Clonal spread of carbapenem-resistant Klebsiella pneumoniae among patients at admission and discharge at a Vietnamese neonatal intensive care unit

Antimicrobial Resistance & Infection Control

Lennart E. Nilsson¹  Björn Berglund¹  Maria Tärnberg¹  Elin Bornefall¹  Maud Nilsson¹  Ludwig Lundberg²  Håkan Hanberger³  Jenny Welander⁴  Mattias Larsson⁵  Linus Olson⁶  Tran Minh Dien⁷  Ngai Kien Le⁷  Ngoc Thi Bich Hoang⁷  Dung Thi Khanh Khu⁸  Hai Thanh Le⁸ 

[1] Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden;Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden;Department of Molecular Sciences, Swedish University of Agricultural Sciences, Uppsala, Sweden;Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden;Training and Research Academic Collaboration (TRAC) – Sweden – Vietnam, Hanoi, Vietnam;Department of Clinical Microbiology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden;Training and Research Academic Collaboration (TRAC) – Sweden – Vietnam, Hanoi, Vietnam;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Training and Research Academic Collaboration (TRAC) – Sweden – Vietnam, Hanoi, Vietnam;Department of Global Public Health, Karolinska Institutet, Stockholm, Sweden;Department of Women and Children’s Health, Karolinska Institutet, Stockholm, Sweden;Vietnam National Children’s Hospital, Hanoi, Vietnam;Vietnam National Children’s Hospital, Hanoi, Vietnam;Training and Research Academic Collaboration (TRAC) – Sweden – Vietnam, Hanoi, Vietnam;

关键词: Klebsiella pneumoniae;    Carbapenem resistance;    Carbapenemase;    Hospital-acquired infection;    Colonisation;    Vietnam;    Next-generation sequencing;   

DOI  :  10.1186/s13756-021-01033-3

来源: Springer

【 摘 要 】

BackgroundThe increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is a growing problem globally, particularly in low- to middle-income countries (LMICs). Previous studies have shown high rates of CRE colonisation among patients at hospitals in LMICs, with increased risk of hospital-acquired infections.MethodsWe isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) from faecal samples collected in 2017 from patients at admission and discharge at a Vietnamese neonatal intensive care unit (NICU). 126 CRKP were whole-genome sequenced. The phylogenetic relationship between the isolates and between clinical CRKP isolates collected in 2012–2018 at the same hospital were investigated.ResultsNDM-type carbapenemase-(61%) and KPC-2-encoding genes (41%) were the most common carbapenem resistance genes observed among the admission and discharge isolates. Most isolates (56%) belonged to three distinct clonal clusters of ST15, carrying blaKPC-2, blaNDM-1 and blaNDM-4, respectively. Each cluster also comprised clinical isolates from blood collected at the study hospital. The most dominant ST15 clone was shown to be related to isolates collected from the same hospital as far back as in 2012.ConclusionsHighly resistant CRKP were found colonising admission and discharge patients at a Vietnamese NICU, emphasising the importance of continued monitoring. Whole-genome sequencing revealed a population of CRKP consisting mostly of ST15 isolates in three clonally related clusters, each related to blood isolates collected from the same hospital. Furthermore, clinical isolates collected from previous years (dating back to 2012) were shown to likely be clonally descended from ST15 isolates in the largest cluster, suggesting a successful hospital strain which can colonise inpatients.

【 授权许可】

CC BY