1887

Abstract

Carbapenem-resistant (CRKP) is increasingly isolated in paediatric wards, posing a severe threat to these vulnerable populations. This study investigated the clinical features, determinants of carbapenem resistance and clonal relatedness among CRKP in our hospital.

The prevalence of carbapenem-resistant in paediatric patients differs from the strains isolated from adult patients in carbapenemase and predominant clones.

To investigate the pattern of carbapenemase and the clonal relationships between carbapenem-resistant in a paediatric hospital in Jiangxi Province.

Forty-five CRKP isolates were consecutively collected from October 2016 to October 2020. Medical records were reviewed to analyse clinical features. Detection of carbapenemase genes was used to determine CRKP resistance mechanisms and clonal relatedness among CRKP was identified through multi-locus sequence typing (MLST).

Forty-three (95.6 %) patients developed CRKP infection, and two (4.4 %) were colonized by CRKP in the urinary tract. The overall mortality rate was 13.3 %. In total, 42 (93.3 %) strains were positive for carbapenemase genes, and (62.2 %) was the predominant gene. The MLST identified 24 different sequence types (STs) of CRKP, in which ST11 (=8, 17.8 %) and ST2735 (=8, 17.8 %) were the most common STs.

The pattern of CRKP in paediatric patients reflects evolving changes. The ST2735 may present as a dangerous CRKP clone circulating in paediatric patients.

Funding
This study was supported by the:
  • Jiangxi Provincial Department of Science and Technology (Award NO.20195589)
    • Principle Award Recipient: YanZhou
Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.001482
2022-01-21
2022-05-25
Loading full text...

Full text loading...

