1887

Abstract

The emergence of extensively drug-resistant (XDR) has become a major challenge worldwide. In this study, we characterized the phenotypes and genetic features of nine XDR isolates from an integrated hospital in Zhejiang province, China, from September to October 2014. These XDR possessed at least five resistance determinants which contribute to highly resistant to β-lactam, β-lactam/inhibitor combinations, aminoglycosides, quinolones, carbapenems, chloroamphenicol and fosfomycin. All isolates carried , , and , and several isolates also harboured and . Southern blot experiments confirmed that , and were located on the same ~54.2 kb plasmid. Conjugative plasmids were obtained from all isolates, further proving the transferable characteristic of the resistance determinants. The OmpK36 sequences showed various deletions and insertions that indicated additional amino acid residues and a deleted phenotype of OmpK36. PFGE demonstrated that all the isolates belonged to the same genotype. Multilocus sequence typing was concordant with PFGE results and revealed that ST11 was the most predominant clone. Our study revealed a high incidence and endemic spread of XDR in the hospital. Thus, effective infection control measures should be adopted to monitor and control the spread of multidrug-resistant isolates.

Keyword(s): Klebsiella pneumoniae , Outbreak , ST11 and XDR
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2016-10-18
2024-03-28
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References

  1. Andrade L. N., Curiao T., Ferreira J. C., Longo J. M., Clímaco E. C., Martinez R., Bellissimo-Rodrigues F., Basile-Filho A., Evaristo M. A. et al. 2011; Dissemination of blaKPC-2 by the spread of Klebsiella pneumoniae clonal complex 258 clones (ST258, ST11, ST437) and plasmids (IncFII, IncN, IncL/M) among Enterobacteriaceae species in Brazil. Antimicrob Agents Chemother 55:3579–3583 [View Article][PubMed]
    [Google Scholar]
  2. Bergamasco M. D., Barroso Barbosa M., de Oliveira Garcia D., Cipullo R., Moreira J. C., Baia C., Barbosa V., Abboud C. S. 2012; Infection with Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae in solid organ transplantation. Transpl Infect Dis 14:198–205 [View Article][PubMed]
    [Google Scholar]
  3. Bouza E., Eworo A., Fernández Cruz A., Reigadas E., Rodríguez-Créixems M., Muñoz P. 2013; Catheter-related bloodstream infections caused by gram-negative bacteria. J Hosp Infect 85:316–320 [View Article][PubMed]
    [Google Scholar]
  4. Cantón R., González-Alba J. M., Galán J. C. 2012; CTX-M enzymes: origin and diffusion. Front Microbiol 3:110 [View Article][PubMed]
    [Google Scholar]
  5. Cao X., Xu X., Zhang Z., Shen H., Chen J., Zhang K. 2014; Molecular characterization of clinical multidrug-resistant Klebsiella pneumoniae isolates. Ann Clin Microbiol Antimicrob 13:16 [View Article][PubMed]
    [Google Scholar]
  6. Dallenne C., Da Costa A., Decré D., Favier C., Arlet G. 2010; Development of a set of multiplex PCR assays for the detection of genes encoding important beta-lactamases in Enterobacteriaceae. J Antimicrob Chemother 65:490–495 [View Article][PubMed]
    [Google Scholar]
  7. Doi Y., Arakawa Y. 2007; 16S ribosomal RNA methylation: emerging resistance mechanism against aminoglycosides. Clin Infect Dis 45:88–94 [View Article][PubMed]
    [Google Scholar]
  8. Doménech-Sánchez A., Martínez-Martínez L., Hernández-Allés S., del Carmen Conejo M., Pascual A., Tomás J. M., Albertí S., Benedí V. J. 2003; Role of Klebsiella pneumoniae OmpK35 porin in antimicrobial resistance. Antimicrob Agents Chemother 47:3332–3335 [View Article][PubMed]
    [Google Scholar]
  9. Hernández-Allés S., Conejo M., Pascual A., Tomás J. M., Benedí V. J., Martínez-Martínez L. 2000; Relationship between outer membrane alterations and susceptibility to antimicrobial agents in isogenic strains of Klebsiella pneumoniae. J Antimicrob Chemother 46:273–277 [View Article][PubMed]
    [Google Scholar]
  10. Hou X. H., Song X. Y., Ma X. B., Zhang S. Y., Zhang J. Q. 2015; Molecular characterization of multidrug-resistant Klebsiella pneumoniae isolates. Braz J Microbiol 46:759–768 [View Article][PubMed]
    [Google Scholar]
  11. Landman D., Bratu S., Quale J. 2009; Contribution of OmpK36 to carbapenem susceptibility in KPC-producing Klebsiella pneumoniae. J Med Microbiol 58:1303–1308 [View Article][PubMed]
    [Google Scholar]
  12. Li J. J., Sheng Z. K., Deng M., Bi S., Hu F. S., Miao H. F., Ji Z. K., Sheng J. F., Li L. J. 2012; Epidemic of Klebsiella pneumoniae ST11 clone coproducing KPC-2 and 16S rRNA methylase RmtB in a Chinese university hospital. BMC Infect Dis 12:373 [View Article][PubMed]
    [Google Scholar]
  13. Magiorakos A. P., Srinivasan A., Carey R. B., Carmeli Y., Falagas M. E., Giske C. G., Harbarth S., Hindler J. F., Kahlmeter G. et al. 2012; Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 18:268–281 [View Article][PubMed]
