Infection and Drug Resistance (Dec 2022)
Evidence of Sharing of Carbapenem-Resistant Klebsiella pneumoniae Strains Between Intensive Care Unit Patients and the Environment
Abstract
Jia Kang,1,* Guangqi Li,1,* Miao Ma,2 Min Lan,3 Yuting Kang,4 Ningai Yang,4 Wei Jia,1,4 Zhijun Zhao1,4 1Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China; 2Clinical Laboratory Center, Shaanxi Provincial People’s Hospital, Xi’an, People’s Republic of China; 3School of Clinical Medicine, Ningxia Medical University, Yinchuan, People’s Republic of China; 4Ningxia Key Laboratory of Clinical and Pathogenic Microbiology, General Hospital of Ningxia Medical University, Yinchuan, People’s Republic of China*These authors contributed equally to this workCorrespondence: Wei Jia; Zhijun Zhao, Medical Experimental Center, General Hospital of Ningxia Medical University, Yinchuan, 750001, People’s Republic of China, Tel +86 951-6743543, Email [email protected]; [email protected]: Carbapenem-resistant Klebsiella pneumoniae (CR-KP) has emerged as an important public health threat. Intestinal colonization with CR-KP increases the risk of infection and death, especially in intensive care unit patients. To clarify the source of colonizing bacteria is very important to prevent the spread of CR-KP, so the purpose of this study was to explore the relationship between the ward environment and intestinal colonization of CR-KP.Methods: In this study, 353 environmental swabs from ICU (Intensive Care Unit) wards and 241 anal swab samples from ICU patients were collected and screened on MacConkey plates containing 2 μg/mL ertapenem, and the origin and genotype of CR-KP were analyzed by PCR and sequencing. The sequence type of the strains was also obtained by multi-locus sequence type (MLST) analysis, and plasmid conjugation test was used to clarify whether CR-KP can promote the transmission of drug resistance genes through plasmid integration and rearrangement.Results: A total of 20 CR-KP environmental strains and 7 intestinal strains were obtained, most of which were blaOXA-48 resistant genotypes. Four different STs were identified by multi-locus sequence type (MLST) analysis, among which the large logarithm was ST485 type, and PFGE clustering showed that the similarity between them was > 85%. In the plasmid transcoupling assay, we report that one of the Klebsiella pneumoniae drug-resistant plasmids was successfully transferred to E. coli, indicating that it may promote the spread of drug-resistant genes through plasmid integration and rearrangement.Conclusion: Our research suggests that the environment may be a potential source of CR-KP and that there is a need for us to adopt more effective disinfection measures.Keywords: carbapenem-resistant Klebsiella, intestinal, colonization, environment, ICU, homology
