Molecular Typing and Drug Resistance Analysis of Carbapenem-resistant Klebsiella Pneumoniae from ICU Patients in China
Characteristics of ICU Carbapenem-resistant Klebsiella Pneumoniae in China
DOI:
https://doi.org/10.31661/gmj.v13i.3302Keywords:
ICU; Carbapenem-resistant Klebsiella Pneumoniae; Molecular EpidemiologyAbstract
Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) stands out as one of the most detrimental nosocomial pathogens in Chinese hospitals. The resistance rate of CRKP to carbapenems has persistently remained elevated, particularly in intensive care unit (ICU). This study focused on the molecular epidemiological characteristics of CRKP isolated from Chinese ICU patients. Materials and Methods: Five distinct CRKP isolates were obtained from a Chinese hospital. Strain identification and drug susceptibility testing were conducted using the VITEK® 2 Compact Bacterial Identification and Monitoring System. Whole genome sequencing (WGS) technology was used to analyze sequence typing, phylogenetic relationships and drug resistance genes. Results: All five CRKP isolates carried the carbapenem-resistance gene blaKPC-2 and exhibited complete resistance to β-lactams, aminoglycosides, quinolones, and partial resistance to sulfonamides. Based on the single nucleotide polymorphism differences, we classified the five CRKP isolates into 3 distinct clusters. Multilocus sequence typing (MLST) and core genome multilocus sequence typing (cgMLST) identified the main prevalent sequence type of CRKP as ST11-CT1313. Conclusions: Utilizing WGS for sequence typing, phylogenetic analysis, and antibiotic resistance gene identification is essential in enhancing the control and containment of CRKP infections in ICU. However, it is vital to consider both resistance phenotypes and resistance genes when guiding clinical medication decisions.
References
MacKenzie FM, Forbes KJ, Dorai-John T, Amyes SG, Gould IM. Emergence of a carbapenem-resistant Klebsiella pneumoniae. Lancet. 1997;350(9080):783.
https://doi.org/10.1016/S0140-6736(05)62567-6
PMid:9298003
Liao W, Liu Y, Zhang W. Virulence evolution, molecular mechanisms of resistance and prevalence of ST11 carbapenem-resistant Klebsiella pneumoniae in China: A review over the last 10 years. J Glob Antimicrob Resist. 2020;23:174-80.
https://doi.org/10.1016/j.jgar.2020.09.004
PMid:32971292
Karampatakis T, Antachopoulos C, Iosifidis E, Tsakris A, Roilides E. Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in Greece. Future Microbiol. 2016;11:809-23.
https://doi.org/10.2217/fmb-2016-0042
PMid:27206024
Girmenia C, Serrao A, Canichella M. Epidemiology of Carbapenem Resistant Klebsiella pneumoniae Infections in Mediterranean Countries. Mediterr J Hematol Infect Dis. 2016;8(1):e2016032.
https://doi.org/10.4084/mjhid.2016.032
PMid:27441063 PMCid:PMC4943068
Goncalves Barbosa LC, Silva ESJA, Bordoni GP, Barbosa GO, Carneiro LC. Elevated Mortality Risk from CRKp Associated with Comorbidities: Systematic Review and Meta-Analysis. Antibiotics (Basel). 2022;11(7):874.
https://doi.org/10.3390/antibiotics11070874
PMid:35884128 PMCid:PMC9312274
Wu C, Zheng L, Yao J. Analysis of Risk Factors and Mortality of Patients with Carbapenem-Resistant Klebsiella pneumoniae Infection. Infect Drug Resist. 2022;15:2383-91.
https://doi.org/10.2147/IDR.S362723
PMid:35535031 PMCid:PMC9078358
Tacconelli E, Sifakis F, Harbarth S, Schrijver R, van Mourik M, Voss A et al. Surveillance for control of antimicrobial resistance. Lancet Infect Dis. 2018;18(3):e99-e106.
https://doi.org/10.1016/S1473-3099(17)30485-1
PMid:29102325
Bonomo RA, Burd EM, Conly J, Limbago BM, Poirel L, Segre JA et al. Carbapenemase-Producing Organisms: A Global Scourge. Clin Infect Dis. 2018;66(8):1290-7.
https://doi.org/10.1093/cid/cix893
PMid:29165604 PMCid:PMC5884739
Potter RF, D'Souza AW, Dantas G. The rapid spread of carbapenem-resistant Enterobacteriaceae. Drug Resist Updat. 2016;29:30-46.
