Popivanov, G.; Markovska, R.; Gergova, I.; Konaktchieva, M.; Cirocchi, R.; Kjossev, K.; Mutafchiyski, V. An Intra-Hospital Spread of Colistin-Resistant K. pneumoniae Isolates—Epidemiological, Clinical, and Genetic Analysis. Medicina2024, 60, 511.
Popivanov, G.; Markovska, R.; Gergova, I.; Konaktchieva, M.; Cirocchi, R.; Kjossev, K.; Mutafchiyski, V. An Intra-Hospital Spread of Colistin-Resistant K. pneumoniae Isolates—Epidemiological, Clinical, and Genetic Analysis. Medicina 2024, 60, 511.
Popivanov, G.; Markovska, R.; Gergova, I.; Konaktchieva, M.; Cirocchi, R.; Kjossev, K.; Mutafchiyski, V. An Intra-Hospital Spread of Colistin-Resistant K. pneumoniae Isolates—Epidemiological, Clinical, and Genetic Analysis. Medicina2024, 60, 511.
Popivanov, G.; Markovska, R.; Gergova, I.; Konaktchieva, M.; Cirocchi, R.; Kjossev, K.; Mutafchiyski, V. An Intra-Hospital Spread of Colistin-Resistant K. pneumoniae Isolates—Epidemiological, Clinical, and Genetic Analysis. Medicina 2024, 60, 511.
Abstract
Background and objective
K. pneumoniae appeared to be a significant problem due to its ability to accumulate antibiotic-resistance genes. After 2013, alarming colistin resistance rates among carbapenem-resistant K. pneumoniae have been reported in the Balkans. The study aims to perform an epidemiological, clinical, and genetic analysis of a local outbreak of COLr CR-Kp.
Material and methods
All carbapenem-resistant and colistin-resistant K. pneumoniae isolates observed among patients in the ICU unit of Military Medical Academy, Sofia from 1 January to 31 October 2023 were included. The results were analyzed according to the EUCAST criteria. All isolates were screened for blaVIM, blaIMP, blaKPC, blaNDM, and blaOXA-48. Genetic similarity was determined using the Dice coefficient as a similarity measure and the unweighted pair group method with arithmetic mean (UPGMA). mgrB genes and plasmid-mediated colistin resistance determinants (mcr-1, mcr-2, mcr-3, mcr-4, mcr-5) were investigated.
Results
There was a total of 379 MDR-K. pneumoniae isolates, 88% of which were carbapenem-resistant. Of them, there were 9 (2.7%) colistin-resistant isolates in six patients. A time and space cluster for five patients was found. Epidemiology typing showed that two isolates belonged to clone A (pts. 1, 5) and the rest to clone B (pts. 2-4) with 69% similarity. Clone A were coproducers of blaNDM-like and blaOXA-48-like and had mgrB-mediated colistin resistance (40%). Clone B isolates had only blaOXA-48-like and intact mgrB genes. All isolates were negative for mcr-1,-2,-3,-4,-5 genes.
Conclusions
The study describes a within-hospital spread of two clones of COLr CR-Kp with a 60% mortality rate. Clone A were coproducers of NDM-1 and OXA-48-like enzymes and had mgrB-mediated colistin resistance. Clone B isolates had only OXA-48-like enzymes and intact mgrB genes. No plasmid-mediated was found. The extremely high mortality rate and limited treatment options warrant strict measures to prevent outbreaks.
Keywords
outbreak, colistin-resistant K. pneumoniae, mgrB,; plasmid-mediated resistance, mortality
Subject
Medicine and Pharmacology, Medicine and Pharmacology
Copyright:
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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