Dissemination of Carbapenem-resistant Klebsiella pneumoniae clinical isolates with various combinations of Carbapenemases (KPC-2, NDM-1, NDM-4, and OXA-48) and 16S rRNA Methylases (RmtB and RmtC) in Vietnam

Tada, Tatsuya; Tsuchiya, Mitsuhiro; Shimada, Kayo; Nga, Tran Thi Thanh; Thư, Le Thi Anh; Phú, Trương Thiên; Ohmagari, Norio; Kirikae, Teruo

doi:10.1186/s12879-017-2570-y

Cited by 45 publications

(37 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Hypervirulent strains of K.pneumoniae have traditionally been susceptible to most antibiotics compared with the carbapenem resistant strains that have caused large outbreaks in the nosocomial setting [ 15 – 17 ]. However, a variety of resistance mechanisms, including proposed transmission of mobile genetic elements between “classic” and hypervirulent strains of K.pneumoniae [ 18 ], have resulted in outbreaks of carbapenem-resistant hypervirulent strains in China [ 18 , 19 ] and other parts of the world [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report)

et al. 2018

View full text Add to dashboard Cite

BackgroundHypervirulent strains of Klebsiella pneumoniae are a recognized cause of a distinct invasive syndrome that results in pyogenic liver abscesses and metastatic complications, particularly in the Asia Pacific region. Reports of hypervirulent K.pneumoniae in Europe, the Americas and Australia indicate worldwide spread. We present a case of multi-focal osteomyelitis, a rarely described complication of hypervirulent K.pneumoniae in the medical literature. The prevalence of this condition in countries outside Asia may be expected to rise with increasing travel.Case presentationA 20-year-old Chinese man residing in Australia for 2 years presented with a 2-week history of gradually worsening leg pain preceded by 2 weeks of constitutional symptoms. Imaging with computerized axial tomography (CT) and other modalities revealed bilateral tibial lesions described as lattice-like linear lucencies involving the cortices with scalloping of the outer involved cortex. Cultures of tissue from a left tibial bone biopsy were positive cultures for K.pneumoniae. Whole-genome sequencing identified the isolate as K1 serotype ST23, a well-recognized hyper virulent strain capable of causing invasive disease. An abdominal CT revealed a 27x22mm liver abscess. The patient had no other metastatic manifestations of the disease, and responded to 6 weeks of intravenous ceftriaxone followed by 3 months of oral Ciprofloxacin.ConclusionsIncreased awareness of the manifestations and subsequent management of hyper virulent strains of K.pneumoniae by clinicians is important to assist early recognition and help minimize serious sequelae. Cases with overseas links, such as previous residence in the Asia Pacific area, are at higher risk for infection with the hyper virulent strain. This case highlights the need for clinicians to be able to recognize this important disease, especially in patients with the right epidemiological links, and to investigate and treat appropriately to prevent severe metastatic complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report)

et al. 2018

View full text Add to dashboard Cite

show abstract

“…Available data suggest a heterogenous landscape in terms of drug resistance; for example, CP strains are rare in SE Asia (< 1-4% [5,8,9]) but common in S Asia (28-70% [10,11]) and the prevalence of extendedspectrum beta-lactamase (ESBL, confers resistance to the third-generation cephalosporins) producing organisms varies from 12 to 79% in these regions [4-6, 8, 10]. Studies investigating ESBL and CP variants in S/SE Asia implicate CTX-M-15 as the most common ESBL type [12,13], while NDM and OXA-48-like enzymes are the most commonly described carbapenemases [11,[14][15][16]. However, there is currently only limited information about the underlying population structure of these organisms in terms of multilocus sequence types (STs), or genomically defined phylogenetic lineages.…”

Section: Introductionmentioning

confidence: 99%

“…It is clear from these reports that several well-known globally distributed CP/ESBL-associated STs are present in S/SE Asia, e.g. STs 14,15,17,29,101,147 and 231, a proposition that is further supported by studies exploring K. pneumoniae isolates from a broader range of clinical specimen types [12,13,15,26,27]. However, there remains a clear lack of systematic studies with which to fully understand the CP, ESBL and broader population genotypes of K. pneumoniae causing BSI in these regions.…”

