Whole-genome sequence analysis of carbapenem-resistant Enterobacteriaceae recovered from hospitalized patients.
Journal of global antimicrobial resistance
OBJECTIVES:Carbapenems are among the few effective antibiotics against multidrug-resistant Enterobacteriaceae. This study aimed at characterizing the plasmid content and resistome of clinical carbapenem-resistant Enterobacteriaceae (CRE) recovered from 2016 to 2019 from hospitalized patients in Lebanon. METHODS:Plasmid typing and whole-genome sequencing were used to study the genomic characteristics of 65 clinical CREs including 27 Escherichia coli, 24 Klebsiella pneumoniae, one Klebsiella quasipneumoniae, three Morganella morganii, three Citrobacter freundii, five Enterobacter hormaechei, and two Serratia marcescens. RESULTS:bla (33.8%; n = 22) and bla-like genes were among the detected resistance determinants, with two isolates co-harbouring bla. Various bla variants, bla (16.9%; n = 11), bla (9.2%; n = 6), bla (9.2%; n = 6), and bla (4.6%; n = 3), different ESBLs, and AmpC β-lactamases were detected. Carbapenem resistance determinants were linked to a variety of incompatibility groups with IncFIB(K) (43.1%; n = 28) being the most prevalent, followed by IncFIA (40.0%), IncL (35.4%), IncX3 (32.3%), IncI1 (32.3%), and IncFIIK (29.2%). CONCLUSIONS:We analysed the clonality and resistance determinants of 65 multidrug-resistant (MDR) Enterobacteriaceae recovered in the period from 2016 to 2019 from a large tertiary hospital in Lebanon. NDM variants, OXA-48, and OXA-181 were the most prevalent detected carbapenemases and were mostly linked to the dissemination of IncL, IncX3, and IncF. This study reinforces the need to track the spread and dominance of clinically relevant carbapenemase-encoding plasmids in healthcare settings.
10.1016/j.jgar.2023.07.004
Resistance Phenotype and Molecular Epidemiology of Carbapenem-Resistant Isolated from Nanjing Children's Hospital in Jiangsu Province, China.
Infection and drug resistance
Objective:The drug resistance phenotype and molecular epidemiological characteristics of carbapenem-resistant (CRKP) were identified among children in Jiangsu Province, China. Methods:CRKP strains were collected from the Children's Hospital of Nanjing Medical University from December 2020 to March 2022. CRKP strains were characterized for further study: antimicrobial susceptibility testing, carbapenem resistance genes and homology analysis. Results:Among 86 strains of CRKP, 85 carried carbapenemase genes; the dominant gene was (88.2%, 75/85), followed by (4.7%, 4/85), (4.7%, 4/85), (2.3%, 2/85), and (1.2%, 1/85). Among the 86 strains of CRKP, one isolate contained both the and genes, which is the first time that has been shown to jointly carry these genes in China. Another CRKP strain did not carry any carbapenemase gene. MLST analysis identified a total of 10 different sequence types, among which sequence type (ST) 11 was the most common. PFGE analysis identified 75 -producing CRKP ST11 strains, of which 68 were dominant clusters distributed among 11 different wards, mainly the neonatal medical centre (18 strains), neonatal surgery (17 strains) and cardiac care unit (CCU) (8 strains) wards. Conclusion:Clonal dissemination of KPC-2-producing CRKP ST11 was observed in multiple departments. Additionally, non-ST11 strains showed high polymorphism based on molecular typing, indicating increasing diversity in CRKP strains. To our knowledge, this is the first report of NDM-5 and OXA-181-coproducing causing infection in children in China, which poses a significant health risk for paediatric patients. Active surveillance and effective control measures are urgently needed to prevent further transmission of these strains among children.
10.2147/IDR.S377068
OXA-48 and NDM-1 Klebsiella pneumoniae of Sequence Type 101 from blood in a patient with travel history abroad, Italy.
Nucleo Elisabetta,Marchetti Vittoria Mattioni,Mercato Alessandra,Quatela Michela,Villa Laura,Migliavacca Roberta
The new microbiologica
Klebsiella pneumoniae (KP) is an important pathogen involved in serious nosocomial infections all over the world. Here, we describe the first report on a blood-stream infection caused by an OXA-48/NDM-1 ST101-KP, in Italy. The patient was an Italian woman, transferred from Cairo Hospital to a Neurosurgery ward in Cuneo (IT). The detection described here enhances the need for an effective National infection control strategy in Italy.
Epidemiology of resistance of carbapenemase-producing Klebsiella pneumoniae to ceftazidime-avibactam in a Chinese hospital.
Journal of applied microbiology
AIMS:Klebsiella pneumoniae has been reported to develop increased antibiotic resistance. Ceftazidime-avibactam (CZA) is a novel antibiotic with activity against serine-lactamase. Here, we investigated the sensitivity of carbapenem-resistant K. pneumoniae (CRKP) to CZA and the mechanisms of drug resistance in our hospital. METHODS AND RESULTS:Patient characteristics were obtained from medical records. K. pneumoniae and its antibiotic susceptibility were determined using the Vitek-2 Compact instrument. The antibiotic resistance genes KPC, NDM, OXA-48, VIM, IMP, CIM, SPM, TMB, SMB, SIM, AIM and DIM were detected using real-time PCR. Multilocus sequence typing was used for genetic RELATEDNESS analysis. In total, 121 CRKP strains were isolated from patients in the intensive care unit (51·2%), senior ward (12·4%) and neurosurgery department (10%). With an average age of 72·5 years, most patients were in care for respiratory (34·7%), brain (20·7%), digestive tract (13·2%) and cardiovascular (8·3%) diseases. Specimens were predominantly obtained from sputum (39·67%), urine (29·75%) and blood (6·61%). CONCLUSION:Of 23 CZA-resistant CRKP strains (19·01%), ST11 being the most common at 56·52%, 11 NDM-1-positive (47·83%) and four NDM-5-positive (17·39%) strains were detected. SIGNIFICANCE AND IMPACT OF THE STUDY:Our study indicates that CZA resistance occurs in ~19·01% CRKP strains and that bla and bla might be critical for resistance.
