MCR1 and KPC2 Co-producing Klebsiella pneumoniae Bacteremia: First Case in Korea

Abstract

Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has been disseminating nationwide due to clonal spread and is taking a serious action at the national level in Korea. The mobilized colistin resistance (MCR1) gene confers plasmid-mediated resistance to colistin and is known to be capable of horizontal transfer between different strains of a bacterial species. We have experienced a fatal case of the patient who developed MCR1-possessing, ST307/Tn4401a[blaKPC2] K. pneumonia bacteremia in the community of non-capital region after being diagnosed as pancreatic cancer with multiple liver metastases and treated in the capital region. The ST307/Tn4401a[blaKPC2] K. pneumonia was the most commonly disseminated clone in Korea. Our strain is the first MCR1 and KPC2 co-producing K. pneumonia in Korea and our case is the critical example that the multi-drug resistant clone can cause inter-regional spread and the community-onset fatal infections. Fortunately, our patient was admitted to the intensive care unit on the day of visit, and the contact precaution was well maintained throughout and KPC-KP was not spread to other patients. The high risk patients for KPC-KP need to be screened actively, detected rapidly and preemptively isolated to prevent outbreak of KPC-KP. Inter-facility communications are essential and the nationwide epidemiologic data of KPC-KP should be analyzed and reported regularly to prevent spread of KPC-KP. The prompt identification of species and antimicrobial susceptibilities for successful treatment against KPC-KP should be emphasized as well.

Molecular Mechanism of Polymyxin Resistance in Multidrug-Resistant Klebsiella pneumoniae and Escherichia coli Isolates from Henan Province, China: A Multicenter Study

“…Two carbapenemase genes, bla KPC and bla NDM , are responsible for the phenotypic resistance of 90% of carbapenem-resistant Enterobacteriaceae strains in China. 26 The co-existence of mcr and carbapenemase genes, such as bla NDM-5 , 27 bla NDM-4 , 28 bla KPC , 29 and bla OXA , 30 has been sporadically reported in different countries. In the national monitoring data from China, one report showed that the mcr-1 was detected in 4.6% (13/282) of carbapenem-resistant E. coli isolates and coexisted with New Delhi metallo-enzyme (NDM)-5 in one strain.…”

Emergence of mobilized colistin resistance-1 in multidrug-resistant Klebsiella pneumoniae and Escherichia coli isolates from the Henan province in China: a multicentre study

“…Two carbapenemase genes, bla KPC and bla NDM , are responsible for the phenotypic resistance of 90% of carbapenem-resistant Enterobacteriaceae strains in China [18]. The co-existence of mcr and carbapenemase genes, such as bla NDM-5 [19], bla NDM-4 [20], bla KPC [21], and bla OXA [22], has been sporadically reported in different countries. In the national monitoring data from China, one report showed that the mcr-1 gene was detected in 4.6% (13/282) of carbapenem-resistant E. coli isolates and coexisted with the New Delhi metallo-enzyme (NDM)-5 in one strain [23].…”

A Review on Colistin Resistance: An Antibiotic of Last Resort

“…This plasmid was also seen to be maintained in K. pneumoniaea and P. aeruginosa, showing the possible inter-specific transmission of the plasmid [15]. After this first characterization study, several studies were published from 61 countries across 6 continents showing the pandemic spread of mcr-1 gene-mediated colistin resistance and its similar genetic variants in members belonging to the Enterobacteriaceae family, having a diverse origin [70,81,88,[101][102][103][104]. One study showed the mcr-1 gene as being present in a virulent pathogen, namely Vibrio parahaemolyticus, belonging to a non-Enterobacteriaceae family isolated from the shrimp sample that was collected from Hong Kong [105].…”