    [Google Scholar]
  14. Monari C., Merlini L., Nardelli E., Cacioni M., Repetto A., Mencacci A., Vecchiarelli A. 2016; Carbapenem-resistant Klebsiella pneumoniae: results of a laboratory surveillance program in an Italian general hospital (August 2014–January 2015): surveillance of carbapenem-resistant Klebsiella pneumoniae. Adv Exp Med Biol 901:91–101 Epub ahead of print [View Article][PubMed]
    [Google Scholar]
  15. Mouloudi E., Massa E., Papadopoulos S., Iosifidis E., Roilides I., Theodoridou T., Piperidou M., Orphanou A., Passakiotou M. et al. 2014; Bloodstream infections caused by carbapenemase-producing Klebsiella pneumoniae among intensive care unit patients after orthotopic liver transplantation: risk factors for infection and impact of resistance on outcomes. Transplant Proc 46:3216–3218 [View Article][PubMed]
    [Google Scholar]
  16. Nelson E. C., Segal H., Elisha B. G. 2003; Outer membrane protein alterations and blaTEM-1 variants: their role in beta-lactam resistance in Klebsiella pneumoniae. J Antimicrob Chemother 52:899–903 [View Article][PubMed]
    [Google Scholar]
  17. Park K. S., Kim M. H., Park T. S., Nam Y. S., Lee H. J., Suh J. T. 2012; Prevalence of the plasmid-mediated quinolone resistance genes, aac(6')-Ib-cr, qepA, and oqxAB in clinical isolates of extended-spectrum β-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae in Korea. Ann Clin Lab Sci 42:191–197[PubMed]
    [Google Scholar]
  18. Podschun R., Ullmann U. 1998; Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 11:589–603[PubMed]
    [Google Scholar]
  19. Qi Y., Wei Z., Ji S., Du X., Shen P., Yu Y. 2011; ST11, the dominant clone of KPC-producing Klebsiella pneumoniae in China. J Antimicrob Chemother 66:307–312 [View Article][PubMed]
    [Google Scholar]
  20. Rasheed J. K., Biddle J. W., Anderson K. F., Washer L., Chenoweth C., Perrin J., Newton D. W., Patel J. B. 2008; Detection of the Klebsiella pneumoniae carbapenemase type 2 carbapenem-hydrolyzing enzyme in clinical isolates of Citrobacter freundii and K. oxytoca carrying a common plasmid. J Clin Microbiol 46:2066–2069 [View Article][PubMed]
    [Google Scholar]
  21. Samuelsen Ø., Naseer U., Tofteland S., Skutlaberg D. H., Onken A., Hjetland R., Sundsfjord A., Giske C. G. 2009; Emergence of clonally related Klebsiella pneumoniae isolates of sequence type 258 producing plasmid-mediated KPC carbapenemase in Norway and Sweden. J Antimicrob Chemother 63:654–658 [View Article][PubMed]
    [Google Scholar]
  22. Shen P., Zhang Y., Li G., Jiang X. 2016; Characterization of the genetic environment of the blaKPC-2 gene among Klebsiella pneumoniae isolates from a Chinese hospital. Braz J Infect Dis 20:384–388 [View Article][PubMed]
    [Google Scholar]
  23. Shi W., Li K., Ji Y., Jiang Q., Wang Y., Shi M., Mi Z. 2013; Carbapenem and cefoxitin resistance of Klebsiella pneumoniae strains associated with porin OmpK36 loss and DHA-1 β-lactamase production. Braz J Microbiol 44:435–442 [View Article][PubMed]
    [Google Scholar]
  24. Sun K., Chen X., Li C., Yu Z., Zhou Q., Yan Y. 2015; Clonal dissemination of multilocus sequence type 11 Klebsiella pneumoniae carbapenemase-producing K. pneumoniae in a Chinese teaching hospital. APMIS 123:123–127 [View Article][PubMed]
    [Google Scholar]
  25. Tenover F. C., Arbeit R. D., Goering R. V., Mickelsen P. A., Murray B. E., Persing D. H., Swaminathan B. 1995; Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 33:2233–2239[PubMed]
    [Google Scholar]
  26. Tsai Y. K., Fung C. P., Lin J. C., Chen J. H., Chang F. Y., Chen T. L., Siu L. K., Li C. T. 2011; Klebsiella pneumoniae outer membrane porins OmpK35 and OmpK36 play roles in both antimicrobial resistance and virulence. Antimicrob Agents Chemother 55:1485–1493 [View Article][PubMed]
    [Google Scholar]
  27. Yao B., Xiao X., Wang F., Zhou L., Zhang X., Zhang J. 2015; Clinical and molecular characteristics of multi-clone carbapenem-resistant hypervirulent (hypermucoviscous) Klebsiella pneumoniae isolates in a tertiary hospital in Beijing, China. Int J Infect Dis 37:107–112 [View Article][PubMed]
    [Google Scholar]
  28. Zhang Y., Jiang X., Wang Y., Li G., Tian Y., Liu H., Ai F., Ma Y., Wang B. et al. 2014; Contribution of β-lactamases and porin proteins OmpK35 and OmpK36 to carbapenem resistance in clinical isolates of KPC-2-producing Klebsiella pneumoniae. Antimicrob Agents Chemother 58:1214–1217 [View Article][PubMed]
    [Google Scholar]
  29. Zhou T., Zhang Y., Li M., Yu X., Sun Y., Xu J. 2015; An outbreak of infections caused by extensively drug-resistant Klebsiella pneumoniae strains during a short period of time in a Chinese teaching hospital: epidemiology study and molecular characteristics. Diagn Microbiol Infect Dis 82:240–244 [View Article][PubMed]
    [Google Scholar]
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