https://doi.org/10.1016/j.drup.2016.09.002
PMid:27912842 PMCid:PMC5140036
Liu C, Dong N, Chan EWC, Chen S, Zhang R. Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in China, 2016-20. Lancet Infect Dis. 2022;22(2):167-8.
https://doi.org/10.1016/S1473-3099(22)00009-3
PMid:35092791
Sun QL, Gu D, Wang Q, Hu Y, Shu L, Hu J et al. Dynamic Colonization of Klebsiella pneumoniae Isolates in Gastrointestinal Tract of Intensive Care Patients. Front Microbiol. 2019;10:230.
https://doi.org/10.3389/fmicb.2019.00230
PMid:30804922 PMCid:PMC6378299
Moghadam MT, Mojtahedi A, Moghaddam MM, Fasihi-Ramandi M, Mirnejad R. Rescuing humanity by antimicrobial peptides against colistin-resistant bacteria. Appl Microbiol Biotechnol. 2022;106(11):3879-93.
https://doi.org/10.1007/s00253-022-11940-z
PMid:35604438 PMCid:PMC9125544
Shahbandeh M, Taati Moghadam M, Mirnejad R, Mirkalantari S, Mirzaei M. The Efficacy of AgNO3 Nanoparticles Alone and Conjugated with Imipenem for Combating Extensively Drug-Resistant Pseudomonas aeruginosa. Int J Nanomedicine. 2020;15:6905-16.
https://doi.org/10.2147/IJN.S260520
PMid:33061358 PMCid:PMC7518771
Tan P, Fu H, Ma X. Design, optimization, and nanotechnology of antimicrobial peptides: From exploration to applications. Nano Today. 2021;39:101229.
https://doi.org/10.1016/j.nantod.2021.101229
O'Neill J. Tackling drug-resistant infections globally. final report and recommendations: Government of the United Kingdom; 2016.
Hosseini M, Ahmed Hamad M, Mohseni G, Salamy S, Dehghan Tarzjani S, Taati Moghadam M. Prediction of tsunami of resistance to some antibiotics is not far-fetched which used during COVID-19 pandemic. J Clin Lab Anal. 2023;37(15-16):e24959.
https://doi.org/10.1002/jcla.24959
PMid:37650531 PMCid:PMC10561589
Hosseininasab SS, Gorji M, Hosseini SS, Moghadam MT. The Use of Last-Line Antibiotics for the Treatment of COVID-19 Is a Risk to Disarm Humanity Against Future Antibiotic-Resistant Infectious Diseases: Suggestions for Prevention. Infectious Diseases in Clinical Practice. 2023;31(4):1-2.
https://doi.org/10.1097/IPC.0000000000001272
Chen C, Zhang Y, Yu SL, Zhou Y, Yang SY, Jin JL et al. Tracking Carbapenem-Producing Klebsiella pneumoniae Outbreak in an Intensive Care Unit by Whole Genome Sequencing. Front Cell Infect Microbiol. 2019;9:281.
https://doi.org/10.3389/fcimb.2019.00281
PMid:31440476 PMCid:PMC6694789
Li L, Wang R, Qiao D, Zhou M, Jin P. Tracking the Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in an Emergency Intensive Care Unit by Whole Genome Sequencing. Infect Drug Resist. 2022;15:6215-24.
https://doi.org/10.2147/IDR.S386385
PMid:36324669 PMCid:PMC9621004
Xian Z, Jian X, Mei-Jing S, Wen-Hong A, Ze-Qiong C, Kai-Feng W. Molecular typing and drug resistance analysis of carbapenem-resistant Klebsiella pneumoniae from paediatric patients in China. The Journal of Infection in Developing Countries. 2022;16(11):1726-31.
https://doi.org/10.3855/jidc.17003
PMid:36449644
Wang J, Liu F, Tartari E, Huang J, Harbarth S, Pittet D et al. The Prevalence of Healthcare-Associated Infections in Mainland China: A Systematic Review and Meta-analysis. Infect Control Hosp Epidemiol. 2018;39(6):701-9.
https://doi.org/10.1017/ice.2018.60
PMid:29655388
Rochford C, Sridhar D, Woods N, Saleh Z, Hartenstein L, Ahlawat H et al. Global governance of antimicrobial resistance. Lancet. 2018;391(10134):1976-8.
https://doi.org/10.1016/S0140-6736(18)31117-6
PMid:29864011
CLSI supplement M100. Clinical and Laboratory Standards Institute; 2022.
