Risk Factors and Molecular Mechanism of Polymyxin B Resistance in Carbapenem-Resistant Klebsiella pneumoniae Isolates from a Tertiary Hospital in Fujian, China

Xu, Xiaohong; Zhu, Rongping; Lian, Siyan; Zhang, Hui; Chen, Xin; Fan, Lingfang; Chen, Peisong; Cao, Yong

doi:10.2147/idr.s391674

Cited by 5 publications

(4 citation statements)

References 34 publications

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“…It was reported that coronary heart disease is an independent risk factor that predisposes patients to PR resistance. 28 Chronic renal failure has been shown as a risk factor in critically ill patients with PR and carbapenemase-producing Enterobacterales in a previous study, which also included other risk factors such as surgical procedures, indwelling devices (urinary catheters), and transfer between hospital wards. 16 Other risk factors associated with colistin resistance in Gram-negative bacilli include neurological disease, residence in a nursing facility prior to admission, receipt of carbapenems or an antimicrobial with anti-methicillin-resistant Staphylococcus aureus activity, and receipt of ventilatory support.…”

Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes for Isolation with Polymyxin B-Resistant Enterobacterales from 2018–2022: A Case-Control Study

Yan,

Wu,

Wang

et al. 2023

IDR

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To analyze the risk factors and clinical outcomes of patients isolated with polymyxin B-resistant (PR) Enterobacterales from various clinical specimens to prevent and control the spread of these strains. Methods: This retrospective case-control study included 72 PR Enterobacterales-positive cases and 144 polymyxin B-susceptible (PS) Enterobacterales controls from 2018 to 2022. Patients with PR Enterobacterales isolated in various clinical cultures were defined as cases. Patients with PS Enterobacterales cultures at similar anatomic sites during the same period were randomly selected as controls. Data were collected from clinical and laboratory test records. Bivariable logistic regression and Pearson's chi-square tests were used to assess risk factors. Results: PR strains were predominantly Klebsiella pneumoniae (72.2%) and Salmonella enteritidis (8.3%). Of the patients, 66.04% were admitted to an intensive care unit (ICU). Risk factors for isolation with PR strains included chronic heart disease (P = 0.012; odds ratio [OR] 1.15; 95% confidence interval [CI] 1.03-1.28), immunosuppressant use (P = 0.016; OR 1.04 [1.0-1.07), drainage tube [head] (P = 0.006; OR 1.1 [1.0-1.1]), and polymyxin B exposure (P = 0.007; OR 1. 03 [1.0-1.06]. With respect to outcomes, admission to an ICU (P = 0.003; OR 7.1 [1.9-25.4]), hypertension (P = 0.035; OR 1.4 [1.02-1.83]), and drainage tube [head] (P = 0.044; OR 1.1 [1.0-1.15]) were associated with treatment failure. Additionally, treatment failure was more frequent in patients (45.83%) than in controls (14.58%). Conclusion:The major risk factors for isolation with PR strains were chronic heart disease, exposure to immunosuppressants, use of drainage tubes, and polymyxin B exposure. The isolation of PR strains in patients was a predictor of unfavorable outcomes. These findings provide a basis for monitoring the spread of PR Enterobacterales.

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Section: Discussionmentioning

confidence: 99%

Risk Factors and Outcomes for Isolation with Polymyxin B-Resistant Enterobacterales from 2018–2022: A Case-Control Study

Yan,

Wu,

Wang

et al. 2023

IDR

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“…In addition, there are several other genes potentially associated with the virulence of KP, including kpn gene involved in capsule polysaccharide synthesis, and wcaG and wagGI genes encoding extracellular toxins. Research has suggested that genes related to iron carriers, pili, and lipopolysaccharides are located on virulence plasmids in highly virulent KP strains and serving as specific molecular markers for high-virulent strains (Russo et al 2019; Xu Shuibao et al 2017). Therefore, it can be inferred that wabG, uge, and ycf may potentially serve as high virulence genes.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance, virulence genes profiles and molecular epidemiology of carbapenem-resistantKlebsiella pneumoniaestrains from captive giant pandas (Ailuropoda melanoleuca)

