Dissemination of Klebsiella pneumoniae ST11 isolates with carbapenem resistance in integrated and emergency intensive care units in a Chinese tertiary hospital

Feng, Yu; Hu, Longhua; Zhong, Qiaoshi; Hang, Yaping; Liu, Yanling; Hu, Xiaoyan; Ding, Hui; Chen, Yanhui; Xiu-hua, XU; Fang, Xueyao; Yu, Fangyou

doi:10.1099/jmm.0.000981

Cited by 22 publications

(15 citation statements)

References 40 publications

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“…In that case, the spread of such strains would be horizontally and vertically accelerated within hospitals. To date, the co-occurrence of blaCTX-M-65 and blaKPC-2 in our study has been previously reported in K. pneumoniae [27]. Notably, we found quite high prevalence of fosA in blaKPC-2 producing K. pneumoniae.…”

Section: Discussionsupporting

confidence: 74%

Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae collected from 17 hospitals in Nanjing district of China

Zhou

Zhang

Chen

et al. 2020

Antimicrob Resist Infect Control

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Objective In total, 97 carbapenem-resistant Enterobacteriaceae (CRE) were collected from 17 hospitals located in Nanjing, Southeast China, and analyzed for epidemiological characteristics. Methods Antimicrobial susceptibility was determined; followed by determination of the prevalence of resistance determinants, including extended-spectrum β-lactamase (ESBLs), plasmid-mediated AmpC enzyme (pAmpCs), plasmid-mediated quinolone resistance genes (PMQRs), fosfomycin resistance gene and exogenously acquired 16S rRNA methyltransferase (16S-RMTase) using PCR and DNA sequencing. The sequence types (STs) of CRE were determined by multi-locus sequence typing (MLST). The plasmid profiles were detected by PCR-based replicon typing (PBRT). Results All the CRE strains displayed high MIC50 and MIC90 for nearly all clinical available antibiotics, except for aztreonam/avibactam, minocycline, ceftazidime/avibactam, tigecycline, and colistin. KPC-2 (79.4%) and NDM (19.6%) were the main carbapenemases, CTX-M (76.3%) and SHV (60.8%) were the predominant ESBLs. In addition, oqxAB (70.1%) and qnr (63.9%) were the major PMQRs; rmtB (47.4%) was the main 16S-RMTase; fosA (76.3%) and fosA3 (37.1%) were the fosfomycin resistance gene. PBRT analysis showed presence of IncR (66.0%) and IncFII (64.9%) replicon types in the majority of the isolates, followed by IncFIB (46.4%) and IncX3 (16.5%). The IncFII and IncR replicon-types were found mainly in K. pneumoniae (68.8%), whereas the IncX3 replicons dominated in E. coli isolates (100.0%). The three dominating MLST-types ST11, ST15 and ST268 comprised 68.0% of the 77 K. pneumoniae. Seven distinct STs were identified among 8 E. coli. Conclusions The treatment for infections caused by CRE isolates is challenged by the presence of multiple resistance determinants and plasmid replicons. Our results highlighted the expansion of blaKPC-2 carrying K. pneumoniae ST11, the new emergency of single blaNDM-5 carrying K. oxytoca ST36, as well as blaIMP-4 and blaNDM-1 co-carrying E. cloacae ST418, which alert us on the urgency for antimicrobial resistant surveillance, to prevent dissemination of these highly transmissible and dangerous lineages.

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Section: Discussionsupporting

confidence: 74%

Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae collected from 17 hospitals in Nanjing district of China

Zhou

Zhang

Chen

et al. 2020

Antimicrob Resist Infect Control

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“…MLST could be used to understand the epidemiology at a large scale in local outbreak situations. In the current study, ST11 was the most predominant epidemic type among the six different ST types identified, concordant with the report that ST11 was the major sequence type in Mainland China (Fu et al, 2019; Yu et al, 2019), and different from the international hyper-epidemic lineage ST258. Previous studies have shown that the hyperepidemic clonal complex of multidrug-resistant K. pneumoniae in ST258 clone may be spreading in the north-eastern region of Hungary (Toth et al, 2010), which were different from our results.…”

