Outbreak of colistin and carbapenem-resistant Klebsiella pneumoniae ST16 co-producing NDM-1 and OXA-48 isolates in an Iranian hospital.

Publication date: Feb 17, 2024

Colistin and carbapenem-resistant Klebsiella pneumoniae (Col-CRKP) represent a significant and constantly growing threat to global public health. We report here an outbreak of Col-CRKP infections during the fifth wave of COVID-19 pandemic. The outbreak occurred in an intensive care unit with 22 beds at a teaching university hospital, Isfahan, Iran. We collected eight Col-CRKP strains from seven patients and characterized these strains for their antimicrobial susceptibility, determination of hypermucoviscous phenotype, capsular serotyping, molecular detection of virulence and resistance genes. Clonal relatedness of the isolates was performed using MLST. The COVID-19 patients were aged 24-75 years with at least 50% pulmonary involvement and were admitted to the intensive care unit. They all had superinfection caused by Col-CRKP, and poor responses to antibiotic treatment and died. With the exception of one isolate that belonged to the ST11, all seven representative Col-CRKP strains belonged to the ST16. Of these eight isolates, one ST16 isolate carried the iucA and ybtS genes was identified as serotype K20 hypervirulent Col-CRKP. The bla and bla genes were the most prevalent resistance genes, followed by bla and bla and bla genes. Mobilized colistin-resistance genes were not detected in the isolates. The continual emergence of ST16 Col-CRKP strains is a major threat to public health worldwide due to multidrug-resistant and highly transmissible characteristics. It seems that the potential dissemination of these clones highlights the importance of appropriate monitoring and strict infection control measures to prevent the spread of resistant bacteria in hospitals.

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Concepts Keywords
Hospital Carbapenem-resistant Klebsiella pneumoniae
Iranian Carbapenemase genes
Pneumoniae Colistin resistance
Virulence Sequence type 16
Worldwide Ventilator-associated pneumonia


Type Source Name
drug DRUGBANK Colistin
disease VO report
disease MESH infections
disease MESH COVID-19 pandemic
disease IDO susceptibility
disease IDO virulence
disease MESH superinfection
disease IDO infection
disease VO Bacteria
drug DRUGBANK Trestolone
disease MESH pneumonia
pathway REACTOME Reproduction
drug DRUGBANK Coenzyme M
disease IDO pathogen
disease MESH morbidity
disease IDO production
drug DRUGBANK Amoxicillin
disease MESH point mutations
disease VO gene
disease VO effectiveness
drug DRUGBANK Meropenem
drug DRUGBANK Vaborbactam
drug DRUGBANK Imipenem
drug DRUGBANK Cilastatin
drug DRUGBANK Relebactam
drug DRUGBANK Tigecycline
disease IDO country
drug DRUGBANK Ceftazidime
drug DRUGBANK Avibactam
disease VO effective
disease MESH nosocomial infections
drug DRUGBANK Cefotaxime
drug DRUGBANK Cefepime
drug DRUGBANK Amikacin
drug DRUGBANK Gentamicin
drug DRUGBANK Ciprofloxacin
drug DRUGBANK Piperacillin
drug DRUGBANK Tazobactam
drug DRUGBANK Ampicillin
drug DRUGBANK Sulbactam
drug DRUGBANK Nitrofurantoin
disease VO inactivation
disease IDO colony
drug DRUGBANK Polyethylene glycol
disease VO IutA
disease VO protocol
disease IDO blood
disease MESH chronic kidney disease
drug DRUGBANK Tocilizumab
disease MESH pulmonary edema
disease MESH leukocytosis
disease MESH urinary tract infection
disease MESH cervicitis
drug DRUGBANK Sodium Tetradecyl Sulfate
disease VO device
disease MESH leukopenia
disease VO time
disease MESH co infection
drug DRUGBANK Hydroxyethyl Starch
drug DRUGBANK Methylergometrine
drug DRUGBANK Levofloxacin
drug DRUGBANK Linezolid
drug DRUGBANK Vancomycin
disease VO Tig
drug DRUGBANK Clindamycin
drug DRUGBANK Methyl isocyanate
disease IDO host
disease MESH Bacteremia
disease MESH liver abscess
disease MESH complications
disease IDO commensal
disease MESH bacterial infection
disease MESH Ventilator-associated pneumonia

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