Dissemination of NDM-producingKlebsiella pneumoniaeandEscherichia colihigh-risk clones in Catalan healthcare institutions

Abstract

Objectives To characterize the clonal spread of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli isolates between different healthcare institutions in Catalonia, Spain. Methods Antimicrobial susceptibility was tested by disc diffusion. MICs were determined by gradient diffusion or broth microdilution. Carbapenemase production was confirmed by lateral flow. PCR and Sanger sequencing were used to identify the allelic variants of resistance genes. Clonality studies were performed by PFGE and MLST. Plasmid typing, conjugation assays, S1-PFGE plus Southern blotting and MinION Oxford Nanopore sequencing were used to characterize resistance plasmids. Results Twenty-nine carbapenem-resistant isolates recovered from three healthcare institutions between January and November 2016 were included: 14 K. pneumoniae isolates from a tertiary hospital in the south of Catalonia (hospital A); 2 K. pneumoniae isolates from a nearby healthcare centre; and 12 K. pneumoniae isolates and 1 E. coli isolate from a tertiary hospital in Barcelona (hospital B). The majority of isolates were resistant to all antimicrobial agents, except colistin, and all were NDM producers. PFGE identified a major K. pneumoniae clone (n = 27) belonging to ST147 and co-producing NDM-1 and CTX-M-15, with a few isolates also harbouring blaOXA-48. Two sporadic isolates of K. pneumoniae ST307 and E. coli ST167 producing NDM-7 were also identified. blaNDM-1 was carried in two related IncR plasmid populations and blaNDM-7 in a conjugative 50 kb IncX3 plasmid. Conclusions We report the inter-hospital dissemination of XDR high-risk clones of K. pneumoniae and E. coli associated with the carriage of small, transferable plasmids harbouring blaNDM genes.

Bloodstream infections in patients with rectal colonization by Klebsiella pneumoniae producing different type of carbapenemases: a prospective, cohort study (CHIMERA study)

“…ST147 consists of multiple clades/clusters associated with various carbapenemases (i.e., KPCs, NDMs, OXA-48-like, and VIMs) and has been responsible for several nosocomial outbreaks, including endoscopy-associated transmission and long-term care center outbreaks and is endemic in India, Italy, Greece, and certain North African countries [28]. Recently, a single ST147 clone carrying both bla NDM-1 and bla CTX-M-15 in the same transferable IncR plasmid is emerging in the Spanish healthcare system in Catalonia and is responsible for rapid dissemination and hospital outbreaks [29]. Studies addressing the prevalence of ST147 among Kp isolates are relatively rare.…”

Genomic Epidemiology Insights on NDM-Producing Pathogens Revealed the Pivotal Role of Plasmids on bla NDM Transmission

“…This phenomenon is similar to previous domestic reports ( 21 , 22 ). ST167 NDM-producing E. coli strains are not only widely disseminated in China ( 11 , 23 ); they also cause infections worldwide ( 6 , 24 , 25 ), which has gained much attention. Consistent with this study, the bla NDM-5 gene is mainly carried by E. coli of ST167 ( 26 , 27 ), suggesting that ST167 E. coli is an important repository of bla NDM-5 .…”

Clonal Spread and Intra- and Inter-Species Plasmid Dissemination Associated With Klebsiella pneumoniae Carbapenemase-Producing Enterobacterales During a Hospital Outbreak in Barcelona, Spain

“…Clonality was studied by pulsed-field gel electrophoresis (PFGE) using Xba I (New England BioLabs Inc., United States) genomic digestions and a CHEFF-DRIII system (Bio-Rad, Spain) ( Marí-Almirall et al, 2021 ). Molecular patterns were analyzed with InfoQuest TM FP-v.5.4 (Bio-Rad, Spain) and the unweighted pair group method with arithmetic mean (UPGMA) to create dendrograms based on Dice’s similarity coefficient.…”

“…In Spain, OXA-48 is currently the predominant mechanism associated with the dissemination of carbapenem-resistant Enterobacterales ( Grundmann et al, 2017 ). NDM-producing bacteria are reported less frequently in Spain but their presence is increasing and associated with a few clonal lineages ( Marí-Almirall et al, 2021 ) while KPC-producing Enterobacterales are also sporadic in Spain, and only a few outbreaks have been reported in Madrid and Andalusia ( Oteo et al, 2016 ).…”