Characterization of an emergent high-risk KPC-producing Klebsiella pneumoniae lineage causing a fatal wound infection after spine surgery

• Published in: Infection, genetics and evolution genetics and evolution, 2021-12, Vol.96, p.105122-105122, Article 105122
• Main Authors: Boff, Luana, de Sousa Duarte, Humberlânia, Kraychete, Gabriela Bergiante, de Castro Santos, Mayara Gil, Vommaro, Rossiane Claudia, Lima, Carla Ormund Gonçalves Ximenes, Lima-Morales, Daiana, Wink, Priscila Lamb, de Oliveira Ferreira, Eliane, Picao, Renata Cristina, da Rocha, Vinícius Magno
• Format: Article
• Language: English
• Subjects: Aged; Biofilm; Carbapenemase; Drug Resistance, Multiple, Bacterial; Fatal Outcome; Female; High-risk clone; Humans; Klebsiella Infections - drug therapy; Klebsiella Infections - microbiology; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; KPC-2; Spine - surgery; ST16; Surgical Wound Infection - drug therapy; Surgical Wound Infection - microbiology; Wound Infection - drug therapy; Wound Infection - microbiology
• ISSN: 1567-1348; 1567-7257
• DOI: 10.1016/j.meegid.2021.105122

Surgical site infections in instrumented posterior lumbar interbody fusion surgery are normally due to gram-positive bacteria, but gram-negative bacteria can cause infections in cases involving lower lumbar interventions as its closer to the perianal area. Here we report an uncommon fatal wound infection caused by a multidrug-resistant Klebsiella pneumoniae after an elective spine surgery. In silico analysis revealed that LWI_ST16 belonged to ST16, an emergent international clone notable for its increased virulence potential. We also observed that this strain carried a conjugative IncF plasmid encoding resistance genes to beta-lactams (blaKPC-2 and blaOXA-1), tetracycline (tetA), aminoglycosides and fluoroquinolones (aac(6′)-Ib-cr). The carbapenemase encoding gene blaKPC-2 was located on a Tn4401e transposon previously characterized to increase blaKPC expression. LWI_ST16 is a strong biofilm producer on polystyrene and capable of forming tower-like structures on a titanium device like the one inserted in the patient's spine. Our findings strengthen the valuable contribution of continuous surveillance of multidrug-resistant and high-risk K. pneumoniae clones to avoid unfavourable clinical outcomes. •A blaKPC-2-carrying Klebsiella pneumoniae caused a surgical site infection.•The strain belonged to ST16 frequently associated with increased virulence potential.•blaKPC-2 was inserted in a Tn4401e transposon within an IncF conjugative plasmid.•It formed a strong biofilm on the metallic device like the one used in surgery.