Emergence of clinical isolates of highly carbapenem-resistant Klebsiella pneumoniae co-harboring blaNDM-5 and blaOXA-181 or-232 in Nepal

Objectives: The aim of this study was to describe the emergence in Nepal of clinical isolates of Klebsiella pneumoniae harboring both bla(NDM-5) and bla(OXA-181/-232). Methods: Six clinical isolates of K. pneumoniae highly resistant to carbapenems and aminoglycosides were obtained from inpatients in Nepal. Their whole genomes were sequenced by a next generation sequencer. Results: The minimum inhibitory concentrations of meropenem, amikacin and ciprofloxacin were >= 128 mu g/ml, >1024 mu g/ml and >= 256 mu g/ml, respectively. All six isolates co-harbored bla(NDM-5), bla(OXA-181) or -232 and rmtB. Of them, 1 also harbored rmtF. The bla(NDM-5), bla(OXA-232) and rmtB in all six isolates were located on plasmids. Of the six isolates tested, one isolate harbored two copies of bla(OXA-181) and rmtF on the chromosome. Conclusions: This is the first report of clinical isolates of K. pneumoniae co-harboring bla(NDM-5), bla(OXA-181) or -232 and rmtB in Nepal. These strains were highly carbapenem-and aminoglycoside-resistant, and belonged to ST147 or ST395. Of them, ST147 isolate harbored two copies of bla(OXA-181) on the chromosome. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Infectious Diseases.