Nosocomial spread of OXA-232-producing Klebsiella pneumoniae ST15 in a teaching hospital, Shanghai, China

Li, Xin; Ma, Wei; Qin, Qin; Liu, Shanrong; Ye, Liyan; Yang, Jiyong; Li, Boan

doi:10.1186/s12866-019-1609-1

Cited by 34 publications

(43 citation statements)

References 33 publications

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“…All ST15 strains were susceptible to amikacin in our study, while the resistant rates to amikacin were 100% reported in Vietnam 11 and Shanghai, China. 16 The diversity of plasmid types acquired by ST15 clones in the different study locations, such as bla KPC-2 -bearing IncQ1 plasmid in Brazil, 17 bla KPC-2 -bearing IncFII plasmid in Bulgaria, 10 bla KPC-3 -bearing IncF plasmid in Portugal 12 and bla OXA-232 -bearing ColKP3 plasmid in China, 16 suggests this clone has a high capacity for horizontal acquisition of resistance.…”

Section: Discussionmentioning

confidence: 99%

“…8 It is associated with high-level resistance to β-lactam antibiotics due to the production of extendedspectrum β-lactamases (ESBLs), mainly CTX-M-15, 9 and a diversity of carbapenemases such as KPC-2, KPC-3, NDM-1, OXA-48 and OXA-232. [10][11][12][13][14][15][16] K. pneumoniae ST15 strains in different regions are variable in terms of antimicrobial resistance patterns and resistance genes, which is likely related to the differences in plasmid types carrying antimicrobial resistance genes. 17 Here, we report a clustering of K. pneumoniae ST15 isolates in the cardiac surgery intensive care unit (CSICU), and investigate its molecular characteristics and drug resistance mechanisms, which can provide a basis for the control and prevention of nosocomial infections.…”

Section: Introductionmentioning

confidence: 99%

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Characterization of Carbapenem-Resistant Klebsiella pneumoniae ST15 Clone Coproducing KPC-2, CTX-M-15 and SHV-28 Spread in an Intensive Care Unit of a Tertiary Hospital

Yan

Huang

Liu

et al. 2021

IDR

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Objective Nosocomial infection caused by carbapenem-resistant Klebsiella pneumoniae (CRKP) is a great threat to severely ill patients. Here we report an outbreak of K. pneumoniae ST15 isolates co-producing KPC-2, CTX-M-15, and SHV-28 in the cardiac surgery intensive care unit (CSICU) of a tertiary hospital. Materials and Methods From November 2019 to August 2020, all non-duplicated CRKP isolates were collected from the CSICU. The VITEK-2 compact system was used for bacterial identification and antimicrobial susceptibility testing. Clinical data were retrieved from electronic case records. All strains were also subjected to antibiotic resistance genes detection. Clonal relationships were analyzed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). Results A total of 28 non-duplicated CRKP isolates were collected, including 23 strains belonging to ST15 and 5 strains belonging to ST11. All ST15 isolates were susceptible to amikacin, tigecycline, polymyxin B and ceftazidime/avibactam, but resistant to carbapenems, cephalosporins, quinolones, tobramycin and gentamicin. The detection of resistant determinants showed that 21 strains of ST15 CRKP co-harboured bla KPC-2 , bla CTX-M-15 , bla SHV-28 , bla TEM-1 , bla OXA-1 and aac(6ʹ)-Ib-cr . All the 28 CRKP isolates were classified into five PFGE patterns (A, B, C, D and E), of which type A and B belonged to ST15 and type C, D and E belonged to ST11. PFGE type A was the predominant clonotype of this nosocomial infection and belonged to ST15. Conclusion K. pneumoniae ST15 co-producing KPC-2, CTX-M-15, SHV-28, TEM-1, OXA-1 and aac(6ʹ)-Ib-cr is the predominant clone spread in the CSICU. Surveillance and comprehensive infection control measures should be strengthened in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Characterization of Carbapenem-Resistant Klebsiella pneumoniae ST15 Clone Coproducing KPC-2, CTX-M-15 and SHV-28 Spread in an Intensive Care Unit of a Tertiary Hospital

Yan

Huang

Liu

et al. 2021

IDR

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“…For sequence comparison of pOXA-484 to plasmids encoding related OXA-48-like variants, we conducted whole genome (Qin et al, 2018;Li et al, 2019).…”

Section: Sequence Analysis Of Poxa-484mentioning

confidence: 99%

“…The gene encoding OXA-48, bla OXA – 48 , is mostly present on an epidemic 63.6 kb IncL plasmid and bracketed by two identical insertion sequences (IS), IS 1999 , forming the composite transposon Tn 1999 ( Poirel et al, 2012 ). In contrast, bla OXA – 181 is primarily found on a 51.5 kb IncX3 plasmid and has been associated with IS Ecp1 in a Tn 2013 transposon structure, whereas bla OXA – 232 is commonly located on a non-conjugative 6.1 kb ColE-type plasmid ( Qin et al, 2018 ; Li et al, 2019 ). In case of bla OXA – 244 , the gene is mostly identified on the chromosome of E. coli and has been increasingly identified in the European Union in recent years ( European Centre for Disease Prevention and Control, 2020 ; Kremer et al, 2020 ; Chudejova et al, 2021 ).…”

Section: Introductionmentioning

confidence: 99%

OXA-484, an OXA-48-Type Carbapenem-Hydrolyzing Class D β-Lactamase From Escherichia coli

Sommer

Krause

et al. 2021

Front. Microbiol.