References

  1. Wyres KL, Lam MMC, Holt KE. Population genomics of Klebsiella pneumoniae . Nat Rev Microbiol 2020; 18:344–359 [View Article] [PubMed]
    [Google Scholar]
  2. Podschun R, Ullmann U. Klebsiella spp. as nosocomial pathogens: epidemiology, taxonomy, typing methods, and pathogenicity factors. Clin Microbiol Rev 1998; 11:589–603 [View Article] [PubMed]
    [Google Scholar]
  3. Bagley ST. Habitat association of Klebsiella species. Infect Control 1985; 6:52–58 [View Article] [PubMed]
    [Google Scholar]
  4. Tzouvelekis LS, Markogiannakis A, Psichogiou M, Tassios PT, Daikos GL. Carbapenemases in Klebsiella pneumoniae and other Enterobacteriaceae: an evolving crisis of global dimensions. Clin Microbiol Rev 2012; 25:682–707 [View Article] [PubMed]
    [Google Scholar]
  5. Wang G, Zhao G, Chao X, Xie L, Wang H. The characteristic of virulence, biofilm and antibiotic resistance of Klebsiella pneumoniae . Int J Environ Res Public Health 2020; 17:E6278 [View Article] [PubMed]
    [Google Scholar]
  6. Papp-Wallace KM, Endimiani A, Taracila MA, Bonomo RA. Carbapenems: past, present, and future. Antimicrob Agents Chemother 2011; 55:4943 [View Article]
    [Google Scholar]
  7. Nordmann P, Dortet L, Poirel L. Carbapenem resistance in Enterobacteriaceae: here is the storm!. Trends Mol Med 2012; 18:263–272 [View Article] [PubMed]
    [Google Scholar]
  8. De Angelis G, Del Giacomo P, Posteraro B, Sanguinetti M, Tumbarello M. Molecular mechanisms, epidemiology, and clinical importance of β-lactam resistance in Enterobacteriaceae . Int J Mol Sci 2020; 21:E5090 [View Article] [PubMed]
    [Google Scholar]
  9. Sawa T, Kooguchi K, Moriyama K. Molecular diversity of extended-spectrum β-lactamases and carbapenemases, and antimicrobial resistance. J Intensive Care 2020; 8:13 [View Article] [PubMed]
    [Google Scholar]
  10. Kang H, Zheng W, Kong Z, Jiang F, Gu B et al. Disease burden and molecular epidemiology of carbapenem-resistant Klebsiella pneumonia infection in a tertiary hospital in China. Ann Transl Med 2020; 8:605 [View Article] [PubMed]
    [Google Scholar]
  11. Cassini A, Högberg LD, Plachouras D, Quattrocchi A, Hoxha A et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: a population-level modelling analysis. Lancet Infect Dis 2019; 19:56–66 [View Article] [PubMed]
    [Google Scholar]
  12. Zhu J, Sun L, Ding B, Yang Y, Xu X et al. Outbreak of NDM-1-producing Klebsiella pneumoniae ST76 and ST37 isolates in neonates. Eur J Clin Microbiol Infect Dis 2016; 35:611–618 [View Article]
    [Google Scholar]
  13. Flannery DD, Chiotos K, Gerber JS, Puopolo KM. Neonatal multidrug-resistant gram-negative infection: epidemiology, mechanisms of resistance, and management. Pediatr Res 2021 [View Article] [PubMed]
    [Google Scholar]
  14. Folgori L, Bielicki J. Future challenges in pediatric and neonatal sepsis: emerging pathogens and antimicrobial resistance. J Pediatr Intensive Care 2019; 8:17–24 [View Article] [PubMed]
    [Google Scholar]
  15. Aguilera-Alonso D, Escosa-García L, Saavedra-Lozano J, Cercenado E, Baquero-Artigao F. Carbapenem-resistant gram-negative bacterial infections in children. Antimicrob Agents Chemother 2020; 64: [View Article]
    [Google Scholar]
  16. Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT et al. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. Lancet Infect Dis 2017; 17:153–163 [View Article] [PubMed]
    [Google Scholar]
  17. Hu F, Guo Y, Yang Y, Zheng Y, Wu S et al. Resistance reported from China antimicrobial surveillance network (CHINET) in 2018. Eur J Clin Microbiol Infect Dis 2019; 38:2275–2281 [View Article]
    [Google Scholar]
  18. Chitnis AS, Caruthers PS, Rao AK, Lamb J, Lurvey R et al. Outbreak of carbapenem-resistant Enterobacteriaceae at a long-term acute care hospital: sustained reductions in transmission through active surveillance and targeted interventions. Infect Control Hosp Epidemiol 2012; 33:984–992 [View Article] [PubMed]
    [Google Scholar]
  19. Wei Z-Q, Du X-X, Yu Y-S, Shen P, Chen Y-G et al. Plasmid-Mediated KPC-2 in a Klebsiella pneumoniae Isolate from China. Antimicrob Agents Chemother 2007; 51:763–765 [View Article]
