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. 2021 Jun 2:11:656070.
doi: 10.3389/fcimb.2021.656070. eCollection 2021.

An Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Chongqing, China

Lingyi Zeng  1   2 , Chengru Yang  1   2 , Jisheng Zhang  1 , Kewang Hu  1   2 , Jingbo Zou  3 , Jie Li  1 , Jianmin Wang  1 , Wan Huang  1 , Lining Yin  1   2 , Xiaoli Zhang  1   2
Affiliations

An Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Chongqing, China

Lingyi Zeng et al. Front Cell Infect Microbiol. .

Abstract

Background: Due to the critical condition and poor immunity of patients, the intensive care unit (ICU) has always been the main hospital source of multidrug-resistant bacteria. In recent years, with the large-scale use of antibiotics, the detection rate and mortality of carbapenem-resistant Klebsiella pneumoniae (CRKP) have gradually increased. This study explores the molecular characteristics and prevalence of CRKP isolated from the ICU ward of a tertiary hospital in China.

Methods: A total of 51 non-duplicated CRKP samples isolated from the ICU were collected from July 2018-July 2020. The enzyme production of the strains was preliminarily screened by carbapenemase phenotypic test, and drug-resistant and virulence genes were detected by PCR. The transferability of plasmid was verified by conjugation test. The minimal inhibitory concentration (MIC) was determined by microbroth dilution method and genetic diversity was detected by multilocus sequence typing and pulsed-field gel electrophoresis.

Results: blaKPC-2 was the only carbapenemase detected. The major virulence genes were uge (100%), mrkD (94.1%), kpn (94.1%), and fim-H (72.5%), while wcag, ironB, alls and magA genes were not detected. One sequence type ST1373 strain, hypervirulent K. pneumoniae (hvKP), was detected. CRKP strains were highly resistant to quinolones, cephalosporins, aminoglycosides, and polymyxin, but susceptive to tigecycline and ceftazidime-avibactam. The success rate of conjugation was 12.2%, indicating the horizontal transfer of blaKPC-2 . Homology analysis showed that there was a clonal transmission of ST11 CRKP in the ICU of our hospital.

Conclusion: The present study showed the outbreak and dissemination in ICU were caused by ST11 CRKP, which were KPC-2 producers, and simultaneously, also carried some virulence genes. ST11 CRKP persisted in the ward for a long time and spread among different areas. Due to the widespread dispersal of the transferable blaKPC-2 plasmid, the hospital should promptly adopt effective surveillance and strict infection control strategies to prevent the further spread of CRKP. Ceftazidime-avibactam showed high effectiveness against CRKP and could be used for the treatment of ICU infections.

Keywords: ST11; carbapenem-resistant Klebsiella pneumoniae; intensive care unit; molecular epidemiology; outbreak.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
ICU internal layout plan. The number represents the corresponding beds. (A–G) indicate different areas divided artificially.
Figure 2
Figure 2
CRKP genetic similarity and antibiotic sensitivity. IMP, Imipenem; MEM, Meropenem; ATM, Aztreonam; FEP, Cefepime; CAZ, Ceftazidime; CZO, Cefazolin; TZP, Piperacillin tazobactam; CIP, Ciprofloxacin; LEV, Levofloxacin; AK, Amikacin; PB, Polymyxin B; TIG, Tigecycline; CAZ–AVI, ceftazidime–avibactam.
Figure 3
Figure 3
Distribution of MIC values of different types of antibiotics determined by broth micro-dilution method. MIC, the minimal inhibitory concentration; µg/ml, micrograms per milliliter; IMP, Imipenem; MEM, Meropenem; LEV, Levofloxacin; AK, Amikacin; PB, Polymyxin B; TIG, Tigecycline; CAZ–AVI, ceftazidime–avibactam.
Figure 4
Figure 4
The carrying status of phenotype, drug resistance genes, virulence genes and homology heat map of CRKP.
Figure 5
Figure 5
A timeline represents the ICU stay of patients. Different colors in the legend indicate the different groups.
See this image and copyright information in PMC

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