Genetic factors related to the widespread dissemination of ST11 extensively drug-resistant carbapenemase-producing Klebsiella pneumoniae strains within hospital.
10.1097/CM9.0000000000001101
- Author:
Dai-Xi LI
1
;
Yao ZHAI
2
;
Zhao ZHANG
1
;
Ya-Tao GUO
1
;
Zhan-Wei WANG
3
;
Zi-Long HE
4
;
Song-Nian HU
4
;
Yu-Sheng CHEN
5
;
Yu KANG
4
;
Zhan-Cheng GAO
1
Author Information
1. Department of Respiratory and Critical Care Medicine, Peking University People's Hospital, Beijing 100044, China.
2. University of Technology Sydney, Ultimo, NSW 2007, Australia.
3. Clinical Laboratory, Peking University People's Hospital, Beijing 100044, China.
4. Beijing Institute of Genomics, Chinese Academy of Sciences, Beijing 100044, China.
5. Department of Respiratory Medicine, Fujian Provincial Hospital, Fuzhou, Fujian 350000, China.
- Publication Type:Journal Article
- MeSH:
Anti-Bacterial Agents;
Bacterial Proteins;
China;
Electrophoresis, Gel, Pulsed-Field;
Hospitals;
Humans;
Klebsiella Infections/drug therapy*;
Klebsiella pneumoniae/genetics*;
Microbial Sensitivity Tests;
Multilocus Sequence Typing;
Pharmaceutical Preparations;
Retrospective Studies;
beta-Lactamases/genetics*
- From:
Chinese Medical Journal
2020;133(21):2573-2585
- CountryChina
- Language:English
-
Abstract:
BACKGROUND:Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) poses distinct clinical challenges due to extensively drug resistant (XDR) phenotype, and sequence type (ST) 11 is the most dominant blaKPC-2-bearing CP-Kp clone in China. The purpose of this current retrospective study was to explore the genetic factors associated with the success of XDR CP-Kp ST11 strains circulated in the intensive care unit (ICU) of a Chinese tertiary hospital.
METHODS:Six ST11 XDR CP-Kp strains were identified between May and December 2014 and validated by minimum inhibitory concentration examination, polymerase chain reaction, and pyrosequencing. The six ST11 XDR CP-Kp, as well as three multi-drug resistant (MDR) and four susceptible strains, were sequenced using single-molecule real-time method. Comprehensively structural and functional analysis based on comparative genomics was performed to identify genomic characteristics of the XDR ST11 CP-Kp strains.
RESULTS:We found that ST11 XDR blaKPC-2-bearing CP-Kp strains isolated from inpatients spread in the ICU of the hospital. Functionally, genes associated with information storage and processing of the ST11 XDR CP-Kp strains were more abundant than those of MDR and susceptible strains, especially genes correlative with mobile genetic elements (MGEs) such as transposons and prophages. Structurally, eleven large-scale genetic regions taken for the unique genome in these ST11 XDR CP-Kp strains were identified as MGEs including transposons, integrons, prophages, genomic islands, and integrative and conjugative elements. Three of them were located on plasmids and eight on chromosomes; five of them were with antimicrobial resistance genes and eight with adaptation associated genes. Notably, a new blaKPC-2-bearing ΔΔTn1721-blaKPC-2 transposon, probably transposed and truncated from ΔTn1721-blaKPC-2 by IS903D and ISKpn8, was identified in all six ST11 XDR CP-Kp strains.
CONCLUSION:Our findings suggested that together with clonal spread, MGEs identified uniquely in the ST11 XDR CP-Kp strains might contribute to their formidable adaptability, which facilitated their widespread dissemination in hospital.
