Emergence of blaNDM-1 among Klebsiella pneumoniae ST15 and novel ST1031 clinical isolates in China

Hu, Longhua; Zhong, Qiaoshi; Tu, Jinjing; Xu, Yuanyuan; Qin, Zhiqiang; Parsons, Chris; Zhang, Bailing; Hu, Xiaoyan; Wang, Liangxing; Yu, Fangyou; Pan, Jingye

doi:10.1016/j.diagmicrobio.2013.01.006

Cited by 45 publications

(32 citation statements)

References 28 publications

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“…[10][11][12][13] but the gene has been noted in Enterobacteriaceae in the country, albeit with a relatively low prevalence thus far [27]. We recently reported that two unrelated K. pneumoniae isolates harboured bla NDM-1 [14,28] and it was unexpected to find such a high prevalence (17·6%) of this gene in CRE in this study. The nine isolates expressing bla NDM-1 included five K. pneumoniae, two K. ozaenae, one K. oxytoca and one Es.…”

Section: Resultsmentioning

confidence: 66%

The prevalence of carbapenemase genes and plasmid-mediated quinolone resistance determinants in carbapenem-resistant Enterobacteriaceae from five teaching hospitals in central China

Zhong

Shang

et al. 2013

Epidemiol. Infect.

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We investigated the prevalence of β-lactamase genes and plasmid-mediated quinolone resistance (PMQR) determinants in 51 carbapenem-resistant Enterobacteriaceae (CRE) from five teaching hospitals in central China. The prevalence of carbapenem resistance in Enterobacteriaceae was 1·0% (51/5012). Of 51 CRE, 31 (60·8%) isolates were positive for one tested carbapenemase gene, while 10 (19·6%) were simultaneously positive for two tested carbapenemase genes. The positive rates of bla KPC-2, bla NDM-1, bla IMP-4, bla IMP-26 and bla IMP-8 were 54·9%, 17·6%, 11·8%, 11·8% and 3·9%, respectively. Of 10 CRE with two carbapenemase genes, three, five, one and one were positive for bla KPC-2 and bla IMP-4, bla KPC-2 and bla IMP-26, bla KPC-2 and bla IMP-8, and bla KPC-2 and bla NDM-1, respectively. Eight of nine bla NDM-1-positive isolates lacked carbapenemases by the modified Hodge test, while 27/28 isolates harbouring bla KPC-2 were positive for carbapenemases determined by this test; 41·2% of the CRE-positive isolates also harboured ESBL genes in various combinations (three and two positive for bla KPC-2 also carried bla DHA-1 and bla CMY-2). The positive rates of qnrS1, qnrA1, qnrB and aac-(6/)-Ib-cr in CRE were 25·5%, 9·8%, 23·5% and 15·7%, respectively. In particular, 7/9 isolates harbouring bla NDM-1 were positive for these quinolone resistance genes, of which five carried qnrS1 and two carried qnrS1 and qnrB4. All but two of 29 Klebsiella pneumoniae isolates were grouped into 20 clonal clusters by PFGE, with the predominant cluster accounting for four bla KPC-2-positive isolates distributed in the same hospital. We conclude that there is a high prevalence of bla NDM-1 and PMQR determinants in CRE isolates in central China. Multiple resistance determinants in various combinations co-exist in these strains and we report for the first time the co-existence of bla KPC-2 and bla IMP-26 in a strain of Klebsiella oxytoca.

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Section: Resultsmentioning

confidence: 66%

The prevalence of carbapenemase genes and plasmid-mediated quinolone resistance determinants in carbapenem-resistant Enterobacteriaceae from five teaching hospitals in central China

Zhong

Shang

et al. 2013

Epidemiol. Infect.

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“…The sporadic emergence of NDM-1-producing E. coli and K. pneumoniae in mainland China has been reported in two recent studies (12,13). Additionally, several cases of NDM-1-producing CRE reported from Hong Kong and Taiwan were also epidemiologically linked to mainland China (40)(41)(42).…”

Section: Resultsmentioning

confidence: 94%

“…Carbapenem resistance in Enterobacteriaceae in China has been mainly associated with Klebsiella pneumoniae carbapenemases (KPCs), such as KPC-2, and MBLs (such as IMP-4) other than NDM-1 (10,11). NDM-1-mediated carbapenem resistance in Enterobacteriaceae in China has been rarely reported; so far there have been only two confirmed cases of NDM-1-producing K. pneumoniae and E. coli infections in China (12,13). A recent study detected a high infection rate (14.8%) of NDM-1-producing bacteria in clinical fecal samples from multiple hospitals in China, but none of the NDM-1-carrying bacteria belonged to Enterobacteriaceae (14).…”