10.1111/jam.15166
Isolation and genome characterization of a Klebsiella pneumoniae clinical strain carrying blaNDM-5 and blaOXA-48 isolated in Italy.
The new microbiologica
Carbapenemase-producing Enterobacteriales (CPE) represent an emerging threat for global public health and a serious problem for clinicians due to the limited available treatment options. The emergence of CPE has been recently described worldwide by describing different antimicrobial mechanisms. Here, we describe a CPE carrying dual-carbapenemase isolated in Italy and we provide a deep characterization of the antimicrobial resistance genes, virulence-factors and prophage regions within the genome.
OXA-181-Like Carbapenemases in Klebsiella pneumoniae ST14, ST15, ST23, ST48, and ST231 from Septicemic Neonates: Coexistence with NDM-5, Resistome, Transmissibility, and Genome Diversity.
Naha Sharmi,Sands Kirsty,Mukherjee Subhankar,Saha Bijan,Dutta Shanta,Basu Sulagna
mSphere
Studies on the epidemiology and genomes of isolates harboring OXA-48-like genes in septicemic neonates are rare. Here, isolates producing these carbapenemases which emerged and persisted in an Indian neonatal unit were characterized in terms of their resistome, transmissibility, and genome diversity. Antibiotic susceptibility and whole-genome sequencing were carried out. The sequence types, resistome, virulome, mobile genetic elements, and transmissibility of carbapenem-resistant plasmids were evaluated. Core genome analysis of isolates was shown in a global context with other OXA-48-like carbapenemase-harboring genomes, including those from neonatal studies. Eleven OXA-48-like carbapenemase-producing ( , = 7 and , = 4) isolates belonging to diverse sequence types (ST14, ST15, ST23, ST48, and ST231) were identified. and were found in a high-risk clone, ST14 ( = 4). were in small, nonconjugative ColKP3 plasmids located on truncated Tn, whereas was in self-transmissible, conjugative IncFII plasmids, within truncated Tn Conjugal transfer of was observed in the presence of The study strains were diverse among themselves and showed various levels of relatedness with non-neonatal strains from different parts of the world and similarity with neonatal strains from Tanzania and Ghana when compared with a representative collection of carbapenemase-positive strains. We found that -harboring isolates from a single neonatal unit had remarkably diverse genomes, ruling out clonal spread and emphasizing the extent of plasmid spreading across different STs. This study is probably the first to report the coexistence of and in neonatal isolates. Neonatal sepsis is a leading cause of neonatal mortality in low- and middle-income countries (LMICs). Treatment of sepsis in this vulnerable population is dependent on antimicrobials, and resistance to these life-saving antimicrobials is worrisome. Carbapenemases, enzymes produced by bacteria, can make these antimicrobials useless. Our study describes how OXA-48-like carbapenemases in neonatal septicemic shows remarkable diversity in the genomes of the strains and relatedness with strains from other parts of world and also to some neonatal outbreak strains. It is also the first to describe such resistance due to coproduction of dual carbapenemases, (OXA)-48 and New Delhi metallo-β-lactamase-5, in from neonatal settings. Carbapenemase genes situated on plasmids within high-risk international clones, as seen here, increase the ease and transfer of resistant genetic material. With the WHO treatment protocols not adequately poised to handle such infections, prompt attention to neonatal health care is required.
10.1128/mSphere.01156-20
An outbreak of double carbapenemase-producing Klebsiella pneumoniae, harbouring NDM-5 and OXA-48 genes, at a tertiary hospital in Canberra, Australia.
Communicable diseases intelligence (2018)
Abstract:In July 2023, a carbapenemase-producing (CPKP) with New Delhi metallo-beta-lactamase (NDM-5) and oxacillinase (OXA-48) carbapenemase genes was detected in the urine sample of a patient. A similar CPKP organism had previously been isolated from a surveillance rectal swab of an admitted patient, prompting an outbreak investigation. A confirmed case was defined as any suspected case in which a species of Enterobacterales was isolated from a clinical or surveillance specimen (infection or colonisation) exhibiting an NDM-5 or OXA-48 CPE gene or both, irrespective of phenotypic susceptibility. A descriptive epidemiological investigation was conducted to describe the investigation, infection prevention and control responses, and public health intervention carried out. Three confirmed cases of CPKP were identified, including the index case; 62 contacts were identified, of which 13 contacts were screened. CPKP transmission occurred between two patients on contact transmission-based precautions in separate single ensuite rooms. Despite being in the same ward, the patients did not share medical teams but shared nursing teams and ancillary staff. This study emphasises the importance of strict adherence to infection prevention and control practices and contact transmission-based precautions for patients admitted with carbapenemase-producing Enterobacterales.
10.33321/cdi.2024.48.50