Molecular epidemiology and drug-resistance mechanisms in carbapenem-resistant Klebsiella pneumoniae isolated in patients from a tertiary hospital in Valencia, Spain

Begoña Fuster; Carme Salvador; Nuria Tormo; Neris García-González; Concepción Gimeno; Fernando González-Candelas

doi:10.1016/j.jgar.2020.05.002

Molecular epidemiology and drug-resistance mechanisms in carbapenem-resistant Klebsiella pneumoniae isolated in patients from a tertiary hospital in Valencia, Spain

J Glob Antimicrob Resist. 2020 Sep:22:718-725. doi: 10.1016/j.jgar.2020.05.002. Epub 2020 May 22.

Authors

Begoña Fuster¹, Carme Salvador², Nuria Tormo², Neris García-González³, Concepción Gimeno⁴, Fernando González-Candelas⁵

Affiliations

¹ Microbiology Department, Valencia General University Hospital, Valencia, Spain. Electronic address: begona.fuster@gmail.com.
² Microbiology Department, Valencia General University Hospital, Valencia, Spain.
³ Joint Research Unit (Infection and Public Health), FISABIO, University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain.
⁴ Microbiology Department, Valencia General University Hospital, Valencia, Spain; Faculty of Medicine, University of Valencia, Valencia, Spain.
⁵ Joint Research Unit (Infection and Public Health), FISABIO, University of Valencia, Institute for Integrative Systems Biology (I2SysBio), Valencia, Spain; CIBER Epidemiology and Public Health, Valencia, Spain.

PMID: 32446938
DOI: 10.1016/j.jgar.2020.05.002

Abstract

Objectives: The aim of this study has been to characterize carbapenem-resistant Klebsiella pneumoniae isolates and to determine the resistance mechanisms involved, the clonal relationship between strains and clinical and demographical data of the infected patients.

Methods: Clinical and demographical data from patients were collected and statistically analysed. Antimicrobial susceptibility testing was performed and resistance genes were detected both phenotypically and genotypically. Conjugation assays were performed to show horizontal transferability of resistance genes. Clonal relationship was also studied. Next-generation sequencing (NGS) was performed to obtain information regarding resistance genes, sequence types, virulence factors and plasmid types.

Results: Statistical significance was shown by the presence of an infection if there had been a previous hospital stay; urinary catheter carriage and chronic renal disease also indicated higher probabilities of being infected. More than 95% of the isolates were non-susceptible to third-generation cephalosporins, and more than 90% were non-susceptible to quinolones. Phenotypic and genotypic methods for resistance detection were concordant and later confirmed by NGS. This is the first detection of OXA-48, NDM-1 and CTX-M-15 co-production in the area. No plasmid-mediated colistin resistance was found. Tetracycline, sulfonamides and aminoglycoside resistance genes were found in almost all the isolates studied. No virulence factors were detected. Multilocus sequence typing showed more than 15 different sequence types, with ST101, ST307 and ST11 being the most prevalent.

Conclusions: This study is the first to report such a large group of OXA-48 carbapenemases with clonal dissemination among carbapenem-resistant K. pneumoniae in Valencia. This is also the first detection of OXA-48, NDM-1 and CTX-M-15 co-production in the area.

Keywords: Carbapenemases; Klebsiella pneumoniae; Resistance mechanisms.

Publication types

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

MeSH terms

Carbapenems / pharmacology
Humans
Klebsiella Infections* / epidemiology
Klebsiella pneumoniae* / genetics
Molecular Epidemiology
Pharmaceutical Preparations*
Spain / epidemiology
Tertiary Care Centers

Substances

Carbapenems
Pharmaceutical Preparations