Tracking short-term changes in the genetic diversity and antimicrobial resistance of OXA-232-producing Klebsiella pneumoniae ST14 in clinical settings

Abstract

a b s t r a c tObjectives: To track stepwise changes in genetic diversity and antimicrobial resistance in rapidly evolving OXA-232-producing Klebsiella pneumoniae ST14, an emerging carbapenem-resistant high-risk clone, in clinical settings. Methods: Twenty-six K. pneumoniae ST14 isolates were collected by the Korean Nationwide Surveillance of Antimicrobial Resistance system over the course of 1 year. Isolates were subjected to whole-genome sequencing and MIC determinations using 33 antibiotics from 14 classes. Results: Single-nucleotide polymorphism (SNP) typing identified 72 unique SNP sites spanning the chromosomes of the isolates, dividing them into three clusters (I, II and III). The initial isolate possessed two plasmids with 18 antibiotic-resistance genes, including bla OXA-232 , and exhibited resistance to 11 antibiotic classes. Four other plasmids containing 12 different resistance genes, including bla CTX-M-15 and strA/B, were introduced over time, providing additional resistance to aztreonam and streptomycin. Moreover, chromosomal integration of insertion sequence Ecp1-bla CTX-M-15 mediated the inactivation of mgrB responsible for colistin resistance in four isolates from cluster III. To the best of our knowledge, this is the first description of K. pneumoniae ST14 resistant to both carbapenem and colistin in South Korea. Furthermore, although some acquired genes were lost over time, the retention of 12 resistance genes and inactivation of mgrB provided resistance to 13 classes of antibiotics. Conclusions: We describe stepwise changes in OXA-232-producing K. pneumoniae ST14 in vivo over time in terms of antimicrobial resistance. Our findings contribute to our understanding of the evolution of emerging high-risk K. pneumoniae clones and provide reference data for future outbreaks. Y.-J. Kim, Clin Microbiol Infect 2020;26:78

Epidemiological Characteristics of OXA-232-Producing Carbapenem-Resistant Klebsiella pneumoniae Strains Isolated during Nosocomial Clonal Spread Associated with Environmental Colonization

“…Qin et al reported that the infection incidence of patients who had CRKP colonization in the intestinal tract and nasopharyngeal tract was almost 45.9% in the ICU at Huashan Hospital (Shanghai, China), which posed a true threat to public health because antimicrobial agents are rarely used to treat multidrug- resistant pathogens ( 21 ). Although the environment has been considered a reservoir for pathogens in the ICU and nosocomial outbreaks of OXA-232-CRKP have increased in recent years, there is limited literature reporting on the relationship and transmission of OXA-232-CRKP between the environment and patients ( 9 , 22 , 23 ). In this study, we focused on the OXA-232-CRKP that was first reported by Potron et al in 2013 and then spread throughout the world in recent years ( 12 ), whereas limited literature focuses on colonization in hospitals and patient infections.…”

Global Prevalence of Nosocomial Multidrug-Resistant Klebsiella pneumoniae: A Systematic Review and Meta-Analysis

“…Most of the ESBL-KP and CRKP have contributed to the emergence of multidrug-resistance strains, diminishing treatment options for patients [ 6 , 11 ]. Furthermore, both resistance ( bla TEM , bla SHV , bla KPC , bla OXA , qnrB1 , oqxA , dfrA12 , sul2 , fosA, and mgrB ) [ 12 ], and virulence genes (iro , kpn , fimH, mrkD , entB , traT , rmpA , fyuA , magA, and hlyA ) [ 13 ] encoded in the bacterium genome played significant factors in the emergence of MDR K . pneumoniae.…”

Co-occurrence of Carbapenemase-encoding Genes Among Klebsiella pneumoniae Clinical Isolates: Positive Relationship of bla NDM and bla SIM with Imipenem Resistance

“…Klebsiella pneumoniae ST14, resistant to both carbapenem and colistin, was previously described in South Korea (39). ST 14 was also reported in hospitals from Dubai, United Arab Emirates, which produced OXA-48-type and NDM carbapenemases (40).…”