KPC-producing Klebsiella pneumoniae ST11 spreading in colonized and infected patient from a Transplant Unit. (March 2022)

• Record Type: Journal Article
• Authors: Allende, N. García; Álvarez, V.; Quiroga, M.P.; Massó, M.; Campos, J.; Fox, B.; Canigia, L.B. Fernandez; Popkoleviech, T.; Centrón, D.
• Is Part Of: International journal of infectious diseases. Volume 116(2022)Supplement
• Page Start: S87
• Publication Date: 2022-03
• Subjects: Communicable diseases -- Periodicals; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; Electronic journals; 616.9
• DOI: 10.1016/j.ijid.2021.12.206
• Languages: English
• ISSNs: 1201-9712

Abstract

Abstract : Purpose: The rational use of antimicrobials is essential and can be achieved through antimicrobial stewardship programs. Although several studies identify the clonal relationships of nosocomial carbapenemase KPC-producing Klebsiella pneumoniae (KPC-Kp) strains, none of them, at our knowledge, investigates at the same time clonal status of colonizing KPC-Kp strains. Our aim was to perform a whole-genome sequencing (WGS) of both, colonizing and infecting KPC-Kp strains, to perform genomic analysis, and identification of acquired antimicrobial resistance genes (ARG). Methods & Materials: A 38 years old woman received a deceased donor kidney transplant in 2013 after 11 years of hemodialysis. The patient developed recurrent urinary tract infections (UTI) with high antibiotic exposition. First sample analyzed was a colonizing strain isolated the first day of hospitalization (HAp39) from a surveillance rectal swab. The second strain was isolated 7 days after hospitalization (HA40) from a urine sample taken in context of UTI suspicion. Both strains showed reduced susceptibility to β-lactams, sulfamethoxazole, trimethoprim, chloramphenicol, tetracycline, and ciprofloxacin according to CLSI, 2020. WGS was carried out using Illumina MiSeq-I, and de novo assembly was performed using SPAdes v.3.11. Genomic analysis was made. Results: Both strains belonged to ST11. They possessed in common a total of 21 transferable ARG, aadA1, aac(6′)-Ib, aph(3′')-Ib, aph(6)-Id, arr-3, bla KPC-2, bla OXA-1, bla OXA-9, bla TEM-1A, catB3, floR, fosA, mph(E ), msr(E ), oqxA, oqxB, qacEΔ1, qnrB19, sul1, sul2, and tet(A). HAp39 strain also harbored a second carbapenemase bla OXA-163, and a dfrA22 -like gene. bla OXA-163 had as flanking sequences IS 4 (TnpA)- bla OXA-163- HP-Tn 3 family (TnpA). Loss of bla OXA-163, and dfrA22 -like gene was observed in HA40 strain, though acquisition of bla CTX-M-2, rmtD and a cat -like genes were identified in this strain. The bla KPC-2 gene was located in the same genetic platform (IS Kpn27 -blaKPC2 - IS Kpn6- HP-Tn 3 (TnpR)) in both strains Conclusion: Colonizing and infecting KPC-Kp strains showed to belong to the same ST11 with a high similarity at DNA level, suggesting they are the same strains. Loss and acquisition of ARG during the hospitalization was observed. Also, a change in epidemiology is being observed displacing KPC-Kp ST258 isolates suggesting that molecular surveillance of ST11 KPC-Kp should be performed in our region to prevent further spread.