Emergence of ST147 Klebsiella pneumoniae carrying blaNDM-7 on IncA/C2 with ompK35 and ompK36 mutations in India

Abstract

India is known to be endemic to NDM carbapenemases. However, NDM-7 among Klebsiella pneumoniae has not been described from India. Apart from carbapenemases, ompK35 and ompK36 also contribute to carbapenem resistance in K. pneumoniae. This study describes molecular mechanisms of antimicrobial resistance in an isolate from bacteraemia investigated through whole genome sequencing. blaNDM-7 was found on IncA/C2 plasmid which also carried sul-1, aadA2, rmtC, blaCMY-6 and ARR-2. ompK35 had mutations and changes from 39th amino acid. ompK36 was truncated to 248 amino acids. The isolate belonged to ST147. The patient was a known case systemic lupus erythematosus (SLE) and blood culture grew carbapenem resistant K. pneumoniae. Meropenem, colistin and tiecoplanin were administered and the patient was discharged on improvement. Emergence of new resistance variants and porin mutations among clones such as ST147 which has been prevalent has potential for rapid spread and thus challenges infection control. Keywords: K. pneumoniae, NDM-7, ST147, ompK35, ompK36