Emergence of Klebsiella pneumoniae ST307 co- producing CTX-M with SHV and KPC from paediatric patients at Shenzhen children’s hospital, China

Abstract

Aim: We investigated the clonal diversity of carbapenemase-producing Klebsiella pneumo- niae isolates from the Shenzhen Children’s Hospital, China, and drew conclusions on the clinical and public health impact of these isolates as multidrug-resistant. Methods: From January 2014 to December 2018, a total number of 36 unique carbapene- mase-producing clinical isolates of Klebsiella pneumoniae were collected out of 900 clinical isolates in paediatric patients from the Shenzhen Children’s Hospital, China. After carbape- nemase production confirmation, antimicrobial susceptibility, resistance determinants and phylogenetic relationship were determined. Results: The isolates showed resistance to ceftazidime, ertapenem, ampicillin, cefazolin, cef- triaxone, cefotetan, ticarcillin, cefaclor, cefpodoxime, azlocillin, cefcapene, mezlocillin and ampi- cillin-sulbactam. Of the 36 Klebsiella pneumoniae carbapenemase genes coding isolates, blaNDM was the mostly detected 50% (n=18) followed by blaKPC and blaIMP 19% (n=7), blaVIM 17% (n=6), blaOXA-48-like 8% (n=3) and blaSME 5% (n=2), whereas extended-spectrum β-lactamase (blaSHV) was predominantly detected 92% (n=33) followed by blaCTX-M 53% (n=19) and blaCMY 28% (n=10). Pulsed-field gel electrophoresis typing showed eight different patterns, and twenty-five distinct sequences types were observed with ST307 being predominantly identified 11% (n=4), followed by ST2407 8% (n=3). Plasmid replicon typing results indicated that IncFIS, IncHI2, IncFIC and IncFIA plasmids carry blaCTX-M, blaSHV and blaNDM genes. Conclusion: This study reports on the occurrence and spread of carbapenemase and extended-spectrum β-lactamase encoding genes co-existence in sporadic Klebsiella pneumo- niae ST307 in paediatric patients from the Shenzhen Children’s Hospital, China.