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Emergence and nosocomial spread of ST11 carbapenem-resistant Klebsiella pneumoniae co-producing OXA-48 and KPC-2 in a regional hospital in Taiwan.
J Med Microbiol. 2018 Jul; 67(7):957-964.JM

Abstract

Purpose.

Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a major challenge for global healthcare systems. The objectives of this study were to determine the nosocomial spread of CRKP clones and analyse the molecular characteristics of CRKP in our hospital.Methodology. Ninety-eight non-duplicated clinical CRKP isolates were collected from March 2014-June 2015. Clinical, demographic and microbiological data of patients with CRKP were reviewed. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing were applied to investigate the genetic relationship between the 98 isolates. Antibiotic resistance genes were identified by conventional PCR-sequencing.

Results.

PFGE patterns were grouped into 26 clusters. Two main PFGE clusters were identified: L (53 isolates, belonging to ST11) and N (11 isolates, belonging to ST11). The most dominant ST was ST11 (79 %, 77/98), followed by ST273 (5 %, 5/98). KPC-2 (n=82) was the predominant carbapenemase followed by OXA-48 (n=64). Fifty isolates (51 %, 50/98) harboured bla KPC-2 and bla OXA-48 simultaneously, and three of these isolates were detected with the third carbapenemase genes (bla IMP-8 or bla VIM-1).

Conclusion.

The clonal spread of K. pneumoniae ST11 expressing OXA-48, KPC-2 and CTX-M-14 β-lactamases was the cause of an outbreak of CRKP. To the best of our knowledge, a single strain harbouring A-, B- and D-class carbapenemase genes has not previously been identified. There is a high prevalence of plasmid-encoded KPC-2- and OXA-48-producing CRKP in our hospital; most isolates were members of ST11, which may be representative of a high-risk CRKP clone disseminating in central Taiwan.

Authors+Show Affiliations

Department of Internal Medicine, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC. Department of Health Food, Chung Chou University of Science and Technology, Changhua, Taiwan, ROC.The Institute of Medical Science and Department of Microbiology, China Medical University, Taichung, Taiwan, ROC.Infection Control Office, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC. Department of Medical Technology, Jen-The Junior College of Medicine, Nursing and Management, Miaoli, Taiwan, ROC.Department of Medical Research, Tungs' Taichung MetroHarbor Hospital, Taichung, Taiwan, ROC.Section of Infectious Diseases, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan, ROC.The Institute of Biomedical Sciences College of Medicine, China Medical University, Taichung, Taiwan, ROC.The Institute of Medical Science and Department of Microbiology, China Medical University, Taichung, Taiwan, ROC.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29873627

Citation

Chen, Chih-Ming, et al. "Emergence and Nosocomial Spread of ST11 Carbapenem-resistant Klebsiella Pneumoniae Co-producing OXA-48 and KPC-2 in a Regional Hospital in Taiwan." Journal of Medical Microbiology, vol. 67, no. 7, 2018, pp. 957-964.
Chen CM, Guo MK, Ke SC, et al. Emergence and nosocomial spread of ST11 carbapenem-resistant Klebsiella pneumoniae co-producing OXA-48 and KPC-2 in a regional hospital in Taiwan. J Med Microbiol. 2018;67(7):957-964.
Chen, C. M., Guo, M. K., Ke, S. C., Lin, Y. P., Li, C. R., Vy Nguyen, H. T., & Wu, L. T. (2018). Emergence and nosocomial spread of ST11 carbapenem-resistant Klebsiella pneumoniae co-producing OXA-48 and KPC-2 in a regional hospital in Taiwan. Journal of Medical Microbiology, 67(7), 957-964. https://doi.org/10.1099/jmm.0.000771
Chen CM, et al. Emergence and Nosocomial Spread of ST11 Carbapenem-resistant Klebsiella Pneumoniae Co-producing OXA-48 and KPC-2 in a Regional Hospital in Taiwan. J Med Microbiol. 2018;67(7):957-964. PubMed PMID: 29873627.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Emergence and nosocomial spread of ST11 carbapenem-resistant Klebsiella pneumoniae co-producing OXA-48 and KPC-2 in a regional hospital in Taiwan. AU - Chen,Chih-Ming, AU - Guo,Ming-Kai, AU - Ke,Se-Chin, AU - Lin,Yi-Pei, AU - Li,Chia-Ru, AU - Vy Nguyen,Hong Thuy, AU - Wu,Lii-Tzu, PY - 2018/6/7/pubmed PY - 2019/12/27/medline PY - 2018/6/7/entrez KW - Carbapenem-resistant Klebsiella pneumoniae KW - KPC-2 KW - OXA-48 KW - ST11 KW - carbapenemase SP - 957 EP - 964 JF - Journal of medical microbiology JO - J. Med. Microbiol. VL - 67 IS - 7 N2 - Purpose. Carbapenem-resistant Klebsiella pneumoniae (CRKP) has emerged as a major challenge for global healthcare systems. The objectives of this study were to determine the nosocomial spread of CRKP clones and analyse the molecular characteristics of CRKP in our hospital.Methodology. Ninety-eight non-duplicated clinical CRKP isolates were collected from March 2014-June 2015. Clinical, demographic and microbiological data of patients with CRKP were reviewed. Pulsed-field gel electrophoresis (PFGE) and multi-locus sequence typing were applied to investigate the genetic relationship between the 98 isolates. Antibiotic resistance genes were identified by conventional PCR-sequencing.Results. PFGE patterns were grouped into 26 clusters. Two main PFGE clusters were identified: L (53 isolates, belonging to ST11) and N (11 isolates, belonging to ST11). The most dominant ST was ST11 (79 %, 77/98), followed by ST273 (5 %, 5/98). KPC-2 (n=82) was the predominant carbapenemase followed by OXA-48 (n=64). Fifty isolates (51 %, 50/98) harboured bla KPC-2 and bla OXA-48 simultaneously, and three of these isolates were detected with the third carbapenemase genes (bla IMP-8 or bla VIM-1).Conclusion. The clonal spread of K. pneumoniae ST11 expressing OXA-48, KPC-2 and CTX-M-14 β-lactamases was the cause of an outbreak of CRKP. To the best of our knowledge, a single strain harbouring A-, B- and D-class carbapenemase genes has not previously been identified. There is a high prevalence of plasmid-encoded KPC-2- and OXA-48-producing CRKP in our hospital; most isolates were members of ST11, which may be representative of a high-risk CRKP clone disseminating in central Taiwan. SN - 1473-5644 UR - https://www.unboundmedicine.com/medline/citation/29873627/Emergence_and_nosocomial_spread_of_ST11_carbapenem_resistant_Klebsiella_pneumoniae_co_producing_OXA_48_and_KPC_2_in_a_regional_hospital_in_Taiwan_ L2 - http://jmm.microbiologyresearch.org/pubmed/content/journal/jmm/10.1099/jmm.0.000771 DB - PRIME DP - Unbound Medicine ER -