Section: Discussionsupporting

confidence: 92%

Molecular Epidemiology of and Risk Factors for Extensively Drug-Resistant Klebsiella pneumoniae Infections in Southwestern China: A Retrospective Study

et al. 2019

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Background: The increasing prevalence of extensively drug-resistant Klebsiella pneumoniae (XDR-KP) poses a serious threat to clinical anti-infective treatment. This retrospective study assessed the molecular epidemiology of and risk factors for infections with XDR-KP to investigate the mechanism of drug resistance and the epidemiological characteristics.Methods: A retrospective 1:2 case-control study was conducted at Chongqing Renji Affiliated Hospital of the Chinese Academy of Sciences University from January 2015 to December 2017. A total of 69 non-repetitive XDR-KP strains were collected. Patients infected with XDR-KP comprised the case group, and 138 matched patients with non-XDR-KP infection at the same site comprised the control group. The chi-square test and logistic regression were performed to evaluate the related risk factors. Molecular typing was performed by multilocus sequence typing (MLST). Potential resistance genes were detected by polymerase chain reaction (PCR) and sequencing. Predictors of 28-day mortality in patients with XDR-KP infection were also identified in our study.Results: Only tigecycline and polymyxin B showed favorable in vitro drug sensitivity tests. These XDR-KP strains had a high prevalence rate (n = 66, 95.7%) of carbapenemase-related drug resistance genes. Among them, KPC-2 was the most frequently detected gene (n = 52, 75.4%). Particularly, all of the isolates harbored multiple drug resistance genes. Epidemiological analysis showed that fifty-eight XDR-KP isolates were resistant strains with the ST-11 genotype. Multivariate logistic regression analysis showed that ICU admission (OR: 3.28, 95% CI: 1.66–6.49, P < 0.001), tracheal cannula (OR: 3.16, 95% CI: 1.48–6.76, P = 0.003), and carbapenem exposure (OR: 3.16, 95% CI: 1.25–7.98, P = 0.015) were independent risk factors for XDR-KP infection. Solid tumors (OR: 7.22, 95% CI: 1.84–28.34, P = 0.005) and septic shock (OR: 9.46, 95% CI: 2.00–44.72, P = 0.005) were independent risk factors for 28-day mortality from XDR-KP infection.Conclusion: This study showed that XDR-KP isolates were highly resistant and exhibited clonal transmission. ST11 was the predominant epidemic type of XDR-KP producing KPC-2 in Southwestern China. Physicians should be aware of these high-risk patients with notable predictive factors for XDR-KP infection. These findings may provide some recommendation for the diagnosis and treatment of patients infected with XDR-KP strains in Southwestern China.

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“…It was highly effective against a common public health associated infectious agent i.e. K. pneumoniae 1, which causes severe infections of the urinary tract, bloodstream, and intra abdominal infections (Yu et al 2019 ). The effectiveness of C. globosum against the clinical isolates of MRSA, further endorses the relevance of the study against resistant pathogens.…”

Section: Discussionmentioning

confidence: 99%

Prospecting the antimicrobial and antibiofilm potential of Chaetomium globosum an endophytic fungus from Moringa oleifera

Kaur

Arora

2020

AMB Expr

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The current study prospects the antimicrobial potential of an endophytic fungus Chaetomium globosum which showed a wide spectrum antimicrobial activity against the tested pathogenic microorganisms. This is apparently the first report where Chaetomium globosum as an endophyte from Moringa oleifera showed antimicrobial potential and is optimized for physiochemical parameters to enhance the antimicrobial metabolites production. In the classical optimization yeast peptone dextrose medium, inoculum size of two discs, incubation period of 6 days, production temperature of 25 ºC and pH 7 was best supportive for optimal growth and antimicrobial activity whereas maltose and ammonium nitrate were the best carbon and nitrogen sources, respectively. The statistical optimization resulted in up to 1.33 fold increase in antimicrobial activity. Chloroform was found to be the best extractant. The chloroformic extract showed minimum inhibitory concentration ranging from 0.05 to 5 mg/ml and its microbicidal nature was established by viable cell count studies. The efficacy of the extract was also established in terms of post antibiotic effect which ranged from 2 to 20 h. The chloroformic extract exhibited the good antibiofilm potential and was also found to be biosafe. The clinical relevance of the study was justified as it showed good antimicrobial efficacy against some resistant clinical isolates, too.

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Dissemination of Klebsiella pneumoniae ST11 isolates with carbapenem resistance in integrated and emergency intensive care units in a Chinese tertiary hospital

Cited by 22 publications

References 40 publications

Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae collected from 17 hospitals in Nanjing district of China

Epidemiological characteristics of carbapenem-resistant Enterobacteriaceae collected from 17 hospitals in Nanjing district of China

Molecular Epidemiology of and Risk Factors for Extensively Drug-Resistant Klebsiella pneumoniae Infections in Southwestern China: A Retrospective Study

Prospecting the antimicrobial and antibiofilm potential of Chaetomium globosum an endophytic fungus from Moringa oleifera

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