1887

Abstract

This study characterizes KPC-2 producing Klebsiella pneumoniae belonging to ST101. Whole genome sequencing using the Ion Torrent PGM platform with 400 bp chemistry was performed. bla KPC-2 was found on an IncFIIK plasmid associated with ISKpn6 and ISKpn7 without Tn4401. This is the first report of KPC-2 K. pneumoniae from bacteremia in India. The isolate also coded for other resistance genes such as aadA1, aadA2, armA, aac(3)-Ild, aac(6)-Ild for aminoglycoside; bla SHV-11 , bla TEM-1B , bla OXA-9, for β-lactams and aac(6)-Ild, oqxA, oqxB, qnrB1 for fluoroquinolones. It belonged to the K17 capsular type. India is endemic to New Delhi metallo-β-lactamase and OXA48-like carbapenemases and K. pneumoniae carbapenemase (KPC) is seldom reported. With high rates of carbapenem resistance, emergence of KPC in India will challenge patient management. The isolate was susceptible to colistin. The patient had a fatal outcome.

Keyword(s): bacteraemia , IncFIIK , India , K. pneumoniae , KPC-2 and ST101
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/content/journal/jmm/10.1099/jmm.0.000767
2018-05-22
2019-10-18
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References

  1. Zarkotou O, Pournaras S, Tselioti P, Dragoumanos V, Pitiriga V et al. Predictors of mortality in patients with bloodstream infections caused by KPC-producing Klebsiella pneumoniae and impact of appropriate antimicrobial treatment. Clin Microbiol Infect 2011;17:1798–1803 [CrossRef][PubMed]
    [Google Scholar]
  2. Nadkarni AS, Schliep T, Khan L, Zeana CB. Cluster of bloodstream infections caused by KPC-2 carbapenemase-producing Klebsiella pneumoniae in Manhattan. Am J Infect Control 2009;37:121–126 [CrossRef][PubMed]
    [Google Scholar]
  3. Lee CR, Lee JH, Park KS, Kim YB, Jeong BC et al. Global dissemination of carbapenemase-producing Klebsiella pneumoniae: epidemiology, genetic context, treatment options, and detection methods. Front Microbiol 2016;7:895 [CrossRef][PubMed]
    [Google Scholar]
  4. Veeraraghavan B, Shankar C, Karunasree S, Kumari S, Ravi R et al. Carbapenem resistant Klebsiella pneumoniae isolated from bloodstream infection: Indian experience. Pathog Glob Health 2017;111:240–246 [CrossRef][PubMed]
    [Google Scholar]
  5. Nagaraj S, Chandran SP, Shamanna P, Macaden R. Carbapenem resistance among Escherichia coli and Klebsiella pneumoniae in a tertiary care hospital in south India. Indian J Med Microbiol 2012;30:93 [CrossRef][PubMed]
    [Google Scholar]
  6. Chaudhary M, Payasi A. Antimicrobial susceptibility patterns and molecular characterization of Klebsiella pneumoniae clinical isolates from north Indian patients. Int J Med Med Sci 2013;46:1218–1224
    [Google Scholar]
  7. Feng J, Yin Z, Zhao Q, Zhao Y, Zhang D et al. Genomic characterization of novel IncFII-type multidrug resistant plasmids p0716-KPC and p12181-KPC from Klebsiella pneumoniae. Sci Rep 2017;7:5830 [CrossRef][PubMed]
    [Google Scholar]
  8. Naas T, Cuzon G, Villegas MV, Lartigue MF, Quinn JP et al. Genetic structures at the origin of acquisition of the β-lactamase blaKPC gene. Antimicrob Agents Chemother 2008;52:1257–1263 [CrossRef][PubMed]
    [Google Scholar]
  9. Cheruvanky A, Stoesser N, Sheppard AE, Crook DW, Hoffman PS et al. Enhanced Klebsiella pneumoniae carbapenemase expression from a novel Tn4401 deletion. Antimicrob Agents Chemother 2017;61:e00025-17 [CrossRef][PubMed]
    [Google Scholar]
  10. Kim JO, Song SA, Yoon EJ, Shin JH, Lee H et al. Outbreak of KPC-2-producing Enterobacteriaceae caused by clonal dissemination of Klebsiella pneumoniae ST307 carrying an IncX3-type plasmid harboring a truncated Tn4401a. Diagn Microbiol Infect Dis 2017;87:343–348 [CrossRef][PubMed]
