Department of Microbiology, University of Health Sciences, Lahore, Pakistan.
Department of Biochemistry, King Edward Medical University, Lahore, Pakistan..
J Infect Dev Ctries. 2023 Feb 28;17(2):210-217. doi: 10.3855/jidc.17041.
Carbapenemases are primarily responsible for the intensified spread of multidrug-resistant (MDR) K. pneumoniae by virtue of antibiotics overuse. Therefore, frequent investigation of high-risk clones especially from developing world is crucial to curtail global spread.
In this observational study, 107 K. pneumoniae were retrieved and confirmed genotypically from April 2018 to March 2020 from tertiary care hospitals in Lahore, Pakistan. Carbapenemases and extended-spectrum β-lactamases were verified by Polymerase Chain Reaction and Sanger sequencing. Multilocus sequence typing and plasmid replicon typing were used to assign clonal lineages and plasmid replicons.
Among the K. pneumoniae, 72.9% (78/107) strains were carbapenem resistant (CR) with 65.4% (51/78) exhibiting carbapenemase producing phenotype. Among CR K. pneumoniae 38.5% (30/78) strains exhibited the following carbapenemase genotypes: blaNDM-1 (26.7%, 8/30), blaOXA-48 (26.7%, 8/30), blaKPC-2 (20.0%, 6/30), blaVIM (10.0%, 3/30), blaNDM-1/blaOXA-48 (10.0%, 3/30), blaOXA-48/blaVIM (3.3%, 1/30) and blaOXA-48/blaIMP (3.3%, 1/30). Tigecycline and polymyxin-B retained susceptible profile. β-lactam drugs showed intermediate to high resistance. The occurrence of CR K. pneumoniae infections was significantly associated with wound (39.7%, p = 0.0007), pus (38.5%, p = 0.009), general surgery (34.6%, p = 0.002) and intensive-care unit (26.9%, p = 0.04). blaKPC-2 producing K. pneumoniae coharboring blaCTX-M/blaSHV (66.7%) and blaCTX-M (33.3%) exhibited sequence type (ST) 258 (n = 4) and ST11 (n = 2) sequence types with IncFII, IncN, IncFIIA, IncL/M and IncFIIK plasmids.
This is the first report describing the emergence of MDR blaKPC-2 producing K. pneumoniae ST11 coharboring blaCTX-M and blaSHV in Pakistan.
碳青霉烯酶主要通过抗生素的过度使用导致多药耐药（MDR）肺炎克雷伯菌的传播加剧。因此，频繁调查高危克隆体，特别是来自发展中国家的高危克隆体，对于遏制全球传播至关重要。
在这项观察性研究中，从 2018 年 4 月至 2020 年 3 月，从巴基斯坦拉合尔的三级护理医院中提取并确认了 107 株肺炎克雷伯菌。通过聚合酶链反应和 Sanger 测序验证碳青霉烯酶和扩展谱β-内酰胺酶。多位点序列分型和质粒复制子分型用于确定克隆谱系和质粒复制子。
在肺炎克雷伯菌中，72.9%（78/107）的菌株对碳青霉烯类药物耐药，其中 65.4%（51/78）表现出产碳青霉烯酶的表型。在耐碳青霉烯类肺炎克雷伯菌中，38.5%（30/78）的菌株具有以下碳青霉烯酶基因型：blaNDM-1（26.7%，8/30）、blaOXA-48（26.7%，8/30）、blaKPC-2（20.0%，6/30）、blaVIM（10.0%，3/30）、blaNDM-1/blaOXA-48（10.0%，3/30）、blaOXA-48/blaVIM（3.3%，1/30）和 blaOXA-48/blaIMP（3.3%，1/30）。替加环素和黏菌素 B 仍保持敏感。β-内酰胺类药物显示出中到高度耐药。耐碳青霉烯类肺炎克雷伯菌感染的发生与伤口（39.7%，p = 0.0007）、脓液（38.5%，p = 0.009）、普通外科（34.6%，p = 0.002）和重症监护病房（26.9%，p = 0.04）显著相关。携带 blaCTX-M/blaSHV（66.7%）和 blaCTX-M（33.3%）的 blaKPC-2 产生肺炎克雷伯菌共带有 ST258（n = 4）和 ST11（n = 2）序列类型，带有 IncFII、IncN、IncFIIA、IncL/M 和 IncFIIK 质粒。
这是首次在巴基斯坦报告出现 MDR blaKPC-2 产生的肺炎克雷伯菌 ST11 共带有 blaCTX-M 和 blaSHV。
