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. 2024 Mar 21;60(3):511.
doi: 10.3390/medicina60030511.

An Intra-Hospital Spread of Colistin-Resistant K. pneumoniae Isolates-Epidemiological, Clinical, and Genetic Analysis

Georgi Popivanov  1 , Rumyana Markovska  2 , Ivanka Gergova  3 , Marina Konaktchieva  4 , Roberto Cirocchi  5 , Kirien Kjossev  1 , Ventsislav Mutafchiyski  1
Affiliations

An Intra-Hospital Spread of Colistin-Resistant K. pneumoniae Isolates-Epidemiological, Clinical, and Genetic Analysis

Georgi Popivanov et al. Medicina (Kaunas). .

Abstract

Background and Objective: Klebsiella pneumoniae appears to be a significant problem due to its ability to accumulate antibiotic-resistance genes. After 2013, alarming colistin resistance rates among carbapenem-resistant K. pneumoniae have been reported in the Balkans. The study aims to perform an epidemiological, clinical, and genetic analysis of a local outbreak of COLr CR-Kp. Material and Methods: All carbapenem-resistant and colistin-resistant K. pneumoniae isolates observed among patients in the ICU unit of Military Medical Academy, Sofia, from 1 January to 31 October 2023, were included. The results were analyzed according to the EUCAST criteria. All isolates were screened for blaVIM, blaIMP, blaKPC, blaNDM, and blaOXA-48. Genetic similarity was determined using the Dice coefficient as a similarity measure and the unweighted pair group method with arithmetic mean (UPGMA). mgrB genes and plasmid-mediated colistin resistance determinants (mcr-1, mcr-2, mcr-3, mcr-4, and mcr-5) were investigated. Results: There was a total of 379 multidrug-resistant K. pneumoniae isolates, 88% of which were carbapenem-resistant. Of these, there were nine (2.7%) colistin-resistant isolates in six patients. A time and space cluster for five patients was found. Epidemiology typing showed that two isolates belonged to clone A (pts. 1, 5) and the rest to clone B (pts. 2-4) with 69% similarity. Clone A isolates were coproducers of blaNDM-like and blaOXA-48-like and had mgrB-mediated colistin resistance (40%). Clone B isolates had only blaOXA-48-like and intact mgrB genes. All isolates were negative for mcr-1, -2, -3, -4, and -5 genes. Conclusions: The study describes a within-hospital spread of two clones of COLr CR-Kp with a 60% mortality rate. Clone A isolates were coproducers of NDM-like and OXA-48-like enzymes and had mgrB-mediated colistin resistance. Clone B isolates had only OXA-48-like enzymes and intact mgrB genes. No plasmid-mediated resistance was found. The extremely high mortality rate and limited treatment options warrant strict measures to prevent outbreaks.

Keywords: colistin-resistant K. pneumoniae; mgrB; mortality; outbreak; plasmid-mediated resistance.

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Conflict of interest statement

The authors declare no conflicts of interest.

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References

    1. [(accessed on 7 March 2022)]. Available online: https://apps.who.int/gb/MSPI/pdf_files/2022/03/Item1_07-03.pdf.
    1. Zimlichman E., Henderson D., Tamir O., Franz C., Song P., Yamin C.K., Keohane C., Denham C.R., Bates D.W. Health Care-associated infections. A meta-analysis of costs and financial impact on the US Health Care System. JAMA Intern. Med. 2013;173:2039–2046. doi: 10.1001/jamainternmed.2013.9763. - DOI - PubMed
    1. Magiorakos A., Srinivasan A., Carey R., Carmeli Y., Falagas M., Giske C., Harbarth S., Hindler J.F., Kahlmeter G., Olsson-Liljequist B., et al. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: An international expert proposal for interim standard definitions for acquired resistance. Clin. Microbiol. Infect. 2012;18:268–281. doi: 10.1111/j.1469-0691.2011.03570.x. - DOI - PubMed
    1. Cassini A., Högberg L., Plachouras D., Quattrocchi A., Hoxha A., Simonsen G., Colomb-Cotinat M., Kretzschmar M.E., Devleesschauwer B., Cecchini M., et al. Attributable deaths and disability-adjusted life-years caused by infections with antibiotic-resistant bacteria in the EU and the European Economic Area in 2015: A population-level modelling analysis. Lancet Infect. Dis. 2019;19:56–66. doi: 10.1016/S1473-3099(18)30605-4. - DOI - PMC - PubMed
    1. Antimicrobial Resistance in the EU/EEA (EARS-Net)—Annual Epidemiological Report for 2021. [(accessed on 17 November 2023)]. Available online: https://www.ecdc.europa.eu/en/publications-data/surveillance-antimicrobi....

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