Clonal transmission of blaIMP-4-carrying ST196 Klebsiella pneumoniae isolates mediated by IncN plasmid in China

Zhaojun Liu; Jun Li; Haolan Wang; Fengjun Xia; Yubing Xia; Haichen Wang; Yongmei Hu; Mingxiang Zou

doi:10.1016/j.jgar.2024.05.002

Clonal transmission of bla_IMP-4-carrying ST196 Klebsiella pneumoniae isolates mediated by IncN plasmid in China

J Glob Antimicrob Resist. 2024 May 10:S2213-7165(24)00081-X. doi: 10.1016/j.jgar.2024.05.002. Online ahead of print.

Authors

Zhaojun Liu¹, Jun Li², Haolan Wang¹, Fengjun Xia², Yubing Xia¹, Haichen Wang², Yongmei Hu², Mingxiang Zou³

Affiliations

¹ Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China.
² Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China.
³ Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, China; National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Changsha, Hunan, China. Electronic address: zoumingxiang@csu.edu.cn.

PMID: 38735531
DOI: 10.1016/j.jgar.2024.05.002

Abstract

Objectives: To investigate the clinical and molecular epidemiological characteristics of bla_IMP-4-carrying Klebsiella pneumoniae in a tertiary hospital in China.

Methods: 10 Carbapenem Resistant K. pneumoniae (CRKP) isolates with bla_IMP-4 gene were collected. Molecular characteristics were analyzed using whole-genome sequencing. Plasmid conjugation experiment was used to analyze the conjugation of plasmids. We compared and analyzed K. pneumoniae carrying bla_IMP-4 on NCBI with the strains in this study.

Results: All 10 CRKP isolates with bla_IMP-4 were collected from 10 adult patients in the respiratory intensive care unit. These strains were only sensitive to polymyxins and tigecycline due to simultaneously carrying multiple resistance genes, such as bla_OKP-A-5, fosA, oqxA and oqxB. Notably, R29 harbored two carbapenemase genes (bla_NDM-1 and bla_IMP-4)_. These strains had similar drug-resistant phenotypes and drug-resistant genes, all belonging to ST196. Additionally, the patients had spatiotemporal intersection during hospitalization, suggesting that these strains had clonal transmission, but they belonged to different clonal clusters from the bla_IMP-4-positive K. pneumoniae currently published on NCBI. Among the 10 strains, bla_IMP-4 was located on the IncN plasmid, and 6 strains had successfully transferred the plasmid to the recipient strain EC600 through plasmid conjugation.

Conclusions: The bla_IMP-4-positive ST196 CRKP had clonal distribution in the respiratory ICU, which was mediated by IncN plasmid. Consequently, there should be increased monitoring of carbapenem-resistant strains in clinical settings to prevent and control of its transmission.

Keywords: IncN; ST196; bla(IMP-4); carbapenem resistant K. pneumoniae; molecular epidemiological characteristics.