Concurrent emergence of multidrug resistance and heat resistance by CTX-M-15-encoding conjugative plasmids in Klebsiella pneumoniae.

A plasmid-encoded ClpK protein was recently identified as a predictor of a heat-resistant phenotype in the opportunistic pathogen Klebsiella pneumoniae. This study was undertaken to evaluate the presence of the clpK gene in extended-spectrum β-lactamase (ESBL)-producing K. pneumoniae and to assess the probable co-transfer of multi-resistance with the heat resistance phenotype. A Danish collection of 80 ESBL-producing K. pneumoniae bloodstream infection isolates was screened for clpK by colony hybridization. Nineteen isolates (24%) were positive for clpK; some of them representing major clones identified in Denmark. Among these, nine isolates belonged to a single K. pneumoniae CTX-M-15 clone with sequence type (ST)16 exhibiting a heat-resistant phenotype. This clone has a multi-hospital occurrence and has also been detected outside Denmark. Horizontal co-transfer of multiple antibiotic resistances, including the CTX-M-15 resistance determinant, and the heat resistance phenotype was observed. Thus, the clpK gene is harbored by different ESBL-producing K. pneumoniae isolates including a clone of ST16 internationally spread. The co-localization of clpK on transferable ESBL-encoding plasmids allowing co-dissemination of multiple drug resistance with bacterial heat resistance is a highly interesting phenomenon that may further complicate the prevention of spreading of certain successful clones of multi-resistant K. pneumoniae.