Emergence of Klebsiella pneumoniae isolate co-producing NDM-1 with KPC-2 from India

Karthikeyan, Kaliaperumal; Kalyanasundaram, Aravindan

doi:10.1093/jac/dkr431

Cited by 72 publications

(49 citation statements)

References 13 publications

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“…To the best of our knowledge, our study is the first report on Multiplex PCR for detection of bla NDM-1 , bla VIM , bla IMP and bla KPC genes among E. coli, K. pneumoniae, P. aeruginosa & A. baumannii and second report for the combined detection of bla NDM-1 and bla KPC genes from India [21].…”

Section: Discussionmentioning

confidence: 86%

Comparative Evaluation of Multiplex P CR and Routine Laboratory Phenotypic Methods for Detection of Carbapenemases among Gram Negative Bacilli

Solanki

Vanjari

Subramanian

et al. 2014

JCDR

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Section: Discussionmentioning

confidence: 86%

Comparative Evaluation of Multiplex P CR and Routine Laboratory Phenotypic Methods for Detection of Carbapenemases among Gram Negative Bacilli

Solanki

Vanjari

Subramanian

et al. 2014

JCDR

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“…in China [11][12][13]. We reported the first NDM-1 isolate of K. pneumoniae from the Chinese mainland [14] and recently, the expression of multiple carbapenemases such as KPC-2 with IMP-4 in K. pneumoniae has been reported [7,[15][16][17][18] as well as with carbapenemases in other Enterobacteriaceae and Acinetobacter spp. [7,[15][16][17].…”

Section: Introductionmentioning

confidence: 96%

“…We reported the first NDM-1 isolate of K. pneumoniae from the Chinese mainland [14] and recently, the expression of multiple carbapenemases such as KPC-2 with IMP-4 in K. pneumoniae has been reported [7,[15][16][17][18] as well as with carbapenemases in other Enterobacteriaceae and Acinetobacter spp. [7,[15][16][17]. Indeed, carbapenemase genes are able to co-exist with several other resistance genes including ESBL, plasmid-mediated AmpC, plasmid-mediated quinolone resistance (PMQR), and plasmid-mediated aminoglycoside resistance determinants which implies acquisition of MDR by carbapenem-resistant Enterobacteriaceae (CRE) in hospital and community settings [19,20].…”

Section: Introductionmentioning

confidence: 97%

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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“…It is alarming that CRE isolates coproducing multiple carbapenemases recently emerged and pose significant challenges to our limited treatment strategies, as these bacteria tend to be extremely highly resistant (3)(4)(5)(6)(7)(8)(9)(10). To date, the coexistence of Klebsiella pneumoniae carbapenemase 2 (KPC-2) and New Delhi metallo-␤-lactamase-1 (NDM-1) in single clinical isolates from different species, including K. pneumoniae, Enterobacter cloacae, Enterobacter hormaechei, and Citrobacter freundii, has been reported in Brazil, India, Pakistan, and China (3-6, 8, 9).…”

mentioning

confidence: 99%

Genomic Characterization of Enterobacter cloacae Isolates from China That Coproduce KPC-3 and NDM-1 Carbapenemases

Chen

Chavda

et al. 2016

Antimicrob Agents Chemother

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c Here, we report two Enterobacter cloacae sequence type 231 isolates coproducing KPC-3 and NDM-1 that have caused lethal infections in a tertiary hospital in China. The bla NDM-1 -harboring plasmids carry IncA/C 2 and IncR replicons, showing a mosaic plasmid structure, and the bla NDM-1 is harbored on a novel class I integron-like element. bla KPC-3 is located on a Tn3-⌬bla TEM-1 -bla KPC-3 -⌬Tn1722 element, flanked by two 9-bp direct-repeat sequences and harbored on an IncX6 plasmid. Carbapenemase-producing Enterobacteriaceae (CRE) strains have spread worldwide and have become a significant public health threat (1, 2). It is alarming that CRE isolates coproducing multiple carbapenemases recently emerged and pose significant challenges to our limited treatment strategies, as these bacteria tend to be extremely highly resistant (3-10). To date, the coexistence of Klebsiella pneumoniae carbapenemase 2 (KPC-2) and New Delhi metallo-␤-lactamase-1 (NDM-1) in single clinical isolates from different species, including K. pneumoniae, Enterobacter cloacae, Enterobacter hormaechei, and Citrobacter freundii, has been reported in Brazil, India, Pakistan,8,9). However, knowledge regarding the genetic content and plasmid structure of these multicarbapenemase-producing bacteria remains limited (3,6). In this study, we used next-generation sequencing to characterize the genomes of two KPC-3-and NDM-1-coproducing E. cloacae strains and their plasmids. Our analysis revealed distinct plasmid structures that, to our knowledge, have not been described previously.Two carbapenem-resistant E. cloacae strains (SZECL1 and SZECL2) were identified in a retrospective study on CRE at a tertiary-care hospital in China. They were isolated from sputum samples from two female patients (63 and 57 years old) admitted to the same intensive care unit in 2012. The two isolates were collected 11 days apart. The patients died 13 and 18 days after the isolation of the organisms as a result of severe pulmonary infections. Antimicrobial susceptibility testing showed that the two isolates, SZECL1 and SZECL2, had the same resistance profile (Table 1). They were resistant to all ␤-lactams and inhibitors, including imipenem, meropenem, ertapenem, and ceftazidime-avibactam, and were resistant to amikacin, gentamicin, tobramycin, ciprofloxacin, levofloxacin, moxifloxacin, and trimethoprim-sulfamethoxazole but remained susceptible to tetracycline, tigecycline, and colistin.Genotyping results showed that SZECL1 carries bla KPC-3 , bla NDM-1 , and bla , while SZECL2 harbors the same ␤-lactamase genes (bla , bla NDM-1 , and bla ) as SZECL1, with an additional bla CTX-M-15 gene (11,12). Multilocus sequence typing indicated that the two isolates were of the same sequence type, ST231 (13), and they displayed indistinguishable patterns in pulsed-field gel electrophoresis analysis, suggesting that these two isolates are closely related and may have evolved from the same ancestor.The bla KPC-3 -harboring plasmids in SZECL1 and SZECL2 were successfully transferred to...

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Emergence of Klebsiella pneumoniae isolate co-producing NDM-1 with KPC-2 from India

Cited by 72 publications

References 13 publications

Comparative Evaluation of Multiplex P CR and Routine Laboratory Phenotypic Methods for Detection of Carbapenemases among Gram Negative Bacilli

Comparative Evaluation of Multiplex P CR and Routine Laboratory Phenotypic Methods for Detection of Carbapenemases among Gram Negative Bacilli

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

Genomic Characterization of Enterobacter cloacae Isolates from China That Coproduce KPC-3 and NDM-1 Carbapenemases

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