Outbreak of OXA-232-producing carbapenem-resistant Klebsiella pneumoniae ST15 in a Chinese teaching hospital: a molecular epidemiological study

Xiaoyan Wu; Xiangchen Li; Junjie Yu; Mengli Shen; Chenliang Fan; Yewei Lu; Junshun Gao; Xiaosi Li; Hongsheng Li

doi:10.3389/fcimb.2023.1229284

Outbreak of OXA-232-producing carbapenem-resistant Klebsiella pneumoniae ST15 in a Chinese teaching hospital: a molecular epidemiological study

Front Cell Infect Microbiol. 2023 Aug 21:13:1229284. doi: 10.3389/fcimb.2023.1229284. eCollection 2023.

Authors

Xiaoyan Wu¹, Xiangchen Li², Junjie Yu¹, Mengli Shen¹, Chenliang Fan¹, Yewei Lu², Junshun Gao², Xiaosi Li¹, Hongsheng Li¹

Affiliations

¹ Department of Laboratory Medicine, the Second Affiliated Hospital of Jiaxing University, Jiaxing, Zhejiang, China.
² Key Laboratory of Precision Medicine in Diagnosis and Monitoring Research, Hangzhou, Zhejiang, China.

Abstract

Background and aims: The incidence of OXA-232-producing carbapenem-resistant Klebsiella pneumoniae (CRKP) has been on the rise in China over the past five years, potentially leading to nosocomial epidemics. This study investigates the first outbreak of CRKP in the Second Affiliated Hospital of Jiaxing University.

Methods: Between February 2021 and March 2022, 21 clinical isolates of OXA-232-producing CRKP were recovered from 16 patients in the Second Affiliated Hospital of Jiaxing University. We conducted antimicrobial susceptibility tests, whole genome sequencing, and bioinformatics to determine the drug resistance profile of these clinical isolates.

Results: Whole-genome sequencing revealed that all 21 OXA-232-producing CRKP strains belonged to the sequence type 15 (ST15) and shared similar resistance, virulence genes, and plasmid types, suggesting clonal transmission between the environment and patients. Integrated genomic and epidemiological analysis traced the outbreak to two clonal transmission clusters, cluster 1 and cluster 2, including 14 and 2 patients. It was speculated that the CRKP transmission mainly occurred in the ICU, followed by brain surgery, neurosurgery, and rehabilitation department. Phylogenetic analysis indicated that the earliest outbreak might have started at least a year before the admission of the index patient, and these strains were closely related to those previously isolated from two major adjacent cities, Shanghai and Hangzhou. Comparative genomics showed that the IncFII-type and IncHI1B-type plasmids of cluster 2 had homologous recombination at the insertion sequence sites compared with the same type of plasmids in cluster 1, resulting in the insertion of 4 new drug resistance genes, including TEM-1, APH(6)-Id, APH(3'')-Ib and sul2.

Conclusions: Our study observed the clonal spread of ST15 OXA-232-producing between patients and the hospital environment. The integration of genomic and epidemiological data offers valuable insights and facilitate the control of nosocomial transmission.

Keywords: carbapenem-resistant Klebsiella pneumonia; clonal transmission; nosocomial epidemics; outbreak; whole genome sequencing.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Carbapenem-Resistant Enterobacteriaceae*
Carbapenems
China
Cross Infection*
Disease Outbreaks
Hospitals, Teaching
Humans
Klebsiella pneumoniae
Phylogeny

Substances

Carbapenems

Grants and funding

This work was supported by grants from the Science and Technology Bureau of Jiaxing City (grant no. 2021AD30104) and the Zhejiang Health Science and Technology Project (grant no. 2021KY1109).