NDM-5-producing carbapenem-resistant Klebsiella pneumoniae of sequence type 789 emerged as a threat for neonates: a multicentre, genome-based study

Klebsiella pneumoniae is a major human pathogen. Carbapenems are the main agents of choice to treat severe K. pneumoniae infections, but carbapenem-resistant K. pneumoniae (CRKP) have emerged as a major global problem. Novel high-risk CRKP lineages are continuously emerging, but those associated with neonatal infections are under-researched. In this study, we identified a common CRKP lineage carrying the bla(NDM-5) carbapenemase-encoding gene belonging to sequence type 789 (ST789) based on analysis of the genome sequences of 28 isolates, including 27 clinical isolates from neonates and 1 isolate from a sink recovered in 2019 from multiple hospitals in Chengdu, southwest China. Isolates of this lineage caused various infections (pneumonia, bloodstream infection and urinary tract infection) in neonates and had circulated in and been transmitted between neonatal intensive care units of multiple local hospitals for several years. Its emergence was likely due to clonal expansion after acquiring a bla(NDM-5)-carrying self-transmissible IncX3 plasmid. Genome clock analysis dated the emergence of this lineage to December 2016 (95% confidence interval, January 2015 to December 2017). The above findings highlight that CRKP lineages in neonates and adults may differ. This ST789 bla(NDM-5)-carrying CRKP lineage represents a new, emerging threat for neonates and warrants rigorous monitoring. (c) 2021 Elsevier Ltd and International Society of Antimicrobial Chemotherapy. All rights reserved.

Automated summary

This study identified a common carbapenem-resistant Klebsiella pneumoniae (CRKP) lineage in neonates that caused various infections and had been circulating in multiple hospitals for several years. The emergence of this lineage was likely due to the acquisition of a self-transmissible carbapenemase-encoding gene. The findings highlight the potential differences between CRKP lineages in neonates and adults.