    [Google Scholar]
  20. Zou M-X, Wu J-M, Li J, Dou Q-Y, Zhou R-R et al. NDM-1-producing Klebsiella pneumoniae in mainland China. Zhongguo Dang Dai Er Ke Za Zhi 2012; 14:616–621 [PubMed]
    [Google Scholar]
  21. Clinical and Laboratory Standards Institute (CLSI) Performance Standards for Antimicrobial Susceptibility Testing. M100-S30 Wayne, PA: CLSI; 2020
    [Google Scholar]
  22. Gupta N, Limbago BM, Patel JB, Kallen AJ. Carbapenem-resistant Enterobacteriaceae: epidemiology and prevention. Clin Infect Dis 2011; 53:60–67 [View Article] [PubMed]
    [Google Scholar]
  23. Stewardson AJ, Marimuthu K, Sengupta S, Allignol A, El-Bouseary M et al. Effect of carbapenem resistance on outcomes of bloodstream infection caused by Enterobacteriaceae in low-income and middle-income countries (PANORAMA): a multinational prospective cohort study. Lancet Infect Dis 2019; 19:601–610 [View Article] [PubMed]
    [Google Scholar]
  24. Nabarro LEB, Shankar C, Pragasam AK, Mathew G, Jeyaseelan V et al. Clinical and bacterial risk factors for mortality in children with carbapenem-resistant Enterobacteriaceae bloodstream infections in India. Pediatr Infect Dis J 2017; 36:e161–e166 [View Article] [PubMed]
    [Google Scholar]
  25. Investigators of the Delhi Neonatal Infection Study (DeNIS) collaboration Characterisation and antimicrobial resistance of sepsis pathogens in neonates born in tertiary care centres in Delhi, India: a cohort study. Lancet Glob Health 2016; 4:e752–60 [View Article] [PubMed]
    [Google Scholar]
  26. Lodise TP, Berger A, Altincatal A, Wang R, Bhagnani T et al. Antimicrobial resistance or delayed appropriate therapy-does one influence outcomes more than the other among patients with serious infections due to carbapenem-resistant versus carbapenem-susceptible enterobacteriaceae?. Open Forum Infect Dis 2019; 6:fz194 [View Article] [PubMed]
    [Google Scholar]
  27. Qiu Y, Lin D, Xu Y, Cheng Y, Wang F et al. Invasive Klebsiella pneumoniae infections in community-settings and healthcare settings. Infect Drug Resist 2021; 14:2647–2656 [View Article] [PubMed]
    [Google Scholar]
  28. Díaz A, Ortiz DC, Trujillo M, Garcés C, Jaimes F et al. Clinical characteristics of carbapenem-resistant Klebsiella pneumoniae infections in ill and colonized children in Colombia. Pediatr Infect Dis J 2016; 35:237–241 [View Article] [PubMed]
    [Google Scholar]
  29. Bhattacharyya N, Kosloske AM, Macarthur C. Nosocomial infection in pediatric surgical patients: A study of 608 infants and children. J Pediatric Surgery 1993; 28:338–344 [View Article]
    [Google Scholar]
  30. Chiotos K, Tamma PD, Flett KB, Naumann M, Karandikar MV et al. Multicenter study of the risk factors for colonization or infection with carbapenem-resistant enterobacteriaceae in Children. Antimicrob Agents Chemother 2017; 61: [View Article]
    [Google Scholar]
  31. Phichaphop C, Apiwattanakul N, Techasaensiri C, Lertudomphonwanit C, Treepongkaruna S et al. High prevalence of multidrug-resistant gram-negative bacterial infection following pediatric liver transplantation. Medicine (Baltimore) 2020; 99:e23169 [View Article] [PubMed]
    [Google Scholar]
  32. Qian T, Zhu H, Zhu L, Chen C, Shen C et al. Small intestinal microbiota composition and the prognosis of infants with ileostomy resulting from distinct primary diseases. BMC Gastroenterol 2020; 20:224 [View Article] [PubMed]
    [Google Scholar]
  33. Righi E, Peri AM, Harris PNA, Wailan AM, Liborio M et al. Global prevalence of carbapenem resistance in neutropenic patients and association with mortality and carbapenem use: systematic review and meta-analysis. J Antimicrob Chemother 2017; 72:668–677 [View Article] [PubMed]
    [Google Scholar]
  34. Satlin MJ, Jenkins SG, Walsh TJ. The global challenge of carbapenem-resistant Enterobacteriaceae in transplant recipients and patients with hematologic malignancies. Clin Infect Dis 2014; 58:1274–1283 [View Article] [PubMed]
    [Google Scholar]
  35. David S, Reuter S, Harris SR, Glasner C, Feltwell T et al. Epidemic of carbapenem-resistant Klebsiella pneumoniae in Europe is driven by nosocomial spread. Nat Microbiol 2019; 4:1919–1929 [View Article] [PubMed]
