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Clonal dissemination of carbapenemase-producing Klebsiella pneumoniae: Two distinct sub-lineages of Sequence Type 11 carrying blaKPC-2 and blaOXA-48.
Int J Antimicrob Agents. 2018 Nov; 52(5):658-662.IJ

Abstract

OBJECTIVES

The global spread of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become a massive threat to human health. We investigated the clonal relatedness of CR-Kp strains in central Taiwan.

METHODS

CR-Kp strains were prospectively collected from inpatients referred to Chung Shan Medical University Hospital (CSMUH) during September 2011 to December 2015. The presence of carbapenemase genes, including blaKPC-2, blaVIM-1, blaNDM-1, and blaOXA-48, was analysed with polymerase chain reaction (PCR) and sequence determination. Clonal relatedness was determined by pulse-field gel electrophoresis and multilocus sequence typing. Capsule synthesis loci were typed based on the variation of the wzi gene.

RESULTS

A total of 174 CR-Kp strains were collected. KPC-2 and OXA-48 were present in 63 (36.2%) and 22 (12.6%) CR-Kp strains, respectively. Two strains isolated in 2014 coproduced KPC-2 and OXA-48. Nearly all (98%) carbapenemase-producing K. pneumoniae strains belonged to the ST11 clone and could be further grouped into distinct sub-lineages. Intriguingly, the first sub-lineage, designated ST11-Clade I, contained all KPC-2 strains; OXA-48 strains were mostly included in the second sub-lineage, ST11-Clade II. Furthermore, a variation on the capsule synthesis loci was detected between these two sub-lineages: KL-47 was assigned to ST11-Clade I, whereas KL-64 or KL-9 were the main types for the ST11-Clade II strains.

CONCLUSIONS

Clonal expansion of ST11 was responsible for the dissemination of carbapenemase-producing K. pneumoniae. Although KPC-2 still predominates, OXA-48 has emerged rapidly. Co-existence of KPC-2 and OXA-48 in two ST11-Clade I K. pneumoniae highlights the urgency to unravel mechanisms that contribute to this highly transmissible lineage.

Authors+Show Affiliations

Division of Infectious Diseases, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan; Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan.Department of Microbiology and Immunology, School of Medicine, China Medical University, Taichung, Taiwan.The Central Region Laboratory, Center for Research and Diagnostics, Centers for Disease Control, Taichung, Taiwan.Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan.Department of Life Science, National Chung Cheng University, Chia-Yi County, Taiwan.Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; Department of Microbiology and Immunology, Chung Shan Medical University, Taichung, Taiwan. Electronic address: yclai@csmu.edu.tw.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29753130

Citation

Lu, Min-Chi, et al. "Clonal Dissemination of Carbapenemase-producing Klebsiella Pneumoniae: Two Distinct Sub-lineages of Sequence Type 11 Carrying blaKPC-2 and BlaOXA-48." International Journal of Antimicrobial Agents, vol. 52, no. 5, 2018, pp. 658-662.
Lu MC, Tang HL, Chiou CS, et al. Clonal dissemination of carbapenemase-producing Klebsiella pneumoniae: Two distinct sub-lineages of Sequence Type 11 carrying blaKPC-2 and blaOXA-48. Int J Antimicrob Agents. 2018;52(5):658-662.
Lu, M. C., Tang, H. L., Chiou, C. S., Wang, Y. C., Chiang, M. K., & Lai, Y. C. (2018). Clonal dissemination of carbapenemase-producing Klebsiella pneumoniae: Two distinct sub-lineages of Sequence Type 11 carrying blaKPC-2 and blaOXA-48. International Journal of Antimicrobial Agents, 52(5), 658-662. https://doi.org/10.1016/j.ijantimicag.2018.04.023
Lu MC, et al. Clonal Dissemination of Carbapenemase-producing Klebsiella Pneumoniae: Two Distinct Sub-lineages of Sequence Type 11 Carrying blaKPC-2 and BlaOXA-48. Int J Antimicrob Agents. 2018;52(5):658-662. PubMed PMID: 29753130.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clonal dissemination of carbapenemase-producing Klebsiella pneumoniae: Two distinct sub-lineages of Sequence Type 11 carrying blaKPC-2 and blaOXA-48. AU - Lu,Min-Chi, AU - Tang,Hui-Ling, AU - Chiou,Chien-Shun, AU - Wang,Yao-Chen, AU - Chiang,Ming-Ko, AU - Lai,Yi-Chyi, Y1 - 2018/05/09/ PY - 2017/11/02/received PY - 2018/04/20/revised PY - 2018/04/29/accepted PY - 2018/5/13/pubmed PY - 2019/3/21/medline PY - 2018/5/13/entrez KW - KPC-2 KW - Klebsiella pneumoniae KW - OXA-48 KW - ST11 KW - antimicrobial resistance KW - carbapenemase SP - 658 EP - 662 JF - International journal of antimicrobial agents JO - Int J Antimicrob Agents VL - 52 IS - 5 N2 - OBJECTIVES: The global spread of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has become a massive threat to human health. We investigated the clonal relatedness of CR-Kp strains in central Taiwan. METHODS: CR-Kp strains were prospectively collected from inpatients referred to Chung Shan Medical University Hospital (CSMUH) during September 2011 to December 2015. The presence of carbapenemase genes, including blaKPC-2, blaVIM-1, blaNDM-1, and blaOXA-48, was analysed with polymerase chain reaction (PCR) and sequence determination. Clonal relatedness was determined by pulse-field gel electrophoresis and multilocus sequence typing. Capsule synthesis loci were typed based on the variation of the wzi gene. RESULTS: A total of 174 CR-Kp strains were collected. KPC-2 and OXA-48 were present in 63 (36.2%) and 22 (12.6%) CR-Kp strains, respectively. Two strains isolated in 2014 coproduced KPC-2 and OXA-48. Nearly all (98%) carbapenemase-producing K. pneumoniae strains belonged to the ST11 clone and could be further grouped into distinct sub-lineages. Intriguingly, the first sub-lineage, designated ST11-Clade I, contained all KPC-2 strains; OXA-48 strains were mostly included in the second sub-lineage, ST11-Clade II. Furthermore, a variation on the capsule synthesis loci was detected between these two sub-lineages: KL-47 was assigned to ST11-Clade I, whereas KL-64 or KL-9 were the main types for the ST11-Clade II strains. CONCLUSIONS: Clonal expansion of ST11 was responsible for the dissemination of carbapenemase-producing K. pneumoniae. Although KPC-2 still predominates, OXA-48 has emerged rapidly. Co-existence of KPC-2 and OXA-48 in two ST11-Clade I K. pneumoniae highlights the urgency to unravel mechanisms that contribute to this highly transmissible lineage. SN - 1872-7913 UR - https://www.unboundmedicine.com/medline/citation/29753130/Clonal_dissemination_of_carbapenemase_producing_Klebsiella_pneumoniae:_Two_distinct_sub_lineages_of_Sequence_Type_11_carrying_blaKPC_2_and_blaOXA_48_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0924-8579(18)30132-8 DB - PRIME DP - Unbound Medicine ER -