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The emergence of carbapenem-resistant  Klebsiella pneumoniae  (CRKP) often responsible for numerous hospital-associated outbreaks has become an important public health problem. From January 2013 to February 2014, a total of 41 non-duplicate  K. pneumoniae  isolates with carbapenem resistance, were collected at a tertiary teaching hospital in Nanchang, central China. Among 41  K. pneumoniae  isolates, 28 were isolated from hospitalized patients including 19 from the patients in surgery intensive care unit (SICU) and 13 were isolated from ventilators. Twenty-four of 28 patients infected by CRKP have been submitted to mechanical ventilation using ventilator. More than 95% of the CRKP isolates were resistant to 13 antimicrobials tested. All CRKP isolates were confirmed as carbapenemase producer and were positive for  bla  KPC-2 , with one positive for both  bla KPC-2   and  bla  NDM-1 . All carbapenemase-producing isolates harbored at least one of extended spectrum β-lactamase genes tested, among which 95.1% (39/41) of the tested isolates were found to harbor both  bla  CTX-M-24  and  bla  KPC-2 , Of note, one isolate harbored simultaneously two carbapenemase genes ( bla  KPC-2  and  bla  NDM-1 ) and two ESBL genes ( bla  CTX-M-3  and  bla  TEM-104 ). To the best of our knowledge, coexistence of  bla  KPC-2  and  bla  CTX-M-24  in one isolate is first reported. MLST results showed that 41 CRKP isolates belonged to four sequence types (STs) including ST11, novel ST1854, novel ST1855, and ST1224. PFGE results displayed three PFGE clusters. Thirty-eight ST11 CRKP isolates (92.7%, 38/41) including all 13 isolates from ventilators and 25 isolates from patients from seven wards (18 from SICU) belonged to same PFGE cluster, indicating these isolates were clonally related. Fifteen isolates have an identical undistinguished pattern (100% similarity) forming a single clonal population. Moreover, this clone was exclusively linked to the cases attended in SICU and linked to the Ventilators. Additionally, the other SICU cases were linked to closely related clones (similarity greater than 95%). These data indicated that the occurrence of a clonal outbreak associated with ventilators has been found. In conclusion, outbreak by ventilator-associated ST11  K. pneumoniae  with co-production of CTX-M-24 and KPC-2 is found in a SICU of a tertiary teaching hospital in central China.

frontiers in microbiology

Outbreak by Ventilator-Associated ST11 K. pneumoniae with Co-production of CTX-M-24 and KPC-2 in a SICU of a Tertiary Teaching Hospital in Central China