Genomic surveillance of carbapenem-resistant Klebsiella pneumoniae reveals a prolonged outbreak of extensively drug-resistant ST147 NDM-1 during the COVID-19 pandemic in the Apulia region (Southern Italy).

Autor: Loconsole D; Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, Bari, Italy., Sallustio A; Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy., Sacco D; Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, Bari, Italy., Santantonio M; Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy., Casulli D; Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy., Gatti D; Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy., Accogli M; Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy., Parisi A; Experimental Zooprophylactic Institute of Apulia and Basilicata, Foggia, Italy., Zagaria R; Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, Bari, Italy., Colella V; Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, Bari, Italy., Centrone F; Hygiene Unit, Azienda Ospedaliero-Universitaria Consorziale Policlinico di Bari, Bari, Italy., Chironna M; Department of Interdisciplinary Medicine, Hygiene Section, University of Bari, Bari, Italy. Electronic address: maria.chironna@uniba.it.
Jazyk: angličtina
Zdroj: Journal of global antimicrobial resistance [J Glob Antimicrob Resist] 2024 Mar; Vol. 36, pp. 260-266. Date of Electronic Publication: 2024 Jan 26.
DOI: 10.1016/j.jgar.2024.01.015
Abstrakt: Objectives: The recent worldwide spread of New Delhi metallo-beta-lactamase-producing Klebsiella pneumoniae (NDM-KP) in health-care settings remains a concern. The aim of the study was to describe an outbreak of extensively drug-resistant ST147 NDM-1-KP in the Apulia region of Southern Italy that occurred between 2020 and 2022 through genomic surveillance of carbapenem-resistant Enterobacterales.
Methods: A total of 459 carbapenem-resistant KP isolates collected from patients hospitalised with bloodstream infections were tested using a commercial multiplex real-time polymerase chain reaction to identify carbapenemase genes. A subset of 27 isolates was subjected to whole-genome sequencing. Core-genome multilocus sequence typing was performed by analysing a panel of 4884 genes.
Results: Molecular testing revealed that 104 (22.6%) isolates carried the carbapenemase NDM gene. Phylogenetic analysis of the 27 isolates subjected to whole-genome sequencing revealed high genetic relatedness among strains. All isolates were resistant to all first-line antibiotics. Virulome analysis identified the ybt locus, the two well-recognised virulence factors iucABCDiutA and rmpA, and the genes encoding the type 3 pilus virulence factor. Plasmids IncFIB(pkPHS1), IncFIB(pNDM-Mar), IncFIB(pQil), IncHI1B(pNDM-MAR), IncR, and Col(pHAD28) were identified in all isolates. Moreover, further analysis identified the IncFIB-type plasmid carrying the NDM-1 genes.
Conclusion: The increasing circulation of extensively drug-resistant NDM-1 ST147 KP strains in Southern Italy in recent years is worrisome, because these clones pose a real risk, particularly in hospital settings. Genomic surveillance is a crucial tool for early identification of emerging threats such as the spread of high-risk pathogens. Rapid infection control measures and antimicrobial stewardship are key to preventing further spread of hypervirulent KP strains.
(Copyright © 2024 The Author(s). Published by Elsevier Ltd.. All rights reserved.)
Databáze: MEDLINE
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