An IncN-ST7 epidemic plasmid mediates the dissemination of carbapenem-resistant Klebsiella pneumoniae in a neonatal intensive care unit in China over 10 years

Wu, Weiyuan1; Wei, Sha2; Xue, Chun-xu2; Zhang, Wenjia1; Yan, Xudong3; Liu, Jinquan2; Song, Yajing2; Yang, Lin3; Lin, Haoyun1; Wu, Benqing4; Wen, Wangrong5,6; Zhou, Kai2

2023-09-01

10.1016/j.ijantimicag.2023.106921

INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS   影响因子和分区

0924-8579

1872-7913

Objectives: Carbapenem-resistant Klebsiella pneumoniae (CRKP) has widely disseminated globally, but its epidemiological characterization and clinical significance in paediatric patients are not well understood. In this study, we aimed to trace the dissemination dynamics of CRKP in the neonatal intensive care unit (NICU) of a tertiary hospital over a 10-y period. Methods: We collected 67 non-duplicate K. pneumoniae species complex isolates from the NICU with patient metadata during 2009-2018. Antimicrobial susceptibility was determined by the agar or broth microdilution method. Risk factors for CRKP-positive patients were identified by univariate and multivariate analysis. Genetic characterization was dissected by whole-genome sequencing. Plasmid transmissibility, stability, and fitness were assessed. Results: Thirty-four of 67 isolates (50.75%) were identified as CRKP. Premature rupture of membranes, gestational age, and invasive procedures are independent risk factors for CRKP-positive patients. The annual isolation rate of CRKP varied between 0% and 88.9%, and multiple clonal replacements were observed during the study period, which could be largely due to the division of the NICU. All but one CRKP produced IMP-4 carbapenemase, which was encoded by an IncN-ST7 epidemic plasmid, suggesting that the IncN-ST7 plasmid mediated the CRKP dissemination in the NICU over 10 y. The same plasmid was found in several CRKP isolates from adult patients, of which two ST17 isolates from the neurosurgery department shared a high homology with the ST17 isolates from the NICU, indicating possible crossdepartmental transmission. Conclusion: Our study highlights the urgent need for infection control measures targeting high-risk plasmids like IncN-ST7. & COPY; 2023 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.

Klebsiella pneumoniae IncN-ST7 Epidemic plasmid IMP-4 Carbapenem resistance

SCI

英语

第一 ; 通讯

National Key Ramp;D Program of China["2021YFC230 030 0","2022YFE010320 0"] ; National Natural Science Foundation of China["82172330","82002105"] ; Shenzhen Basic Research Key Project[JCYJ20200109144220704] ; Shenzhen Basic Research Project[JCYJ2019080714 4 409307]

Infectious Diseases ; Microbiology ; Pharmacology & Pharmacy

Infectious Diseases ; Microbiology ; Pharmacology & Pharmacy

WOS:001053341800001

ELSEVIER

PHARMACOLOGY & TOXICOLOGY

Web of Science

1.Southern Univ Sci & Technol, Shenzhen Peoples Hosp, Jinan Univ, Dept Lab Med,Clin Med Coll 2,Affiliated Hos 1, Shenzhen, Peoples R China
2.Southern Univ Sci & Technol, Shenzhen Inst Resp Dis, Jinan Univ,Affiliated Hosp 1, Shenzhen Peoples Hosp,Clin Med Coll 2, Shenzhen, Peoples R China
3.Southern Univ Sci & Technol, Shenzhen Peoples Hosp,Clin Med Coll 2, Jinan Univ, Dept Neonatol,Affiliated Hosp 1, Shenzhen, Peoples R China
4.Univ Chinese Acad Sci, Dept Neonatol, Shenzhen Hosp, Shenzhen, Peoples R China
5.Jinan Univ, Clin Lab Ctr, Affiliated Hosp 1, Guangzhou, Peoples R China
6.Jinan Univ, Clin Lab, Affiliated Shunde Hosp, Foshan, Peoples R China

Wu, Weiyuan,Wei, Sha,Xue, Chun-xu,et al. An IncN-ST7 epidemic plasmid mediates the dissemination of carbapenem-resistant Klebsiella pneumoniae in a neonatal intensive care unit in China over 10 years[J]. INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS,2023,62(3).

Wu, Weiyuan.,Wei, Sha.,Xue, Chun-xu.,Zhang, Wenjia.,Yan, Xudong.,...&Zhou, Kai.(2023).An IncN-ST7 epidemic plasmid mediates the dissemination of carbapenem-resistant Klebsiella pneumoniae in a neonatal intensive care unit in China over 10 years.INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS,62(3).

Wu, Weiyuan,et al."An IncN-ST7 epidemic plasmid mediates the dissemination of carbapenem-resistant Klebsiella pneumoniae in a neonatal intensive care unit in China over 10 years".INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS 62.3(2023).