Abstract
Objectives
To investigate the clinical characteristics and molecular epidemiology of CRKP infection in neonatal patients in a children’s hospital in China from 2017 to 2021.
Methods
Species identification and antibiotic susceptibilities were tested with matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) and VITEK 2 systems. The clinical data were collected from medical records. Carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates were investigated by antimicrobial susceptibility testing, carbapenemase genes and multilocus sequence typing.
Results
Six kinds of resistant genes and 23 STs were detected. BlaNDM-1 (n=83, 55.3%) was the predominant carbapenemase gene, followed by blaKPC-2 (n=45, 30.0%), blaNDM-5 (n=7, 4.7%), blaIMP-38 (n=6, 4.0%). BlaNDM-1 was predominant in 2017 and 2018, whereas blaKPC-2 increased in 2019 and became the predominant gene from 2020 to 2021. ST11 accounted for most infections (n=35, 23.3%), followed by ST278 (n=23, 15.3%), ST17 (n=17, 11. 3%) and ST2735 (n=16, 10.7%). ST278 and ST17 were predominant in 2017 and 2018, whereas ST11 increased in 2019 and became the predominant sequence type from 2020 to 2021. Compared with blaNDM-1, the CRKP strains producing blaKPC-2 were characterized by high resistance to gentamicin, amikacin and levofloxacin and the change trend of drug resistance rate before and after COVID-19 was consistent with that of blaNDM-1 and blaKPC-2.
Conclusions
The main sequence type of CRKP infection changed dynamically from ST278-NDM-1 to ST11-KPC-2 during the years 2017–2021 in the newborns. Antibiotic exposure and the prevalence of COVID-19 since 2020 may have led to changes in hospital population and lead to the changes.
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Data availability
The data presented in this study are available on reasonable request from the corresponding author.
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Acknowledgements
We thank the staff of the Institute Pasteur MLST and whole genome MLST databases for curating the data and making them publicly available at http://bigsdb.pasteur.fr.
Funding
This work was supported by the National Key Research and Development Program of China (grant numbers 2021YFC2701800，2021YFC2701805)
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Lijun Yin performed data analysis and wrote the paper. Leiyan He carried out the bacteria identification. Lijun Yin and Lu lu prepared the Tables and figures. Laishuan Wang, Guoping Lu, Yun Cao, Xiaowen Zhai and Chuanqing Wang contributed to experiment conception and design.All authors reviewed the manuscript.
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The patient informed consent was waived because only bacterial isolates recovered from routine diagnostic laboratory tests were assessed. The study was approved by the Ethics Committee of the Children's Hospital of Fudan University, Shanghai, China (approval number (2021)372).
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Yin, L., Lu, L., He, L. et al. Shift in the dominant sequence type of carbapenem-resistant Klebsiella pneumonia infection from ST278-NDM-1 to ST11-KPC-2 in neonatal patients in a children’s hospital in Shanghai, China, 2017–2021. Int Microbiol (2023). https://doi.org/10.1007/s10123-023-00436-z
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DOI: https://doi.org/10.1007/s10123-023-00436-z