Section: Introductionmentioning

confidence: 99%

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

et al. 2020

View full text Add to dashboard Cite

Background: Klebsiella pneumoniae is a leading cause of bloodstream infection (BSI). Strains producing extendedspectrum beta-lactamases (ESBLs) or carbapenemases are considered global priority pathogens for which new treatment and prevention strategies are urgently required, due to severely limited therapeutic options. South and Southeast Asia are major hubs for antimicrobial-resistant (AMR) K. pneumoniae and also for the characteristically antimicrobial-sensitive, community-acquired "hypervirulent" strains. The emergence of hypervirulent AMR strains and lack of data on exopolysaccharide diversity pose a challenge for K. pneumoniae BSI control strategies worldwide. Methods: We conducted a retrospective genomic epidemiology study of 365 BSI K. pneumoniae from seven major healthcare facilities across South and Southeast Asia, extracting clinically relevant information (AMR, virulence, K and O antigen loci) using Kleborate, a K. pneumoniae-specific genomic typing tool. Results: K. pneumoniae BSI isolates were highly diverse, comprising 120 multi-locus sequence types (STs) and 63 Kloci. ESBL and carbapenemase gene frequencies were 47% and 17%, respectively. The aerobactin synthesis locus (iuc), associated with hypervirulence, was detected in 28% of isolates. Importantly, 7% of isolates harboured iuc plus ESBL and/or carbapenemase genes. The latter represent genotypic AMR-virulence convergence, which is generally considered a rare phenomenon but was particularly common among South Asian BSI (17%). Of greatest concern, we identified seven novel plasmids carrying both iuc and AMR genes, raising the prospect of co-transfer of these phenotypes among K. pneumoniae.Conclusions: K. pneumoniae BSI in South and Southeast Asia are caused by different STs from those predominating in other regions, and with higher frequency of acquired virulence determinants. K. pneumoniae carrying both iuc and AMR genes were also detected at higher rates than have been reported elsewhere. The study demonstrates how genomics-based surveillance-reporting full molecular profiles including STs, AMR, virulence and serotype locus information-can help standardise comparisons between sites and identify regional differences in pathogen populations.

show abstract

“…Production of carbapenemases has been so far the main mechanism for carbapenem resistance in Enterobacterales (5), and New Delhi metallo-β-lactamase (NDM) is the major carbapenem resistance gene in E. coli all over the world (6). It is worthy to note that the co-occurrence of multiple ß-lactamases among single bacteria species (7), especially carbapenemase, such as co-production of NDM-1 and Klebsiella pneumoniae carbapenemase 2 (KPC-2)(8), co-occurrence of KPC-2 and OXA-48, have so far been frequently described in multiple clinical Enterobacterales, such as K. pneumoniae, Enterobacter cloacae, Citrobacter freundi (8)(9)(10), indicating that the production of carbapenemase has become an urgent public health threat.…”

Section: Introductionmentioning

confidence: 99%

Genomic characterization of carbapenem resistant Escherichia coli from multiple hospitals in Nanjing, China: focusing on frequent co-occurrence of blaNDM and blaKPC-2

Cao¹,

Zheng²,

Li³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The increasing emergence of carbapenem resistant Escherichia coli (CREC) poses a potential threat to public health, hence genomic characterization of isolates is needed for a better understanding of its transmission and implementation of infection control measures. Materials and methods Eleven CREC isolates were collected in 2015 from 6 hospitals in Nanjing, China, and analyzed using whole genome sequencing. Resistance determinants, virulence elements, multi-locus sequence type (MLST), serotypes, phylogeny and fimH types were determined. Results All of the CREC carried at least one carbapenemase. NDM-5 (n = 9) was the most frequent carbapenemase, followed by KPC-2 (n = 3) and NDM-1 (n = 2); three isolates produced NDM-5 and KPC-2. Ten out of the 11 isolates co-carried blaCTX-M variants. MLST analysis found 7 distinct STs, including ST410 (n = 2), ST3489 (n = 1), ST156 (n = 1), ST683 (n = 1), ST297 (n = 1), ST167 (n = 1), and ST361 (n = 1). Six distinct serotypes and 8 Fim types were identified. A great diversity of plasmid profiles was observed with plasmid replicon IncX3 being the most frequent (n = 11). Phylogenetic analysis showed great diversity between the 11 CREC isolates and also between 6 additional isolates co-carrying blaNDM and blaKPC which were selected from the strains collection of Nanjing Drum Tower Hospital for comparison. Conjugation assays demonstrated that blaNDM was transferable. Conclusion NDM is the major carbapenemase among CREC, with NDM-5 being the main variant which can be horizontally disseminated by IncX3 plasmids. These isolates displayed genetic diversity by MLST, Fim typing and serotyping. We herein provided the first report on emergence of NDM-5 producing E. coli ST297, ST683, ST3489, and NDM-1 producing E. coli ST361.

show abstract

Dissemination of Carbapenem-resistant Klebsiella pneumoniae clinical isolates with various combinations of Carbapenemases (KPC-2, NDM-1, NDM-4, and OXA-48) and 16S rRNA Methylases (RmtB and RmtC) in Vietnam

Cited by 45 publications

References 21 publications

Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report)

Bilateral osteomyelitis and liver abscess caused by hypervirulent Klebsiella pneumoniae- a rare clinical manifestation (case report)

Genomic surveillance for hypervirulence and multi-drug resistance in invasive Klebsiella pneumoniae from South and Southeast Asia

Genomic characterization of carbapenem resistant Escherichia coli from multiple hospitals in Nanjing, China: focusing on frequent co-occurrence of blaNDM and blaKPC-2

Contact Info

Product

Resources

About