Molecular and phenotypic characterization of clinical isolates belonging to a KPC-2-producing strain of ST15 Klebsiella pneumoniae from a Vietnamese pediatric hospital

Abstract

Background Carbapenem-resistant Klebsiella pneumoniae are becoming increasingly common in hospital settings worldwide and are a source of increased morbidity, mortality and health care costs. The global epidemiology of carbapenem-resistant K. pneumoniae is characterized by different strains distributed geographically, with the strain ST258 being predominant in Europe and USA, and ST11 being most common in East Asia. ST15 is a less frequently occurring strain but has nevertheless been reported worldwide as a source of hospital outbreaks of carbapenem-resistant K. pneumoniae. Methods In this study, whole-genome sequencing and antimicrobial susceptibility testing was used to characterize 57 clinical isolates of carbapenem-resistant K. pneumoniae belonging to a strain of ST15, which were collected at a Vietnamese pediatric hospital from February throughout September 2015. Results Aside from the carbapenem resistance gene blaKPC-2, which was carried by all isolates, prevalence of resistance genes to other antibiotics including aminoglycosides, macrolides, quinolones, fosfomycin and trimethoprim, was also high. All isolates were multidrug-resistant. Susceptibility was highest to ceftazidime/avibactam (96%), gentamicin (91%) and tigecycline (82%). Notably, the colistin resistance rate was very high (42%). Single-nucleotide polymorphism analysis indicated that most isolates belonged to a single clone. Conclusions The diverse variety of antibiotic resistance genes and the high antibiotic resistance rates to last-resort antibiotics such as carbapenems and colistin, is indicative of a highly adaptable strain. This emphasizes the importance of implementation of infection controls measures, continued monitoring of antibiotic resistance and prudent use of antibiotics to prevent further selection of resistant strains and the emergence of pan-resistant clones.

In vitro activity of tigecycline against multidrug-resistant Enterobacteriaceae isolates from skin and soft tissue infections

“…In Africa-Middle East countries , K. pneumoniae and E. coli displayed in vitro susceptibility rates of 96.8% and 100%, respectively to tigecycline [ 14 ]. Other studies from India and outside have reported an increasing prevalence of tigecycline resistance in carbapenem-resistant/MDR K. pneumoniae clinical isolates [ [15] , [16] , [17] ]. A study on isolates from burn wound infections in an Indian tertiary care hospital, reported tigecyline resistance in 9.09% and 11.76% of E. coli and K. pneumoniae , respectively [ 16 ].…”

“…An increasing prevalence of tigecycline- and carbapenem-resistant K. pneumoniae isolates has been reported from China [ 15 ]. In Vietnam, tigecycline susceptibility was observed in only 82% of 57 carbapenem-resistant clinical isolates of K. pneumoniae , belonging to strain ST15 [ 17 ]. The various mechanisms of tigecycline resistance in Enterobacteriaceae include the tetA and OqxAB genes that encode efflux pumps; mutations in the tigecycline target site of ribosomal protein S10 encoded by the rpsJ gene and mutations in the ramR gene, which results in the overexpression of the AcrAB multi-drug pump [ 15 , 18 , 19 ].…”

A genomic epidemiology study of multidrug-resistant Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii in two intensive care units in Hanoi, Vietnam

“…Over the past decade, various studies have demonstrated the utility of WGS in characterising AMR, transmission routes, and dominant lineages (17)(18)(19). LMICs however remain relatively understudied, with few studies conducted in Vietnamese hospitals (20)(21)(22)(23).…”

Outbreak of KPC-producing Klebsiella pneumoniae ST15 strains in a Chinese tertiary hospital: resistance and virulence analyses

“…A fatal outbreak of carbapenemresistant hypervirulent K. pneumoniae ST11 strains has been reported in a Chinese hospital [17]. The convergence of bla KPC and hypervirulence genes within the same K. pneumoniae ST15 strain has also been identi ed in China and Vietnam [20,23]. Fortunately, none of the ST15 strains detected in this study were positive for hypervirulence genes, and the infection rates of the KPC-producing K. pneumoniae ST15 strains were lower (P = 0.018) than those of the corresponding ST11 strains in our hospital.…”