Molecular Epidemiological Insights into Colistin-Resistant and Carbapenemases-Producing Clinical Klebsiella pneumoniae Isolates

Carbapenemases-producing are challenging antimicrobial therapy of hospitalised patients, which is further complicated by colistin resistance. This study describes molecular epidemiological insights into colistin-resistant and carbapenemases-producing clinical . Cultures collected from 26 hospitalise...

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Bibliographic Details
Published in:Infection and drug resistance 2019-12, Vol.12, p.3783-3795
Main Authors: Di Tella, Domiziana, Tamburro, Manuela, Guerrizio, Giuliana, Fanelli, Incoronata, Sammarco, Michela Lucia, Ripabelli, Giancarlo
Format: Article
Language:English
Subjects:
Antibacterial agents
Antibiotics
Antimicrobial agents
antimicrobial resistance
Beta lactamases
Biotechnology industries
Carbapenemase
Carbapenems
central italy
Colistin
Deoxyribonucleic acid
DNA
Drug resistance
Electrophoresis
Epidemics
Epidemiology
Gel electrophoresis
Genes
genetic relatedness
Genomics
Health aspects
hospital infections
Imipenem
Klebsiella pneumoniae
Laboratories
Meropenem
mgrb gene
Microbial drug resistance
Minimum inhibitory concentration
Multidrug resistance
Multilocus sequence typing
Mutation
Nosocomial infections
Novels
Original Research
Pathogens
Patients
Phenotypes
Pneumonia
Pulsed-field gel electrophoresis
Surveillance
Tazobactam
Tigecycline
Transposons
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Summary:Carbapenemases-producing are challenging antimicrobial therapy of hospitalised patients, which is further complicated by colistin resistance. This study describes molecular epidemiological insights into colistin-resistant and carbapenemases-producing clinical . Cultures collected from 26 hospitalised patients during 2014-2017 in the main hospital in Molise Region, central Italy, were characterized. The minimum inhibitory concentration for 19 antibiotics was determined, including carbapenems and colistin. Prevalence of resistance-associated genes was investigated through PCR, detecting , , , , , , , , , and -1,2,3,4,5,6,7,8. The B gene was also analysed in colistin-resistant strains by PCR and sequencing assays. were typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Twenty out of 26 were phenotypically resistant to carbapenems and 19 were resistant to colistin. All isolates harbored , and and were further the most common resistance-associated genes. In colistin-resistant strains, -1,2,3,4,5,6,7,8 variants were not detected, while mutations and insertion elements in B were observed in 68.4% (n=13) in 31.6% (n=6) isolates, respectively. PFGE revealed 12 clusters and 18 pulsotypes at 85% and 95% cut-off, while the Sequence Types ST512 (n=13, 50%), ST101 (n=10, 38.5%), ST307 (n=2, 7.7%) plus a novel ST were detected using MLST. All showed a multidrug-resistant phenotype, particularly to carbapenems and colistin. According to national data, was the prevailing carbapenemase, followed by , while and were among the most frequent beta-lactamases. Consistent with previous reports in Italy, ST512 was the most common clone, particularly during 2014-15, whilst ST101 became dominant in 2016-17. Colistin resistance was mainly associated with deleterious mutations and transposon in the B gene. Improvements of surveillance, compliance with infection prevention procedures and antimicrobial stewardship are essential to limit the spread of resistant
ISSN:1178-6973
1178-6973
DOI:10.2147/IDR.S226416