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OXA-48-like carbapenemases are among the most frequent carbapenemases in Gram-negative Enterobacterales worldwide with the highest prevalence in the Middle East, North Africa and Europe. Here, we investigated the so far uncharacterized carbapenemase OXA-484 from a clinical E. coli isolate belonging to the high-risk clone ST410 regarding antibiotic resistance pattern, horizontal gene transfer (HGT) and genetic support. OXA-484 differs by the amino acid substitution 214G compared to the most closely related variants OXA-181 (214R) and OXA-232 (214S). The blaOXA–484 was carried on a self-transmissible 51.5 kb IncX3 plasmid (pOXA-484) showing high sequence similarity with plasmids harboring blaOXA–181. Intraspecies and intergenus HGT of pOXA-484 to different recipients occurred at low frequencies of 1.4 × 10–7 to 2.1 × 10–6. OXA-484 increased MICs of temocillin and carbapenems similar to OXA-232 and OXA-244, but lower compared with OXA-48 and OXA-181. Hence, OXA-484 combines properties of OXA-181-like plasmid support and transferability as well as β-lactamase activity of OXA-232.

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“…Clonal spread of the K. pneumoniae ST11 strain is one of the major causes mediating bla KPC dissemination in China [3,4]. Although the K. pneumoniae ST15 strain is occasionally isolated, nosocomial spread of OXA-232-producing ST15 strains has been reported in a teaching hospital in China [21]. However, little is known about the KPC-producing K. pneumoniae ST15 strain in China, and it has never been identi ed before 2018 in our hospital [3,8].…”

Section: Discussionmentioning

confidence: 96%

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

Huang

Chen

Zhao

et al. 2020

Preprint

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Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a major cause of clinical infection. However, KPC-producing K. pneumoniae ST15 strains are occasionally identified and have never been reported to cause hospital outbreaks in China. Methods In this study, pulsed-field gel electrophoresis (PFGE) and whole-genome sequencing (WGS) were used to characterize 32 KPC-producing K. pneumoniae ST15 strains, which were collected at a Chinese tertiary hospital. Susceptibilities, resistance genes, virulence factors and clinical performances of the ST15 strains were comparatively analysed with corresponding ST11 strains. Results The ST15 strains were distributed in 7 wards, mainly in the intensive care unit (ICU, 24/32, 75%). PFGE results from 24 strains covering all the wards presented a similarity of more than 92%, indicating clonal spread. In 84% of the ST15 strains, the imipenem (IPM) and meropenem (MEM) minimum inhibitory concentrations (MICs) were ≤ 8 and ≤ 16 µg/mL, respectively, both of which were 4-fold lower than those of the ST11 strains. The infection rates of the ST15 and ST11 strains were 28.1% and 43.9%, respectively (P = 0.018). PCR evaluation and WGS indicated that all the CRKP strains shared a 100% identical blaKPC−2 genetic structure, though a synonymous mutation and a Gly115-Asp116 (GD) insertion in the OmpK36 were identified in the ST15 and ST11 strains, respectively. None of the ST15 strains were positive for hypervirulence factors; however, the positive rate was 92.7% (38/41) in the ST11 isolates. Conclusion To the best of our knowledge, this is the first description of nosocomial outbreaks caused by KPC-producing K. pneumoniae ST15 strains in China. The ST15 strains had low carbapenem resistance and virulence, emphasizing the importance of careful evaluation of phenotypic and genetic characteristics for anti-infection therapy.

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Nosocomial spread of OXA-232-producing Klebsiella pneumoniae ST15 in a teaching hospital, Shanghai, China

Cited by 34 publications

References 33 publications

Characterization of Carbapenem-Resistant Klebsiella pneumoniae ST15 Clone Coproducing KPC-2, CTX-M-15 and SHV-28 Spread in an Intensive Care Unit of a Tertiary Hospital

Characterization of Carbapenem-Resistant Klebsiella pneumoniae ST15 Clone Coproducing KPC-2, CTX-M-15 and SHV-28 Spread in an Intensive Care Unit of a Tertiary Hospital

OXA-484, an OXA-48-Type Carbapenem-Hydrolyzing Class D β-Lactamase From Escherichia coli

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

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