Using Whole Genome Sequencing to Trace, Control and Characterize a Hospital Infection of IMP-4-Producing Klebsiella pneumoniae ST2253 in a Neonatal Unit in a Tertiary Hospital, China

Abstract

Background: The purpose of this study is to use whole genome sequencing (WGS) combined with epidemiological data to track a hospital infection of the carbapenem-resistant Klebsiella pneumoniae (CRKP), which affected 3 neonatal patients in the neonatal intensive care unit (NICU).Methods: The minimum inhibitory concentrations for the antimicrobial agents were determined according to the guidelines of the Clinical and Laboratory Standards Institute. Beta-lactamases were investigated using the polymerase chain reaction and DNA sequencing. The transferability of the plasmid was investigated by a conjugation experiment. The clonal relationships were evaluated using multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). WGS and single nucleotide polymorphisms (SNPs) analysis were performed on the CRKP isolates to investigate how the infection might progress.Results: Nine CRKP isolates were obtained from the NICU, seven from three patients, one from a duster cloth and one from the hand of a nurse, they all harbored blaIMP-4. Other resistance genes including blaKPC-2, blaIMP-4, blaSHV-1, blaTEM-1, blaCTX-M-15, and blaDHA-1 were also detected. PFGE analysis showed that IMP-4-producing K. pneumoniae were clonally related, and MLST assigned them to a new sequence type 2253. The SNP variations throughout the genome divided the 9 strains into three clades. Clade 1 comprised 7 strains (K1- K2 and K4-K8), whereas clade 2 and 3 consisted of only one strain each: K3 and K9, respectively.The sputum isolate K3 from patient 3 was the most distinct one differing from the other eight isolates by 239-275 SNPs.Conclusions: This is a report of using WGS to track a hospital infecion of IMP-4-producing K. pneumoniae ST2253 among neonates. Nosocomial surveillance systems are needed to limit the spread of the infection caused by these pathogens resulting from the environmental exposure in NICUs.

Phenotypic and genomic characteristics of clinical IMP-producing Klebsiella spp. Isolates in China

“…And there have also been sporadic epidemics caused by IMPKsp strains. IMP-38-producing ST307 K. pneumoniae strains and IMP-4-producing ST2253 K. pneumoniae infected neonatal patients in the neonatal ward in Shandong and Hunan province, respectively 11 , 32 . This again is consistent with our findings that there was a regional spread of ST307 IMPKsp strains carrying IMP-38 carbapenemases in Hunan province.…”

Risk Factors and Predictive Nomogram for Carbapenem-Resistant Klebsiella pneumoniae in Children in a Grade 3 First-Class General Hospital in Central China

“…None of the infants exhibited infection with CP-CRE. 13 Seesahai et al have found that simple infection control measures involving contact precautions, staff education, and parental cohorting can be useful and cost-effective in preventing transmission. Attention to NICUspecific measures, including screening of at-risk mothers (in vitro fertilization conception) and their probands, careful handling of breastmilk, judicious antibiotic choice, and duration of treatment, are warranted.…”

Resistance Phenotype and Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Isolated from Nanjing Children’s Hospital in Jiangsu Province, China

“…The production of IMP and VIM enzymes by Klebsiella pneumoniae isolates is rare in China. At present, IMP-4-producing Klebsiella pneumoniae has caused outbreaks in a few hospitals in China in recent years, 18 while IMP-8-producing Klebsiella pneumoniae has only been reported in Taiwan, 19 which has not been reported in pediatric patients. Only one case of IMP-26- 20 and IMP-38- 21 producing Klebsiella pneumoniae has been reported in China.…”