    [Google Scholar]
  36. Suay-García B, Pérez-Gracia MT. Present and Future of Carbapenem-resistant Enterobacteriaceae (CRE) Infections. Antibiotics (Basel) 2019; 8:E122 [View Article] [PubMed]
    [Google Scholar]
  37. Kong Z, Liu X, Li C, Cheng S, Xu F et al. Clinical molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae among pediatric patients in Jiangsu Province, China. Infect Drug Resist 2020; 13:4627–4635 [View Article] [PubMed]
    [Google Scholar]
  38. Luo K, Tang J, Qu Y, Yang X, Zhang L et al. Nosocomial infection by Klebsiella pneumoniae among neonates: a molecular epidemiological study. J Hosp Infect 2021; 108:174–180 [View Article] [PubMed]
    [Google Scholar]
  39. Tian D, Pan F, Wang C, Sun Y, Zhang H. Resistance phenotype and clinical molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae among pediatric patients in Shanghai. Infect Drug Resist 2018; 11:1935–1943 [View Article] [PubMed]
    [Google Scholar]
  40. Falcone M, Tiseo G, Galfo V, Giordano C, Leonildi A et al. Bloodstream infections in patients with rectal colonization by Klebsiella pneumoniae producing different type of carbapenemases: a prospective, cohort study (CHIMERA study). Clin Microbiol Infect 2021 [View Article] [PubMed]
    [Google Scholar]
  41. Wang B, Pan F, Wang C, Zhao W, Sun Y et al. Molecular epidemiology of Carbapenem-resistant Klebsiella pneumoniae in a paediatric hospital in China. Int J Infect Dis 2020; 93:311–319 [View Article] [PubMed]
    [Google Scholar]
  42. Zhang R, Liu L, Zhou H, Chan EW, Li J et al. Nationwide surveillance of clinical Carbapenem-resistant Enterobacteriaceae (CRE) strains in China. EBioMedicine 2017; 19:98–106 [View Article] [PubMed]
    [Google Scholar]
  43. Qi Y, Wei Z, Ji S, Du X, Shen P et al. ST11, the dominant clone of KPC-producing Klebsiella pneumoniae in China. J Antimicrob Chemother 2011; 66:307–312 [View Article] [PubMed]
    [Google Scholar]
  44. Yin D, Zhang L, Wang A, He L, Cao Y et al. Clinical and molecular epidemiologic characteristics of carbapenem-resistant Klebsiella pneumoniae infection/colonization among neonates in China. J Hosp Infect 2018; 100:21–28 [View Article] [PubMed]
    [Google Scholar]
  45. Wang Y, Cao W, Zhu X, Chen Z, Li L et al. Characterization of a novel Klebsiella pneumoniae sequence type 476 carrying both bla KPC-2 and bla IMP-4. Eur J Clin Microbiol Infect Dis 2012; 31:1867–1872 [View Article]
    [Google Scholar]
  46. Endimiani A, Carias LL, Hujer AM, Bethel CR, Hujer KM et al. Presence of plasmid-mediated quinolone resistance in Klebsiella pneumoniae isolates possessing bla KPC in the United States. Antimicrob Agents Chemother 2008; 52:2680–2682 [View Article]
    [Google Scholar]
  47. Al-Agamy MH, Jeannot K, El-Mahdy TS, Shibl AM, Kattan W et al. First Detection of GES-5 carbapenemase-producing Acinetobacter baumannii isolate. Microb Drug Resist 2017; 23:556–562 [View Article] [PubMed]
    [Google Scholar]
  48. Tsakris A, Pournaras S, Woodford N, Palepou MF, Babini GS et al. Outbreak of infections caused by Pseudomonas aeruginosa producing VIM-1 carbapenemase in Greece. J Clin Microbiol 2000; 38:1290–1292 [View Article] [PubMed]
    [Google Scholar]
  49. Senda K, Arakawa Y, Ichiyama S, Nakashima K, Ito H et al. PCR detection of metallo-beta-lactamase gene (blaIMP) in gram-negative rods resistant to broad-spectrum beta-lactams. J Clin Microbiol 1996; 34:2909–2913 [View Article] [PubMed]
    [Google Scholar]
  50. Yang J, Chen Y, Jia X, Luo Y, Song Q et al. Dissemination and characterization of NDM-1-producing Acinetobacter pittii in an intensive care unit in China. Clin Microbiol Infect 2012; 18:E506–13 [View Article] [PubMed]
    [Google Scholar]
  51. Poirel L, Héritier C, Tolün V, Nordmann P. Emergence of Oxacillinase-Mediated Resistance to Imipenem in Klebsiella pneumoniae. Antimicrob Agents Chemother 2004; 48:15–22 [View Article]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.001482
Loading
/content/journal/jmm/10.1099/jmm.0.001482
Loading

Data & Media loading...

Supplements

Supplementary material 1

PDF

Supplementary material 2

EXCEL
This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error