One-year surveillance for hypervirulent Klebsiella pneumoniae detected carbapenem-resistant superbugs

Microbiology Spectrum, Journal Year: 2024, Volume and Issue: 12(3)

Published: Jan. 30, 2024

ABSTRACT Hypervirulent Klebsiella pneumoniae (hvKp) can cause infections in clinically healthy people, such as young and immunocompetent patients. Genes involved the capsule synthesis or those encoding siderophores have been adopted predictors of hvKp. Certain sequence types, ST23 ST86, associated with hvKp strains, too. The aim this study was to investigate presence among 354 K. strains isolated from clinical samples patients admitted an Italian 900-bed hospital between 21 May 2021 April 2022. All isolates were screened by PCR for amplification virulence loci. Whole genome sequencing performed tested positive at least one target gene. Thirteen out (3.7%) Five wild type belonged hypervirulent clones ST23, ST5, ST375 new clone ST6310. Six carried blaKPC gene: three ST101, two ST512, ST395. Two ST147 blaNDM Although isolation is not frequent, their should be systematically investigated avoid spreading both virulent combined increase resistance antibiotics. PCR-based protocols are essential surveillance these which do always show a recognizable phenotype. Moreover, also without history recent foreign travels, indicating increased well underestimated circulation so far. IMPORTANCE healthcare-associated pathogen frequently resistant spread primary site infection multiple sites causing life-threatening otherwise individuals. This described 13 large tertiary over 1-year period. Among them, eight multidrug hypervirulent. still rare Italy, particularly concerning since they difficult-to-treat infections. all string test, phenotypically detectable. Molecular biology techniques next generation therefore necessary detection isolates, programs exploiting molecular highly desirable.

Language: Английский

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Risk of death in Klebsiella pneumoniae bloodstream infections is associated with specific phylogenetic lineages

Journal of Infection, Journal Year: 2024, Volume and Issue: 88(5), P. 106155 - 106155

Published: April 2, 2024

BackgroundKlebsiella pneumoniae species complex (KpSC) bloodstream infections (BSIs) are associated with considerable morbidity and mortality, particularly in elderly multimorbid patients. Multidrug resistant (MDR) strains have been poorer outcome. However, the clinical impact of KpSC phylogenetic lineages on BSI outcome is unclear.MethodsIn an 18-month nationwide Norwegian prospective study episodes adults, we used whole genome sequencing to describe molecular epidemiology KpSC, multivariable Cox regression analysis including data determine adjusted hazard ratios (aHR) for death specific genomic lineages.FindingsWe included 1078 1082 bacterial isolates from 1055 The overall 30-day case-fatality rate (CFR) was 12.5%. Median patient age 73.4, 61.7% patients were male. Charlson comorbidity score 3. Klebsiella sensu stricto (Kp) (79.3%, n=858/1082) K. variicola (15.7%, n=170/1082) dominating phylogroups. Global MDR-associated Kp clonal groups (CGs) prevalent (25.0%, n=270/1082) but 78.9% (n=213/270) not MDR, 53.7% (n=145/270) community acquired. major findings increased risk within 30 days monomicrobial BSIs caused by (CFR 16.9%, n=21; aHR 1.86, CI 1.10-3.17, p=0.02), global CGs 17.0%, n=36; 1.52, 0.98-2.38, p=0.06) compared MDR 10.1%, n=46).ConclusionBacterial traits, beyond antimicrobial resistance, a BSIs. spread driven other mechanisms than antibiotic selection alone. Further insights into virulence determinants, their association needed better understand infection

Language: Английский

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Genomic insights unveil the plasmid transfer mechanism and epidemiology of hypervirulent Klebsiella pneumoniae in Vietnam

Nature Communications, Journal Year: 2024, Volume and Issue: 15(1)

Published: May 17, 2024

Hypervirulent Klebsiella pneumoniae (hvKp) is a significant cause of severe invasive infections in Vietnam, yet data on its epidemiology, population structure and dynamics are scarce. We screened hvKp isolates from patients with bloodstream (BSIs) at tertiary infectious diseases hospital Vietnam healthy individuals, followed by whole genome sequencing plasmid analysis. Among 700 BSI-causing Kp strains, 100 (14.3%) were hvKp. Thirteen identified 350 rectal swabs adults; none 500 children. The genetically diverse, encompassing 17 sequence types (STs), predominantly ST23, ST86 ST65. the 113 isolates, 14 (12.6%) carried least one antimicrobial resistance (AMR) gene, largely mediated IncFII, IncR, IncA/C plasmids. Notably, acquisition AMR conjugative plasmids facilitated horizontal transfer non-conjugative virulence between K. strains. Phylogenetic analysis demonstrated BSIs human carriage clustered together, suggesting role intestinal transmission. Enhanced surveillance crucial to understand factors driving transmission for informing preventive measures. Furthermore, we advocate clinical use our molecular assay diagnosing guide effective management.