    [Google Scholar]
  11. Chen L, Chavda KD, Melano RG, Jacobs MR, Koll B et al. Comparative genomic analysis of KPC-encoding pKpQIL-like plasmids and their distribution in New Jersey and New York Hospitals. Antimicrob Agents Chemother 2014;58:2871–2877 [CrossRef][PubMed]
    [Google Scholar]
  12. Cubero M, Cuervo G, Dominguez , Tubau F, Martí S et al. Carbapenem-resistant and carbapenem-susceptible isogenic isolates of Klebsiella pneumoniae ST101 causing infection in a tertiary hospital. BMC Microbiol 2015;15:177 [CrossRef][PubMed]
    [Google Scholar]
  13. Oteo J, Pérez-Vázquez M, Bautista V, Ortega A, Zamarrón P et al. The spread of KPC-producing Enterobacteriaceae in Spain: WGS analysis of the emerging high-risk clones of Klebsiella pneumoniae ST11/KPC-2, ST101/KPC-2 and ST512/KPC-3. J Antimicrob Chemother 2016;71:3392–3399 [CrossRef][PubMed]
    [Google Scholar]
  14. Koshi M. Myer’s and Koshi’s Manual of Diagnostic Procedures in Medical Microbiology and Immunology/Serology Vellore, India: Christian Medical College and Hospital; 2001
    [Google Scholar]
  15. CLSI Performance Standards for Antimicrobial Susceptibility Testing, 26th ed. CLSI supplement M100 Wayne, PA: Clinical and Laboratory Standards Institute; 2016
    [Google Scholar]
  16. The European Committee on Antimicrobial Susceptibility Testing 2016; Breakpoint tables for interpretation of MICs and zone diameters. Version 6.0. www.eucast.org
  17. Pan YJ, Lin TL, Lin YT, Su PA, Chen CT et al. Identification of capsular types in carbapenem-resistant Klebsiella pneumoniae strains by wzc sequencing and implications for capsule depolymerase treatment. Antimicrob Agents Chemother 2015;59:1038–1047 [CrossRef][PubMed]
    [Google Scholar]
  18. Dai X, Zhou D, Xiong W, Feng J, Luo W et al. The IncP-6 plasmid p10265-KPC from Pseudomonas aeruginosa carries a novel ΔISEc33-associated blaKPC-2 gene cluster. Front Microbiol 2016;7:310 [CrossRef][PubMed]
    [Google Scholar]
  19. Chen L, Mathema B, Chavda KD, Deleo FR, Bonomo RA et al. Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding. Trends Microbiol 2014;22:686–696 [CrossRef][PubMed]
    [Google Scholar]
  20. Chen L, Chavda KD, Mediavilla JR, Jacobs MR, Levi MH et al. Partial excision of blaKPC from Tn4401 in carbapenem-resistant Klebsiella pneumoniae. Antimicrob Agents Chemother 2012;56:1635–1638 [CrossRef][PubMed]
    [Google Scholar]
  21. Martinez T, Martinez I, Vazquez GJ, Aquino EE, Robledo IE. Genetic environment of the KPC gene in Acinetobacter baumannii ST2 clone from Puerto Rico and genomic insights into its drug resistance. J Med Microbiol 2016;65:784–792 [CrossRef][PubMed]
    [Google Scholar]
  22. Mezzatesta ML, Gona F, Caio C, Adembri C, dell'utri P et al. Emergence of an extensively drug-resistant ArmA- and KPC-2-producing ST101 Klebsiella pneumoniae clone in Italy. J Antimicrob Chemother 2013;68:1932–1934 [CrossRef][PubMed]
    [Google Scholar]
  23. Kumarasamy K, Kalyanasundaram A. Emergence of Klebsiella pneumoniae isolate co-producing NDM-1 with KPC-2 from India. J Antimicrob Chemother 2012;67:243–244 [CrossRef][PubMed]
    [Google Scholar]
  24. Paul D, Dhar Chanda D, Maurya AP, Mishra S, Chakravarty A et al. Co-carriage of blaKPC-2 and blaNDM-1 in clinical isolates of Pseudomonas aeruginosa associated with hospital infections from India. PLoS One 2015;10:e0145823 [CrossRef][PubMed]
    [Google Scholar]
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