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confidence: 99%

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

Qin

Zhang

et al. 2014

Antimicrob Agents Chemother

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The emergence and spread of New Delhi metallo-␤-lactamase 1 (NDM-1)-producing carbapenem-resistant Enterobacteriaceae (CRE) present an urgent threat to human health. In China, the bla NDM-1 gene has been reported mostly in Acinetobacter spp. but is rarely found in Enterobacteriaceae. Here, we report a high incidence and endemic spread of NDM-1-producing CRE in Henan Province in China. Sixteen (33.3%) of the 48 CRE isolates obtained from patients during June 2011 to July 2012 were positive for bla NDM-1 , and the gene was found to be carried on plasmids of various sizes (ϳ55 to ϳ360 kb). These plasmids were readily transferrable to recipient Escherichia coli by conjugation, conferred resistance to multiple antibiotics, and belonged to multiple replicon types. The bla NDM-1 -positive CRE isolates were genetically diverse, and six new multilocus sequence typing (MLST) sequence types were linked to the carriage of NDM-1. Five of the isolates were classified as extensively drug-resistant (XDR) isolates, four of which also carried the fosA3 gene conferring resistance to fosfomycin, an alternative drug for treating infections by CRE. In each bla NDM-1 -positive CRE isolate, the bla NDM-1 gene was downstream of an intact ISAba125 element and upstream of the ble MBL gene. Furthermore, gene environment analysis suggested the possible transmission of bla NDM-1 -containing sequences from Acinetobacter spp. to Klebsiella pneumoniae and Klebsiella oxytoca. These findings reveal the emergence and active transmission of NDM-1-positive CRE in China and underscore the need for heightened measures to control their further spread.

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“…The seven wzi-2 isolates differed by a single nucleotide from eight isolates of serotype K24 and the reference strain of this serotype, which were identical (allele wzi-24). The K24 isolates belong to ST15, a widely distributed multiresistant clone of K. pneumoniae (9,10,24). Therefore, wzi sequencing might help in the identification of the international clone ST15 of serotype K24.…”

Section: Resultsmentioning

confidence: 99%

“…Pulsed-field gel electrophoresis (PFGE), multilocus sequence typing (MLST), and capsular polysaccharide characterization (K typing) are widely used to characterize K. pneumoniae clinical isolates (4)(5)(6)(7). MLST has been widely adopted as the common language for the characterization of K. pneumoniae and the recognition of important emerging sequence types (STs), such as ST23, which is associated with liver abscesses (8), and ST15, which is associated with multidrug resistance worldwide (9,10). K typing was pioneered in 1926 (11), was further developed up until the 1970s (12), and still is a widely used characterization method.…”

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confidence: 99%

wzi Gene Sequencing, a Rapid Method for Determination of Capsular Type for Klebsiella Strains

et al. 2013

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f Pathogens of the genus Klebsiella have been classified into distinct capsular (K) types for nearly a century. K typing of Klebsiella species still has important applications in epidemiology and clinical microbiology, but the serological method has strong practical limitations. Our objective was to evaluate the sequencing of wzi, a gene conserved in all capsular types of Klebsiella pneumoniae that codes for an outer membrane protein involved in capsule attachment to the cell surface, as a simple and rapid method for the prediction of K type. The sequencing of a 447-nucleotide region of wzi distinguished the K-type reference strains with only nine exceptions. A reference wzi sequence database was created by the inclusion of multiple strains representing K types associated with high virulence and multidrug resistance. A collection of 119 prospective clinical isolates of K. pneumoniae were then analyzed in parallel by wzi sequencing and classical K typing. Whereas K typing achieved typeability for 81% and discrimination for 94.4% of the isolates, these figures were 98.1% and 98.3%, respectively, for wzi sequencing. The prediction of K type once the wzi allele was known was 94%. wzi sequencing is a rapid and simple method for the determination of the K types of most K. pneumoniae clinical isolates.

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Emergence of blaNDM-1 among Klebsiella pneumoniae ST15 and novel ST1031 clinical isolates in China

Cited by 45 publications

References 28 publications

The prevalence of carbapenemase genes and plasmid-mediated quinolone resistance determinants in carbapenem-resistant Enterobacteriaceae from five teaching hospitals in central China

The prevalence of carbapenemase genes and plasmid-mediated quinolone resistance determinants in carbapenem-resistant Enterobacteriaceae from five teaching hospitals in central China

High Incidence and Endemic Spread of NDM-1-Positive Enterobacteriaceae in Henan Province, China

wzi Gene Sequencing, a Rapid Method for Determination of Capsular Type for Klebsiella Strains

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