Evidence of Sharing of Carbapenem-Resistant Klebsiella pneumoniae Strains Between Intensive Care Unit Patients and the Environment

Abstract

Purpose

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 bla_OXA-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

Ethics Approval

The research protocol has been approved by the Medical Research Ethics Review Committee of the General Hospital of Ningxia Medical University (No. 2019-105).

Acknowledgments

This work was supported by the National Natural Science Foundation of China (No.81960386), and Key Research and Development Project of Ningxia Hui Autonomous Region (No. 2021BEG03090).

Disclosure

The authors report no conflicts of interest in this work.