Hu Y, Liu C, Shen Z, Zhou H, Cao J, Chen S et al. Prevalence, risk factors and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in patients from Zhejiang, China, 2008-2018. Emerg Microbes Infect. 2020;9(1):1771-9.
https://doi.org/10.1080/22221751.2020.1799721
PMid:32689907 PMCid:PMC7475806
Zhang WX, Chen HY, Chen C, Chen JH, Wan FS, Li LX et al. Resistance Phenotype and Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Isolates in Shanghai. Microb Drug Resist. 2021;27(10):1312-8.
https://doi.org/10.1089/mdr.2020.0390
PMid:34297609
Wang L, Yuan XD, Pang T, Duan SH. The Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infection: A Single-Center Chinese Retrospective Study. Infect Drug Resist. 2022;15:1477-85..
https://doi.org/10.2147/IDR.S352070
PMid:35411153 PMCid:PMC8994608
Hu FP, Guo Y, Zhu DM, Wang F, Jiang XF, Xu YC et al. CHINET surveillance of antimicrobial resistance among the bacterial isolates in 2021. Chinese Journal of Infection and Chemotherapy. 2022;22(05):521-30.
Han Y, Huang L, Liu C, Huang X, Zheng R, Lu Y et al. 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. Infect Drug Resist. 2021;14:767-73.
https://doi.org/10.2147/IDR.S298515
PMid:33688212 PMCid:PMC7937386
Zhang M, Li J, Lu Y, Wu W, Wu J, Xu Y et al. Expanding of ST11 Carbapenemase-Producing Klebsiella pneumoniae Subclones in a Chinese Hospital, Shenzhen, China. Infect Drug Resist. 2021;14:1415-22.
https://doi.org/10.2147/IDR.S299478
PMid:33880046 PMCid:PMC8053513
Jiang Y, Wei Z, Wang Y, Hua X, Feng Y, Yu Y. Tracking a hospital outbreak of KPC-producing ST11 Klebsiella pneumoniae with whole genome sequencing. Clin Microbiol Infect. 2015;21(11):1001-7.
https://doi.org/10.1016/j.cmi.2015.07.001
PMid:26166545
Zeng L, Yang C, Zhang J, Hu K, Zou J, Li J et al. An Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Chongqing, China. Front Cell Infect Microbiol. 2021;11:656070.
https://doi.org/10.3389/fcimb.2021.656070
PMid:34150672 PMCid:PMC8208809
Xiao S, Chen T, Wang H, Zeng Q, Chen Q, Yang Z et al. Drug Susceptibility and Molecular Epidemiology of Klebsiella pneumoniae Bloodstream Infection in ICU Patients in Shanghai, China. Front Med (Lausanne). 2021;8:754944.
https://doi.org/10.3389/fmed.2021.754944
PMid:34722591 PMCid:PMC8548373
Yan Z, Zhou Y, Du M, Bai Y, Liu B, Gong M et al. Prospective investigation of carbapenem-resistant Klebsiella pneumonia transmission among the staff, environment and patients in five major intensive care units, Beijing. J Hosp Infect. 2019;101(2):150-7.
https://doi.org/10.1016/j.jhin.2018.11.019
PMid:30529506
Li J, Bi W, Dong G, Zhang Y, Wu Q, Dong T et al. The new perspective of old antibiotic: In vitro antibacterial activity of TMP-SMZ against Klebsiella pneumoniae. J Microbiol Immunol Infect. 2020;53(5):757-65.
https://doi.org/10.1016/j.jmii.2018.12.013
PMid:30857922
Gandor NHM, Amr GE, Eldin Algammal SMS, Ahmed AA. Characterization of Carbapenem-Resistant K Pneumoniae Isolated from Intensive Care Units of Zagazig University Hospitals. Antibiotics (Basel). 2022;11(8):1108.
https://doi.org/10.3390/antibiotics11081108
PMid:36009977 PMCid:PMC9405146
Ellington MJ, Ekelund O, Aarestrup FM, Canton R, Doumith M, Giske C et al. The role of whole genome sequencing in antimicrobial susceptibility testing of bacteria: report from the EUCAST Subcommittee. Clin Microbiol Infect. 2017;23(1):2-22.
https://doi.org/10.1016/j.cmi.2016.11.012
PMid:27890457
Lou T, Du X, Zhang P, Shi Q, Han X, Lan P et al. Risk factors for infection and mortality caused by carbapenem-resistant Klebsiella pneumoniae: A large multicentre case-control and cohort study. J Infect. 2022;84(5):637-47.
https://doi.org/10.1016/j.jinf.2022.03.010
PMid:35301013
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