Journal
JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Volume 76, Issue 2, Pages 345-354Publisher
OXFORD UNIV PRESS
DOI: 10.1093/jac/dkaa459
Keywords
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Funding
- Instituto de Salud Carlos III, Subdireccion General de Redes y Centros de Investigacion Cooperativa, Ministerio de Economia y Competitividad, Spanish Network for Research in Infectious Diseases [REIPI RD16/0016/0010]
- 2017 call for Strategic Action on Health [PI17/01932]
- European Development Regional Fund 'A way to achieve Europe'
- operative programme Intelligent Growth 2014-2020
- Departament d'Universitats, Recerca i Societat de la Informacio, of the Generalitat de Catalunya [2017 SGR 0809]
- Spanish Ministry of Education, Culture and Sports [FPU 14/06357, FPU 13/02564]
- Department of Health, Generalitat de Catalunya [SLT002/16/00349]
- Spanish Ministry of Science, Innovation and Universities [CEX2018-000806-S]
- Generalitat de Catalunya
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This study identified the inter-hospital dissemination of carbapenem-resistant high-risk clones of Klebsiella pneumoniae and Escherichia coli in Catalonia, Spain. The isolates were found to carry small transferable plasmids containing bla(NDM) genes, with most showing multidrug resistance and NDM production. The main clone belonged to ST147 and co-produced NDM-1 and CTX-M-15, with a few isolates also carrying bla(OXA-48).
Objectives: To characterize the clonal spread of carbapenem-resistant Klebsiella pneumoniae and Escherichia coli isolates between different healthcare institutions in Catalonia, Spain. Methods: Antimicrobial susceptibility was tested by disc diffusion. MICs were determined by gradient diffusion or broth microdilution. Carbapenemase production was confirmed by Lateral flow. PCR and Sanger sequencing were used to identify the allelic variants of resistance genes. Clonality studies were performed by PFGE and MLST. Plasmid typing, conjugation assays, S1-PFGE plus Southern blotting and MinION Oxford Nanopore sequencing were used to characterize resistance plasmids. Results: Twenty-nine carbapenem-resistant isolates recovered from three healthcare institutions between January and November 2016 were included: 14 K. pneumoniae isolates from a tertiary hospital in the south of Catalonia (hospital A); 2 K. pneumoniae isolates from a nearby healthcare centre; and 12 K. pneumoniae isolates and 1 E. coli isolate from a tertiary hospital in Barcelona (hospital B). The majority of isolates were resistant to all antimicrobial agents, except colistin, and all were NDM producers. PFGE identified a major K. pneumoniae clone (n = 27) belonging to ST147 and co-producing NDM-1 and CTX-M-15, with a few isolates also harbouring bla(OXA-48). Two sporadic isolates of K. pneumoniae ST307 and E. coli ST167 producing NDM-7 were also identified. bla(OXA-48). was carried in two related IncR plasmid populations and bla(NDM)(-1) in a conjugative 50 kb IncX3 plasmid. Conclusions: We report the inter-hospital dissemination of XDR high-risk clones of K. pneumoniae and E. coli associated with the carriage of small, transferable plasmids harbouring bla(NDM) genes.
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