence by whole-genome sequencing

Higashino

Marchi

Martins

et al. 2021

Journal of Medical Microbiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Colistin as a last-resort antibiotic that has been reintroduced today in clinical practices to treat infections caused by MDR CREs (9). Acquired resistance to colistin is mostly caused by chromosomal mutations.…”

Section: Discussionmentioning

confidence: 99%

Molecular characteristics of antibiotic resistance Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran

Sharahi

Hashemi

Ardebili

et al. 2020

Preprint

View full text Add to dashboard Cite

Background We evaluated the distribution of carbapenem and colistin resistance mechanisms of clinical E. coli and K. pneumoniae isolates from Iran. Methods Antibiotic susceptibility testing was performed by disc diffusion and microdilution method according to the Clinical and Laboratory Standards Institute (CLSI) guideline. The presence of extended spectrum β-lactamases (ESBLs) genes, carbapenemase genes, as well as fosfomycin resistance genes, and colistin resistance genes was also examined by PCR-sequencing. The ability of biofilm formation was assessed with crystal violet staining method. The expression colistin resistance genes were measured by quantitative reverse transcription-PCR (RT-qPCR) analysis to evaluate the association between gene upregulation and colistin resistance. Genotyping was performed using the multi-locus sequencing typing (MLST). Results From 2016 to 2018, a total of 165 clinical isolates of K. pneumoniae and E. coli were collected. Colistin and tigecycline were the most effective antimicrobial agents with 90.3% and 82.4% susceptibility. Notably, 16 (9.7%) isolates showed resistance to colistin. Overall, 33 (20%), 31 (18.8%), and 95 (57.6%) isolates were categorized as strong, moderate, and weak biofilm-producer, respectively. Additionally, blaTEM, blaSHV, blaCTX−M, blaNDM−1, and blaNDM−6 resistance genes were detected in 98 (59.4%), 54 (32.7%), 77 (46.7%), 3 (1.8%), and 3 (1.8%) isolates, respectively. Inactivation of mgrB gene due to nonsense mutations and insertion of IS elements was observed in 6 colistin resistant isolates. Colistin resistance was found to be linked to upregulation of pmrA-K, phoP, and phoQ genes. Three of blaNDM−1 and 3 of blaNDM−6 variants were found to be carried by IncL/M and IncF plasmid, respectively. MLST revealed that blaNDM positive isolates were clonally related and belonged to three distinct clonal complexes, including ST147, ST15 and ST3299. Conclusions The large-scale surveillance and effective infection control measures are also urgently needed to prevent the outbreak of diverse carbapenem- and colistin- resistant isolates in the future.

show abstract

“…Since the plasmid-mediated colistin resistance MCR1 gene in E. coli and K. pneumoniae isolates was firstly detected in China, MCR1 has already spread to most continents [14]. The plasmid-mediated MCR1 gene in clinical KPC2 producing E. coli and K. pneumoniae isolates resistant to colistin and carbapenems were detected in Brazil [151617]. These findings highlight that E. coli or K. pneumoniae isolates carrying both MCR1 and bla KPC2 may emergence as a serious threat to antimicrobial therapy.…”

Section: Discussionmentioning

confidence: 99%

MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea

et al. 2019

View full text Add to dashboard Cite

Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has been disseminating nationwide due to clonal spread and is taking a serious action at the national level in Korea. The mobilized colistin resistance (MCR1) gene confers plasmid-mediated resistance to colistin and is known to be capable of horizontal transfer between different strains of a bacterial species. We have experienced a fatal case of the patient who developed MCR1-possessing, ST307/Tn4401a[blaKPC2] K. pneumonia bacteremia in the community of non-capital region after being diagnosed as pancreatic cancer with multiple liver metastases and treated in the capital region. The ST307/Tn4401a[blaKPC2] K. pneumonia was the most commonly disseminated clone in Korea. Our strain is the first MCR1 and KPC2 co-producing K. pneumonia in Korea and our case is the critical example that the multi-drug resistant clone can cause inter-regional spread and the community-onset fatal infections. Fortunately, our patient was admitted to the intensive care unit on the day of visit, and the contact precaution was well maintained throughout and KPC-KP was not spread to other patients. The high risk patients for KPC-KP need to be screened actively, detected rapidly and preemptively isolated to prevent outbreak of KPC-KP. Inter-facility communications are essential and the nationwide epidemiologic data of KPC-KP should be analyzed and reported regularly to prevent spread of KPC-KP. The prompt identification of species and antimicrobial susceptibilities for successful treatment against KPC-KP should be emphasized as well.

show abstract

Colistin-resistant Klebsiella pneumoniae co-harboring KPC and MCR-1 in a Hematopoietic Stem Cell Transplantation Unit

Cited by 16 publications

References 10 publications

Carbapenem-resistant Klebsiella pneumoniae colonization and infection is associated with lower overall survival in a cohort of haematopoietic stem-cell transplantation patients: mechanism of resistance and virulence by whole-genome sequencing

Carbapenem-resistant Klebsiella pneumoniae colonization and infection is associated with lower overall survival in a cohort of haematopoietic stem-cell transplantation patients: mechanism of resistance and virulence by whole-genome sequencing

Molecular characteristics of antibiotic resistance Escherichia coli and Klebsiella pneumoniae strains isolated from hospitalized patients in Tehran, Iran

MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea

Contact Info

Product

Resources

About