Language: Английский

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One health: a structured review and commentary on trends and themes

One Health Outlook, Journal Year: 2024, Volume and Issue: 6(1)

Published: Aug. 14, 2024

Abstract Background One Health (OH) is defined as a unifying approach aiming to sustainably balance and optimise the health of people, animals ecosystem. It recognises that humans, (both domestic wild), plants wider ecosystem are both interdependent linked. As concept, it aims address complex problems requiring input from multiple disciplines. Suitable issues for OH approaches typically include global which can widely impact not only humans animals, but also have significant environmental impact. Examples emerging zoonotic diseases antimicrobial resistance (AMR). Interpretations use term differ in literature potential dilute its The meaning among research community has evolved over time. Here, we collate relevant last two decades, identifying major themes trends considering how been embraced differently across various geographical regions. Methods results Bibliographic databases were searched using “One Health” AND (“Veterinary” OR “Animal”) (“Medicine” “Human”) (“Environment” “Ecosystem”) during period between 1980 2022. Data analysis narrative synthesis identified themes, similarities, differences within literature. Web Science PubMed returned 948 1250 mentioned above. predominant focused on human health, with veterinary second, although often benefit health. was found utilised public approach, generally towards end disease surveillance control. Interestingly, while authors low- middle-income countries well-represented studies OH, they less corresponding authors. Conclusions focus implying human-orientated, despite suggestion all domains share common ‘health’. Potential improvement could be achieved through greater incorporation social sciences more encompassing approach.

Language: Английский

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Within–patient and global evolutionary dynamics of Klebsiella pneumoniae ST17

Microbial Genomics, Journal Year: 2023, Volume and Issue: 9(5)

Published: May 18, 2023

Klebsiella pneumoniae sequence type (ST) 17 is a global problem clone that causes multidrug-resistant (MDR) hospital infections worldwide. In 2008-2009, an outbreak of MDR ST17 occurred at neonatal intensive care unit (NICU) in Stavanger, Norway. Fifty-seven children were colonized. We observed intestinal persistence all the for up to two years after discharge. Here, we investigated within-host evolution 45 those during long-term colonization and compared with 254 strains. Ninety-two outbreak-related isolates whole-genome sequenced. They had capsule locus KL25, O O5 carried yersiniabactin. During remained stable few single nucleotide polymorphisms, no acquisition antimicrobial resistance (AMR) or virulence determinants, persistent carriage blaCTX-M-15-encoding IncFII(K) IncFIB(K) plasmid (pKp2177_1). The collection included from 1993 2020 34 countries, human infection (41.3%), (39.3%) respiratory specimens (7.3%), animals (9.3%), environment (2.7%). estimate emerged mid-to-late 19th century (1859, 95 % HPD 1763-1939) diversified through recombinations K loci form several sublineages, various AMR genes, plasmids. There was limited evidence genes any these lineages. A globally disseminated sublineage KL25/O5 accounted 52.7 genomes. It monophyletic subclade mid-1980s, which comprised Stavanger NICU 10 genomes three other pKp2177_1. also KL155/OL101 2000s. Three clonal expansions identified; healthcare-associated either yersiniabactin and/or To conclude, associated opportunistic hospital-acquired infections. contributes burden infections, but many diverse lineages persist without acquired AMR. hypothesize non-human sources may play crucial role severe vulnerable patients, such as preterm neonates.

Language: Английский

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Exploiting genomics for antimicrobial resistance surveillance at One Health interfaces

The Lancet Microbe, Journal Year: 2023, Volume and Issue: 4(12), P. e1056 - e1062

Published: Nov. 14, 2023

The intersection of human, animal, and ecosystem health at One Health interfaces is recognised as being key importance in the evolution spread antimicrobial resistance (AMR) represents an important, yet rarely realised opportunity to undertake vital AMR surveillance. A working group international experts pathogen genomics, AMR, convened take part a workshop series online consultation focused on opportunities challenges facing genomic surveillance range settings. Here we outline group's discussion potential utility, advantages of, barriers to, implementation propose recommendations for addressing these challenges. Embedding will require development clear beneficial use cases, especially low-income middle-income countries. Evidence directionality, risks human animal health, trade implications were also identified by issues. Addressing be enable technology reach its full assessing risk transmission between environment, animals, humans interfaces.

