Emergence and nosocomial spread of ST11 carbapenem-resistant Klebsiella pneumoniae co-producing OXA-48 and KPC-2 in a regional hospital in Taiwan

Abstract

The clonal spread of K. pneumoniae ST11 expressing OXA-48, KPC-2 and CTX-M-14 β-lactamases was the cause of an outbreak of CRKP. To the best of our knowledge, a single strain harbouring A-, B- and D-class carbapenemase genes has not previously been identified. There is a high prevalence of plasmid-encoded KPC-2- and OXA-48-producing CRKP in our hospital; most isolates were members of ST11, which may be representative of a high-risk CRKP clone disseminating in central Taiwan.

Isolation and Characterization of Novel Lytic Bacteriophages Infecting Epidemic Carbapenem-Resistant Klebsiella pneumoniae Strains

“…In China, ST11 strains accounted for >70% CRKP strains ( Liu et al, 2018 ). CRKP ST11 strains were primarily associated with the bla KPC– 2 gene in China, but other carbapenemase genes, such as bla NDM , bla OXA– 48 –like , bla VIM , and bla IMP , were frequently identified in ST11 strains elsewhere ( Chen et al, 2018 ; Liu et al, 2018 ; Wang et al, 2018 ). For example, in this study, two ST11 strains were also found to carry both bla NDM– 1 and bla KPC– 2 .…”

Epidemiology of β-Lactamase-Producing Pathogens

“…K. pneumoniae ST258 isolates containing bla KPC in the bacterial chromosome now have been reported by several different groups and may be more common than originally expected (216,217). Sequence types other than ST258 have also been reported, with major representatives including ST11, the predominant type in China and Taiwan, and ST25, ST147, and ST512 in the Americas and Europe (210,213,(217)(218)(219)(220).…”

“…In addition to K. pneumoniae, KPC-type ␤-lactamases were also found in E. aerogenes, E. coli, K. oxytoca, C. freundii, and several other species (199). Outside the United States, recent outbreaks of KPCproducing K. pneumoniae have been reported in Brazil, China, Ecuador, Germany, Greece, South Korea, Poland, Portugal, Switzerland, and Taiwan (213,(218)(219)(220)(225)(226)(227)(228)(229)(230)(231)(232). A widely publicized outbreak of KPC-producing K. pneumoniae in the United States was documented in a clinical trial unit at the National Institutes of Health, resulting in the death of 11 of 18 infected patients as a result of infection-associated causes (233).…”

Cocarriage of Distinct bla KPC-2 and bla OXA-48 Plasmids in a Single Sequence Type 11 Carbapenem-Resistant Klebsiella pneumoniae Isolate

“…The uncommon cocarriage of genes encoding different classes of carbapenemases rendered KPC160111 extremely highly resistant to carbapenems (Table 1). Not restricted in our hospital, a total of 50 K. pneumoniae isolates coharboring bla KPC-2 and bla OXA-48 were also isolated from a regional hospital located in central Taiwan (9). For the better control of the endemic spread of carbapenemase-producing K. pneumoniae, horizontal spread of bla OXA-48 plasmids among KPC-2 strains needs to be actively monitored.…”