Chaitra Shankar1, Jobin John Jacob1, Suganya Gopal Sugumar1, Lavanya Natarajan1, Camilla Rodrigues2, Purva Mathur3, Dip Narayan Mukherjee4, Anita Sharma5, D S Chitnis6, Anudita Bharagava7, Abi Manesh8, Karthik Gunasekaran9, Balaji Veeraraghavan1. 1. Department of Clinical Microbiology, Christian Medical College, Vellore, Tamil Nadu, India. 2. Department of Laboratory Medicine, All India Institute of Medical Sciences Trauma Centre, New Delhi, India. 3. Microbiology Section, Department of Laboratory Medicine, P.D. Hinduja Hospital and Research Centre, Mumbai, India. 4. Department of Microbiology, Woodlands Multispeciality Hospital, Kolkata, West Bengal, India. 5. Department of Laboratory Medicine, Fortis Hospital, Mohali, Chandigarh, India. 6. Department of Microbiology and Immunology, Choithram Hospital, Indore, Madhya Pradesh, India. 7. Department of Microbiology, All India Institute of Medical Sciences, Raipur, India. 8. Department of Infectious Diseases, Christian Medical College, Vellore, Tamil Nadu, India. 9. Department of Medicine, Christian Medical College, Vellore, Tamil Nadu, India.
Abstract
Background: Klebsiella pneumoniae (Kp), a common multidrug-resistant pathogen, causes a wide spectrum of nosocomial infections with high rates of morbidity and mortality. The emergence of pan drug-resistant international high-risk clones such as ST258, ST14, ST15, ST147, and ST101 is a global concern. This study was performed to investigate the carbapenemases, the plasmid profile, and the clonal relationship among Indian K. pneumoniae. Materials and Methods: A total of 290 K. pneumoniae isolates from seven centers in India were characterized to determine sequence types (STs) and carbapenemases. A subset of isolates was subjected to whole genome sequencing and hybrid genome assembly to obtain the complete genome. Plasmids carrying carbapenemases were characterized to determine the dissemination of carbapenem-resistant (CR) K. pneumoniae. Results: From this study, 75 different STs were observed with ST231 being predominant. About 79% of the analyzed isolates were CR with 59% (n = 136) producing OXA48-like carbapenemases. While ST231 was the predominant clone among the OXA48-like producers; NDM producers and NDM+OXA48-like producers were mostly associated with ST14. Interestingly, 61% (n = 138) of the total CR K. pneumoniae were colistin resistant, belonging to 22 different STs. Plasmid profiling shows that blaOXA48-like was exclusively carried by ColKP3, whereas blaNDM was associated with IncFII-like plasmids. Conclusion: The highly mosaic genome of K. pneumoniae coupled with the diverse ecological niches in India makes it a hotspot for antimicrobial resistance, leading to increased morbidity and mortality. Extensive molecular surveillance of the clonal spread of K. pneumoniae could help in understanding AMR dynamics and thus rework therapeutic management.
Background: Klebsiella pneumoniae (Kp), a common multidrug-resistant pathogen, causes a wide spectrum of nosocomial infections with high rates of morbidity and mortality. The emergence of pan drug-resistant international high-risk clones such as ST258, ST14, ST15, ST147, and ST101 is a global concern. This study was performed to investigate the carbapenemases, the plasmid profile, and the clonal relationship among Indian K. pneumoniae. Materials and Methods: A total of 290 K. pneumoniae isolates from seven centers in India were characterized to determine sequence types (STs) and carbapenemases. A subset of isolates was subjected to whole genome sequencing and hybrid genome assembly to obtain the complete genome. Plasmids carrying carbapenemases were characterized to determine the dissemination of carbapenem-resistant (CR) K. pneumoniae. Results: From this study, 75 different STs were observed with ST231 being predominant. About 79% of the analyzed isolates were CR with 59% (n = 136) producing OXA48-like carbapenemases. While ST231 was the predominant clone among the OXA48-like producers; NDM producers and NDM+OXA48-like producers were mostly associated with ST14. Interestingly, 61% (n = 138) of the total CR K. pneumoniae were colistin resistant, belonging to 22 different STs. Plasmid profiling shows that blaOXA48-like was exclusively carried by ColKP3, whereas blaNDM was associated with IncFII-like plasmids. Conclusion: The highly mosaic genome of K. pneumoniae coupled with the diverse ecological niches in India makes it a hotspot for antimicrobial resistance, leading to increased morbidity and mortality. Extensive molecular surveillance of the clonal spread of K. pneumoniae could help in understanding AMR dynamics and thus rework therapeutic management.
Entities:
Keywords:
India; K. pneumoniae; MLST; OXA48-like; ST23; ST231; colistin