Language: Английский

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Decoding Klebsiella pneumoniae in poultry chain: unveiling genetic landscape, antibiotic resistance, and biocide tolerance in non-clinical reservoirs

Frontiers in Microbiology, Journal Year: 2024, Volume and Issue: 15

Published: April 12, 2024

The rise of antibiotic resistance in the food chain is influenced by use antimicrobial agents, such as antibiotics, metals, and biocides, throughout entire farm-to-fork continuum. Besides, non-clinical reservoirs potentially contribute to transmission critical pathogens multidrug-resistant (MDR) Klebsiella pneumoniae . However, limited knowledge exists about population structure genomic diversity K. circulating conventional poultry production. We conducted a comprehensive characterization across whole chicken production (7 farms; 14 flocks + environment meat, 56 samples; 2019–2022), exploring factors beyond like copper quaternary ammonium compounds (QACs). Clonal adaptive features were characterized through cultural, molecular (FT-IR), whole-genome-sequencing (WGS) approaches. All except one flock positive for with significant increase ( p < 0.05) from early n = 1/14) pre-slaughter 11/14) stages, most 6/7) persisting meat batches. Colistin-resistant rates low (4%- 1/24 samples), while samples carried MDR strains (67%- 16/24) copper-tolerant isolates (63%- 15/24, sil pco gene clusters; MIC CuSO4 ≥ 16 mM), particularly at pre-slaughter. Benzalkonium chloride consistently exhibited activity against (MIC/MBC range 4–64 mg/L) representative independently presence or absence genes linked QACs tolerance. A polyclonal population, discriminated FT-IR WGS, included various lineages dispersed chicken’s lifecycle farm (ST29-KL124, ST11-KL106, ST15-KL19, ST1228-KL38), until (ST1-KL19, ST11-KL111, ST6405-KL109, ST6406-CG147-KL111), over years (ST631-49 KL109, ST6651-KL107, ST6406-CG147-KL111). Notably, some identical those human clinical isolates. WGS also revealed F-type multireplicon plasmids carrying (copper) co-located qacE Δ1 ± qacF (QACs) disseminated humans. In conclusion, farms their derived are diverse clones enriched metal tolerance genes, exhibiting genetic similarities strains. Further research imperative unravel influencing persistence dissemination within production, contributing improved safety risk management. This study underscores significance understanding interplay between control strategies sources effectively address spread resistance.

Language: Английский

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Prevalence and Phenotypic Antimicrobial Resistance among ESKAPE Bacteria and Enterobacterales Strains in Wild Birds

Antibiotics, Journal Year: 2022, Volume and Issue: 11(12), P. 1825 - 1825

Published: Dec. 15, 2022

Antimicrobial resistance (AMR) is a current public health issue globally. To counter this phenomenon and prioritize AMR in the sector, World Health Organization (WHO) published list of bacterial pathogens against which development new antimicrobial agents urgently needed, designating ESKAPE (i.e., Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species) with 'priority status'. Moreover, One High Level Expert Panel (OHHLEP) states that human closely linked to animal environmental health, thus promoting holistic approach order be prepared address possible emerging threats from human-animal-environment interface. Wild birds may host spread pathogens, integrating epidemiology infectious diseases. The aim study was examine role wild as source bacteria other antibiotic-resistant enterobacterales. A total fifty strains within group were detected 40/163 cloacal samples examined (24.5%). Additionally, different enterobacterales 88/163 (53.9%). Isolated exhibited resistance, including towards critically important antibiotics (e.g., third, fourth, fifth generation cephalosporins, fluoroquinolones) for medicine. Our results confirm are potential reservoirs several antimicrobial-resistant they could involved dissemination those across environments, resulting concerns.

Language: Английский

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The Klebsiella pneumoniae ter Operon Enhances Stress Tolerance

Infection and Immunity, Journal Year: 2023, Volume and Issue: 91(2)

Published: Jan. 18, 2023

Healthcare-acquired infections are a leading cause of disease in patients that hospitalized or long-term-care facilities. Klebsiella pneumoniae (Kp) is bacteremia, pneumonia, and urinary tract these settings. Previous studies have established the

Language: Английский

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Genotypic Evolution of Klebsiella pneumoniae Sequence Type 512 during Ceftazidime/Avibactam, Meropenem/Vaborbactam, and Cefiderocol Treatment, Italy

Emerging infectious diseases, Journal Year: 2023, Volume and Issue: 29(11)

Published: Oct. 20, 2023

In February 2022, a critically ill patient colonized with carbapenem-resistant K. pneumoniae producing KPC-3 and VIM-1 carbapenemases was hospitalized for SARS-CoV-2 in the intensive care unit of Policlinico Umberto I hospital Rome, Italy. During 95 days hospitalization, ceftazidime/avibactam, meropenem/vaborbactam, cefiderocol were administered consecutively to treat 3 respiratory tract infections sustained by different bacterial agents. Those therapies altered resistome sequence type 512 colonizing or infecting during hospitalization period. vivo evolution occurred through plasmid loss, outer membrane porin alteration, nonsense mutation cirA siderophore gene, resulting high levels resistance. Cross-selection can occur between treatments prescribed other infective stably colonize patient, antimicrobial-selective pressure promote progressive evolution, indicating substantial public health threat.

Language: Английский

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