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Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan, China.

Abstract

BACKGROUND

In the past decade, the carbapenemase-producing Enterobacteriaceae (CPE) have been reported worldwide. Emergence of carbapenemase-producing strains among Enterobacteriaceae has been a challenge for treatment of clinical infection. The present study was undertaken to investigate the characteristics of carbapenem-resistant Klebsiella pneumoniae recovered from an outbreak that affected 17 neonatal patients in neonatal intensive care unit (NICU) of Kunming City Maternal and Child health Hospital, which is located in the Kunming city in far southwest of China.

METHODS

Minimum inhibitory concentrations (MICs) for antimicrobial agents were determined according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI); Modified Hodge test and Carba-NP test were preformed to identified the phenotypes of carbapenemases producing; To determine whether carbapenem resistance was transferable, a conjugation experiment was carried out in mixed broth cultures; Resistant genes were detected by using PCR and sequencing; Plasmids were typed by PCR-based replicon typing method; Clone relationships were analyzed by using multilocus-sequence typing (MLST) and pulsed field gel electrophoresis (PFGE).

RESULTS

Eighteen highly carbapenem-resistant Klebsiella pneumoniae were isolated from patients in NICU and one carbapenem-resistant K. pneumoniae isolate was detected in incubator water. All these isolates harbored bla NDM-1. Moreover, other resistance genes, viz., bla IMP-4 , bla SHV-1 , bla TEM-1 , bla CTX-M-15 , qnrS1, qnrB4, and aacA4 were detected. The bla NDM-1 gene was located on a ca. 50 kb IncFI type plasmid. PFGE analysis showed that NDM-1-producing K. pneumoniae were clonally related and MLST assigned them to sequence type 105.

CONCLUSIONS

NDM-1 producing strains present in the hospital environment pose a potential risk and the incubator water may act as a diffusion reservoir of NDM-1- producing bacteria. Nosocomial surveillance system should play a more important role in the infection control to limit the spread of these pathogens.

Authors+Show Affiliations

Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. god_ruirui@aliyun.com. Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. god_ruirui@aliyun.com. Department of Clinical Laboratory, First People's Hospital of Yunnan province, Kunming, Yunnan, China. god_ruirui@aliyun.com.Department of Clinical Laboratory, Kunming City Maternal and Child health Hospital, Kunming, Yunnan, China. zhangqian@163.com.Yunnan Center for Disease Control and Prevention, Kunming, Yunnan, China. Guoyd1979@163.com.Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. fengyue1981@163.com. Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. fengyue1981@163.com.Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. Lli1969@hotmail.com. Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. Lli1969@hotmail.com.Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. zam1980@yeah.net. Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. zam1980@yeah.net.Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. zy19860908@yeah.net. Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. zy19860908@yeah.net.Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. Yangxiaoyu@163.com. Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. Yangxiaoyu@163.com.Faculty of Environmental Science and Engineering, Kunming University of Science and Technology, Kunming, Yunnan, China. oliverxia2000@aliyun.com. Faculty of Life Science and Technology, Kunming University of Science and Technology, No. 727 Jing Ming Road, Chenggong District, Kunming, Yunnan, China. oliverxia2000@aliyun.com.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26896089

Citation

Zheng, Rui, et al. "Outbreak of Plasmid-mediated NDM-1-producing Klebsiella Pneumoniae ST105 Among Neonatal Patients in Yunnan, China." Annals of Clinical Microbiology and Antimicrobials, vol. 15, 2016, p. 10.
Zheng R, Zhang Q, Guo Y, et al. Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan, China. Ann Clin Microbiol Antimicrob. 2016;15:10.
Zheng, R., Zhang, Q., Guo, Y., Feng, Y., Liu, L., Zhang, A., ... Xia, X. (2016). Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan, China. Annals of Clinical Microbiology and Antimicrobials, 15, p. 10. doi:10.1186/s12941-016-0124-6.
Zheng R, et al. Outbreak of Plasmid-mediated NDM-1-producing Klebsiella Pneumoniae ST105 Among Neonatal Patients in Yunnan, China. Ann Clin Microbiol Antimicrob. 2016 Feb 19;15:10. PubMed PMID: 26896089.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outbreak of plasmid-mediated NDM-1-producing Klebsiella pneumoniae ST105 among neonatal patients in Yunnan, China. AU - Zheng,Rui, AU - Zhang,Qian, AU - Guo,Yidan, AU - Feng,Yue, AU - Liu,Li, AU - Zhang,Amei, AU - Zhao,Yue, AU - Yang,Xiaoyu, AU - Xia,Xueshan, Y1 - 2016/02/19/ PY - 2015/08/14/received PY - 2016/02/03/accepted PY - 2016/2/21/entrez PY - 2016/2/21/pubmed PY - 2016/10/19/medline SP - 10 EP - 10 JF - Annals of clinical microbiology and antimicrobials JO - Ann. Clin. Microbiol. Antimicrob. VL - 15 N2 - BACKGROUND: In the past decade, the carbapenemase-producing Enterobacteriaceae (CPE) have been reported worldwide. Emergence of carbapenemase-producing strains among Enterobacteriaceae has been a challenge for treatment of clinical infection. The present study was undertaken to investigate the characteristics of carbapenem-resistant Klebsiella pneumoniae recovered from an outbreak that affected 17 neonatal patients in neonatal intensive care unit (NICU) of Kunming City Maternal and Child health Hospital, which is located in the Kunming city in far southwest of China. METHODS: Minimum inhibitory concentrations (MICs) for antimicrobial agents were determined according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI); Modified Hodge test and Carba-NP test were preformed to identified the phenotypes of carbapenemases producing; To determine whether carbapenem resistance was transferable, a conjugation experiment was carried out in mixed broth cultures; Resistant genes were detected by using PCR and sequencing; Plasmids were typed by PCR-based replicon typing method; Clone relationships were analyzed by using multilocus-sequence typing (MLST) and pulsed field gel electrophoresis (PFGE). RESULTS: Eighteen highly carbapenem-resistant Klebsiella pneumoniae were isolated from patients in NICU and one carbapenem-resistant K. pneumoniae isolate was detected in incubator water. All these isolates harbored bla NDM-1. Moreover, other resistance genes, viz., bla IMP-4 , bla SHV-1 , bla TEM-1 , bla CTX-M-15 , qnrS1, qnrB4, and aacA4 were detected. The bla NDM-1 gene was located on a ca. 50 kb IncFI type plasmid. PFGE analysis showed that NDM-1-producing K. pneumoniae were clonally related and MLST assigned them to sequence type 105. CONCLUSIONS: NDM-1 producing strains present in the hospital environment pose a potential risk and the incubator water may act as a diffusion reservoir of NDM-1- producing bacteria. Nosocomial surveillance system should play a more important role in the infection control to limit the spread of these pathogens. SN - 1476-0711 UR - https://www.unboundmedicine.com/medline/citation/26896089/Outbreak_of_plasmid_mediated_NDM_1_producing_Klebsiella_pneumoniae_ST105_among_neonatal_patients_in_Yunnan_China_ L2 - https://ann-clinmicrob.biomedcentral.com/articles/10.1186/s12941-016-0124-6 DB - PRIME DP - Unbound Medicine ER -