TY - JOUR
T1 - Multihospital occurrence of pan-resistant Klebsiella pneumoniae sequence type 147 with an ISEcp1-directed blaOXA-181 insertion in the mgrB gene in the United Arab Emirates
AU - Sonnevend, Ágnes
AU - Ghazawi, Akela
AU - Hashmey, Rayhan
AU - Haidermota, Aliasgher
AU - Girgis, Safinaz
AU - Alfaresi, Mubarak
AU - Omar, Mohammed
AU - Paterson, David L.
AU - Zowawi, Hosam M.
AU - Pál, Tibor
N1 - Funding Information:
This work was supported by United Arab Emirates University grants UPAR-25143 and CMHS NP/14/07 and Center-Based grant 31R061 to T.P. and United Arab Emirates University grants UPAR-31M235 and CMHS-31M251 to A.S. We acknowledge the contribution of Brian Forde and Scott Beatson in the elucidation of the mechanism of colistin resistance in the previously reported isolate (12). The support and critical comments during the project by Jens Thomsen (HAAD, Abu Dhabi) is highly appreciated. D.P. has received honoraria for attendance at advisory boards of Merck, AstraZeneca, Shionogi, Achaogen, and GlaxoSmithKline. The other authors declare no conflicts of interest.
Publisher Copyright:
© 2017 American Society for Microbiology. All Rights Reserved.
PY - 2017/7
Y1 - 2017/7
N2 - The emergence of pan-resistant Klebsiella pneumoniae strains is an increasing concern. In the present study, we describe a cluster of 9 pan-resistant K. pneumoniae sequence type 147 (ST147) isolates encountered in 4 patients over nearly 1 year in 3 hospitals of the United Arab Emirates (UAE). The isolates exhibited highly similar genotypes. All produced chromosomally encoded OXA-181, and the majority also produced the NDM-5 carbapenemase. As with the previously described single isolate from the UAE, MS6671, the mgrB was disrupted by a functional, ISEcp1-driven blaOXA-181 insertion causing resistance to carbapenems. The mutation was successfully complemented with an intact mgrB gene, indicating that it was responsible for colistin resistance. blaNDM-5 was located within a resistance island of an approximately 100-kb IncFII plasmid carrying ermB, mph(A), blaTEM-1B, rmtB, blaNDM-5, sul1, aadA2, and dfrA12 resistance genes. Sequencing this plasmid (pABC143-NDM) revealed that its backbone was nearly identical to that of plasmid pMS6671E from which several resistance genes, including blaNDM-5, had been deleted. More extensive similarities of the backbone and the resistance island were found between pABC143C-NDM and the blaNDM-5-carrying IncFII plasmids of two K. pneumoniae ST147 isolates from South Korea, one of which was colistin resistant, and both also produced OXA-181. Notably, one of these strains was isolated from a patient transferred from the UAE. Our data show that this pan-resistant clone has an alarming capacity to maintain itself over an extended period of time and is even likely to be transmitted internationally.
AB - The emergence of pan-resistant Klebsiella pneumoniae strains is an increasing concern. In the present study, we describe a cluster of 9 pan-resistant K. pneumoniae sequence type 147 (ST147) isolates encountered in 4 patients over nearly 1 year in 3 hospitals of the United Arab Emirates (UAE). The isolates exhibited highly similar genotypes. All produced chromosomally encoded OXA-181, and the majority also produced the NDM-5 carbapenemase. As with the previously described single isolate from the UAE, MS6671, the mgrB was disrupted by a functional, ISEcp1-driven blaOXA-181 insertion causing resistance to carbapenems. The mutation was successfully complemented with an intact mgrB gene, indicating that it was responsible for colistin resistance. blaNDM-5 was located within a resistance island of an approximately 100-kb IncFII plasmid carrying ermB, mph(A), blaTEM-1B, rmtB, blaNDM-5, sul1, aadA2, and dfrA12 resistance genes. Sequencing this plasmid (pABC143-NDM) revealed that its backbone was nearly identical to that of plasmid pMS6671E from which several resistance genes, including blaNDM-5, had been deleted. More extensive similarities of the backbone and the resistance island were found between pABC143C-NDM and the blaNDM-5-carrying IncFII plasmids of two K. pneumoniae ST147 isolates from South Korea, one of which was colistin resistant, and both also produced OXA-181. Notably, one of these strains was isolated from a patient transferred from the UAE. Our data show that this pan-resistant clone has an alarming capacity to maintain itself over an extended period of time and is even likely to be transmitted internationally.
KW - Carbapenems
KW - Colistin
KW - Klebsiella pneumoniae
KW - Pan-resistance
UR - http://www.scopus.com/inward/record.url?scp=85021887585&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85021887585&partnerID=8YFLogxK
U2 - 10.1128/AAC.00418-17
DO - 10.1128/AAC.00418-17
M3 - Article
C2 - 28438945
AN - SCOPUS:85021887585
SN - 0066-4804
VL - 61
JO - Antimicrobial Agents and Chemotherapy
JF - Antimicrobial Agents and Chemotherapy
IS - 7
M1 - e00418
ER -