Clonal Dissemination of Clinical Carbapenem-Resistant Klebsiella pneumoniae Isolates Carrying fosA3 and blaKPC-2 Coharboring Plasmids in Shandong, China
作者
Hao, YY; Zhao, XG; Zhang, C; Bai, YY; Song, Z; Lu, XL; Chen, R; Zhu, YY; Wang, YL
作者单位
[Hao, Yingying; Chen, Ran] Shandong Univ, Shandong Prov Hosp, Cheeloo Coll Med, Dept Clin Lab, Jinan, Peoples R China; [Hao, Yingying; Bai, Yuanyuan; Song, Zhen; Lu, Xinglun; Zhu, Yaoyao; Wang, Yueling] Shandong First Med Univ, Dept Clin Lab, Shandong Prov Hosp Affiliated, Jinan, Peoples R China; [Zhao, Xuguang] Peoples Hosp Shouguang City, Dept Clin Lab, Shouguang, Peoples R China; [Zhang, Cui] Feicheng Hosp, Dept Clin Lab, Shandong Guoxin Yiyang Grp, Feicheng, Peoples R China
摘要
Treatment strategies of infection by carbapenem-resistant Klebsiella pneumoniae (CRKP) are limited. Fosfomycin, a broad-spectrum antibiotic, has attracted renewed interest in combination therapy to fight K. pneumoniae infections. However, reports on fosfomycin-resistant K. pneumoniae are increasing. Among the 57 CRKP strains, 40 (70.2%) were resistant to fosfomycin. Thus, whole-genome sequencing and bioinformatics analysis were conducted to reveal molecular characteristics of fosfomycin-resistant K. pneumoniae. Twenty-three isolates coharbored fosA(kp) and fosA3, with K. pneumoniae carbapenemase (KPC)-producing ST11-KL64-wzi64-O2 (n = 13) and ST11-KL47-wzi209-OL101 (n = 8), the predominating clonal groups, while fosA3 was not detected in isolates carrying class B carbapenemase genes. Twenty-two (out of 26) ST11-KL64 strains were positive for rmpA2, of which 12 carried fosA3. Four of the 23 fosA3-positive isolates could successfully transfer their fosfomycin-resistant determinants to Escherichia coli J53Azi(R). All four strains belonged to ST11-KL47 with the same pulsed-field gel electrophoresis profile, and their transconjugants acquired fosfomycin, carbapenem, and aminoglycoside resistance. A 127-kb conjugative pCT-KPC-like hybrid plasmid (pJNKPN52_KPC_fosA) coharboring fosA3, bla(KPC-2), bla(CTX-M-65), bla(SHV-12), rmtB, and bla(TEM-1) was identified. ST11-KL64 and ST11-KL47 K. pneumoniae, with higher resistance and virulence, should be critically monitored to prevent the future dissemination of resistance.
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