Clinical Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Among Pediatric Patients in Jiangsu Province, China

Abstract

Purpose

The continuous emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a serious public health problem globally, especially for children, but data on CRKP infection in pediatric patients are limited. This study aimed to identify epidemiological and molecular patterns of CRKP among pediatric patients in Jiangsu province, China.

Patients and Methods

CRKP were consecutively collected from the Children’s Hospital of Nanjing Medical University in China from July 2018 to May 2019. Then, CRKP strains were performed for further study: antimicrobial susceptibility testing, drug-resistance determinants screening and homology analysis.

Results

We collected 94 CRKP from 94 children. Overall, bla_KPC-2 (79.8%) was the predominant carbapenemase gene, followed by bla_NDM-1(14.9%), bla_IMP-4 (5.3%) and bla_NDM-5(4.3%). Notably, two isolates coharbored bla_KPC-2 and bla_IMP-4, and two isolates coharbored bla_KPC-2 and bla_NDM-5. MLST analysis revealed that 14 distinct sequence types (STs) were identified, of which ST11 was the most common sequence type identified. Moreover, two novel STs, ST4854 and ST4855, were detected in this study. PFGE revealed that a predominant cluster consisting of KPC-2-producing CRKP ST11 clone isolates was identified and was distributed mainly in the pediatric intensive care unit (PICU) and cardiac intensive care unit (CCU). Moreover, this is the first report to identify the dissemination of ST716 CRKP coproducing KPC-2 and IMP-4 clones.

Conclusion

Clonal dissemination of KPC-2-producing CRKP ST11 was observed in multiple departments. Moreover, two novel STs (ST4854 and ST4855) were identified, which indicates an increased diversity of CRKP strains. To our knowledge, this is the first report that identified the dissemination of Klebsiella pneumoniae coproducing KPC-2 and IMP-4 clones among children, which represents a significant health risk to pediatric patients. Active surveillance and effective control measures are urgently needed to prevent further transmission of these strains among children.

Keywords:

• Klebsiella pneumoniae
• carbapenemase
• KPC-2
• ST11
• clonal dissemination
• children

Acknowledgments

This research was supported by the National Natural Science Foundation of China (16611840).

Ethical Approval

The guardian of the child patient signed informed consent to participate in the study before the study began and this study was conducted in accordance with the Declaration of Helsinki. The Clinical Research Ethics Committee of the Children’s Hospital of Nanjing Medical University approved the study (201907222-1), as all samples collected in this work were initially used to diagnose patient care without increasing the patient’s medical costs and suffering.

Disclosure

The authors report no conflicts of interest in this work.