Yan,

Yang,

Ayala

et al. 2024

Preprint

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This study aimed to investigate the antibiotic susceptibility, antibiotic resistance genes (ARGs), mobile genetic elements (MGEs), virulence genes, and molecular epidemiology of carbapenem-resistantKlebsiella pneumoniae(CRKP) strains isolated from giant pandas. The screening of 178 nonduplicatedKlebsiella pneumoniaestrains identified eight CRKP strains, with the most abundant ARGs observed in ampC/blaDHA, blaSHV-01, blaSHV-02, tetB-01, tetB-02, tetC-01, and tetC-02. MGE analysis revealed the presence of intI1 in all strains, while other MGEs exhibited varying detection rates. Strain 24 exhibited the highest diversity in terms of MGE species. Seven virulence genes including wabG, uge, ycf, entB, kpn, alls, and wcaG, showed positive results with different proportions across the strains. Molecular epidemiology analysis using pulsed-field gel electrophoresis (PFGE) patterns indicated a high level of genetic diversity among the CRKP strains. Multi-locus sequence typing (MLST) analysis classified the strains into different sequence types (STs). In conclusion, this study highlighted the diverse nature of CRKP strains found in giant pandas, which exhibited varying levels of antibiotic resistance along with multiple ARGs and virulence genes present. These findings emphasized the importance of monitoring and researching antibiotic resistance within wildlife populations to safeguard the health status of these endangered animals.

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“…In addition, there are several other genes potentially associated with the virulence of KP, including kpn gene involved in capsule polysaccharide synthesis, and wcaG and wagGI genes encoding extracellular toxins. Research has suggested that genes related to iron carriers, pili, and lipopolysaccharides are located on virulence plasmids in highly virulent KP strains and serving as speci c molecular markers for high-virulent strains [36,37]. Therefore, it can be inferred that wabG, uge, and ycf may potentially serve as high virulence genes.…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial resistance, virulence genes profiles and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae strains from captive giant pandas (Ailuropoda melanoleuca)

Yan,

Yang,

Ayala

et al. 2024

Preprint

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Background:Carbapenem-resistant Klebsiella pneumoniae (CRKP) increases the difficulty of clinical treatmen of giant pandas. This study aimed to investigate the antibiotic susceptibility, ARGs, MGEs, virulence genes, and molecular epidemiology of CRKP strains isolated from giant pandas. 187 nonduplicated Klebsiella pneumoniae (KP) isolates were collected from fresh feces of captive giant pandas at the Chengdu Research Base of Giant Panda Breeding. Then CRKP were isolated and identified through carbapenase Carba NP assay. Subsequently, the antimicrobial susceptibility testing and antibiotic resistance genes of CRKP isolates were studied by disk diffusion (K-B) and HT-qPCR, respectively. Then the mobile genetic elements (MGEs) and virulence gene of CRKP isolates were analyzed both by PCR. In addition, molecular epidemiology was analyzed among the CRKP strains using pulsed-field gel electrophoresis (PFGE) and Multi-locus sequence typing (MLST). Results: 8 strains of CRKP (4.5%) were isolated and identified among the 187 KP strains, and seven of eight CRKP strains both exhibited resistance to imipenem, while one strain showed resistance to meropenem, and one demonstrated multiple resistance; 8 CRKP strains carried a large amount of ARGs, among which ampC/blaDHA,blaSHV-01, blaSHV-02, tetB-01, tetB-02, tetC-01, and tetC-02 were the most abundant. MGEs analysis revealed the presence of intI1 in all strains, while the detection rates of other MGEs varied, and strain 24 exhibited the highest diversity of MGE species. Seven virulence genes, including wabG, uge, ycf, entB, kpn, alls, and wcaG, showed positive results with different proportions across the strains. In addition, PFGE patterns indicated a high level of genetic diversity among the CRKP strains. MLST analysis classified the strains into different sequence types (STs). Conclusions: This study highlighted the diversity of CRKP strains isolated from giant pandas, which exhibited varying levels of antibiotic resistance along with multiple ARGs, MGEs and virulence genes present. These findings emphasized the importance of monitoring and researching antibiotic resistance within wildlife populations to protect the health status of these endangered animals.

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Risk Factors and Molecular Mechanism of Polymyxin B Resistance in Carbapenem-Resistant Klebsiella pneumoniae Isolates from a Tertiary Hospital in Fujian, China

Cited by 5 publications

References 34 publications

Risk Factors and Outcomes for Isolation with Polymyxin B-Resistant Enterobacterales from 2018–2022: A Case-Control Study

Risk Factors and Outcomes for Isolation with Polymyxin B-Resistant Enterobacterales from 2018–2022: A Case-Control Study

Antimicrobial resistance, virulence genes profiles and molecular epidemiology of carbapenem-resistantKlebsiella pneumoniaestrains from captive giant pandas (Ailuropoda melanoleuca)

Antimicrobial resistance, virulence genes profiles and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae strains from captive giant pandas (Ailuropoda melanoleuca)

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