Putative horizontal transfer of carbapenem resistance between Klebsiella pneumoniae and Kluyvera ascorbata during abdominal infection: A case report

ENTEROBACTERIACEAE IN SOILS AND ATMOSPHERIC DUST AEROSOL ACCUMULATIONS OF MOSCOW CITY

The topsoils and atmospheric dust aerosols of the various areas of the city of Moscow were studied. Most of the dust samples contained a considerable number of particles enriched in phosphorus - a sign of contamination by feces. A variety of Enterobacteriaceae species, including opportunistic and pathogenic species, were isolated from the topsoil and dust samples and identified using 16S rDNA nucleotide sequences: Enterobacter aerogenes, E. agglomerans, E. cloacae, E. kobei, E. nimipressuralis, Escherichia coli, Citrobacter europaeus, Klebsiella granulomatis, K. grimontii, K. oxytoca, K. quasipneumoniae, K. variicola, Kluyvera ascorbate, Kluyvera intermedia, Leclercia adecarboxylata, Salmonella enterica and Trabulsiella guamensis. The greatest diversity of pathogens was isolated from spring soil and dust samples immediately after spring snowmelt. Antibiotic resistance of the isolated E. coli strains was tested using disks with a wide range of antimicrobial drugs: Amoxicillin, Ampicillin, Meropenem, Pefloxacin, Streptomycin, Ticarcillin+clavulanic acid, Fosfomycin, Ceftibuten, Ciprofloxacin. Resistance was observed in more than 22% of E. coli strains. The traffic area had a significant number of antibiotic-resistant E. coli strains, clearly indicating a high health risk from soil and dust exposure.

First isolation of an IMP-1 metallo-β-lactamase-producing Kluyvera ascorbata in Japan

OBJECTIVES

The emergence of carbapenemase-producing Enterobacterales has been increasing globally, causing growing concerns. Although Kluyvera ascorbata is not known as a metallo-β-lactamase (MBL)-producer, in the present study we isolated a K. ascorbata strain producing IMP-1 MBL from catheter-associated urine of a paediatric patient and performed whole-genome analysis to elucidate the features of this strain and the origin of IMP-1.

METHODS

Carbapenemase production was confirmed by a modified carbapenemase inactivation method. Whole-genome sequencing was performed using NovaSeq 6000 and GridION. Conjugation ability was evaluated using Escherichia coli ML1410 by a broth mating assay.

RESULTS

Thebla_IMP-1 gene was located on a 149 316-bp transferable plasmid (pKATP2) and formed a class 1 integron structure. In addition, this plasmid had two types of repA genes as well as astA encoding a putative heat-stable enterotoxin. Comparison with other plasmids from Enterobacterales and Pseudomonas aeruginosa suggested that this plasmid might have originated by the integration of multiple plasmids. In addition, pKATP2 harboured conjugation-associated genes and was transferable.

CONCLUSION

This is the first report of MBL-producing K. ascorbata. Therefore, our findings suggest that species which do not typically produce MBL could acquire the corresponding genes, attracting attention as potential MBL-producing pathogens.

Carbapenemase-Producing Klebsiella pneumoniae From Transplanted Patients in Brazil: Phylogeny, Resistome, Virulome and Mobile Genetic Elements Harboring bla KPC- 2 or bla NDM- 1

Objectives

Carbapenemase-producing Klebsiella pneumoniae (CP-Kp) is a major cause of infections in transplanted patients and has been associated with high mortality rates in this group. There is a lack of information about the Brazilian structure population of CP-Kp isolated from transplanted patients. By whole-genome sequencing (WGS), we analyzed phylogeny, resistome, virulome of CP-Kp isolates, and the structure of plasmids encoding bla_KPC–2 and bla_NDM–1 genes.

Methods

One K. pneumoniae isolated from each selected transplanted patient colonized or infected by CP-Kp over a 16-month period in a hospital complex in Porto Alegre (Brazil) was submitted for WGS. The total number of strains sequenced was 80. The hospital complex in Porto Alegre comprised seven different hospitals. High-resolution SNP typing, core genome multilocus sequence typing (cgMLST), resistance and virulence genes inference, and plasmid reconstruction were performed in 80 CP-Kp.

Results

The mortality rate of CP-Kp colonized or infected transplanted inpatients was 21.3% (17/80). Four CP-Kp epidemic clones were described: ST11/KPC-2, ST16/KPC-2, and ST15/NDM-1, all responsible for interhospital outbreaks; and ST437/KPC-2 affecting a single hospital. The average number of acquired resistance and virulence genes was 9 (range = 2–14) and 27 (range = 6–36), respectively. Two plasmids carrying the bla_KPC–2 were constructed and belonged to IncN and IncM types. Additionally, an IncFIB plasmid carrying the bla_NDM–1 was described.

Conclusion

We detected intrahospital and interhospital spread of mobile structures and international K. pneumoniae clones as ST11, ST16, and ST15 among transplanted patients, which carry a significant range of acquired resistance and virulence genes and keep spreading across the world.

Cohorting KPC+ Klebsiella pneumoniae (KPC-Kp)-positive patients: A genomic exposé of cross-colonization hazards in a long-term acute-care hospital (LTACH)

OBJECTIVE

Cohorting patients who are colonized or infected with multidrug-resistant organisms (MDROs) protects uncolonized patients from acquiring MDROs in healthcare settings. The potential for cross transmission within the cohort and the possibility of colonized patients acquiring secondary isolates with additional antibiotic resistance traits is often neglected. We searched for evidence of cross transmission of KPC+ Klebsiella pneumoniae (KPC-Kp) colonization among cohorted patients in a long-term acute-care hospital (LTACH), and we evaluated the impact of secondary acquisitions on resistance potential.

DESIGN

Genomic epidemiological investigation.

SETTING

A high-prevalence LTACH during a bundled intervention that included cohorting KPC-Kp-positive patients.

METHODS

Whole-genome sequencing (WGS) and location data were analyzed to identify potential cases of cross transmission between cohorted patients.

RESULTS

Secondary KPC-Kp isolates from 19 of 28 admission-positive patients were more closely related to another patient's isolate than to their own admission isolate. Of these 19 cases, 14 showed strong genomic evidence for cross transmission (<10 single nucleotide variants or SNVs), and most of these patients occupied shared cohort floors (12 patients) or rooms (4 patients) at the same time. Of the 14 patients with strong genomic evidence of acquisition, 12 acquired antibiotic resistance genes not found in their primary isolates.

CONCLUSIONS

Acquisition of secondary KPC-Kp isolates carrying distinct antibiotic resistance genes was detected in nearly half of cohorted patients. These results highlight the importance of healthcare provider adherence to infection prevention protocols within cohort locations, and they indicate the need for future studies to assess whether multiple-strain acquisition increases risk of adverse patient outcomes.