51. Genetic factors related to the widespread dissemination of ST11 extensively drug-resistant carbapenemase-producing Klebsiella pneumoniae strains within hospital
- Author
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Zhanwei Wang, Yatao Guo, Yu Kang, Songnian Hu, Yao Zhai, Zhao Zhang, Yusheng Chen, Zhancheng Gao, Zilong He, and Daixi Li
- Subjects
China ,Klebsiella pneumoniae ,lcsh:Medicine ,Microbial Sensitivity Tests ,Drug resistance ,Carbapenemase-producing Klebsiella pneumoniae ,Genome ,beta-Lactamases ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Plasmid ,Bacterial Proteins ,law ,Humans ,Adaptation associated genes ,Polymerase chain reaction ,Prophage ,Retrospective Studies ,Comparative genomics ,Genetics ,biology ,lcsh:R ,Original Articles ,General Medicine ,biology.organism_classification ,Hospitals ,Anti-Bacterial Agents ,Electrophoresis, Gel, Pulsed-Field ,Klebsiella Infections ,Antimicrobial resistance genes ,Pharmaceutical Preparations ,Mobile genetic elements ,Whole genome sequencing ,030220 oncology & carcinogenesis ,030217 neurology & neurosurgery ,Multilocus Sequence Typing - 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.
- Published
- 2020