Rapid Emergence of a Pandrug-Resistant Klebsiella pneumoniae ST11 Isolate in an Inpatient in a Teaching Hospital in China After Treatment with Multiple Broad-Spectrum Antibiotics

Figures & data

Table 1 MICs of the Antibiotics Tested in K. pneumoniae KP65

Antibiotics	MIC (mg/L)
	BKP19	Interpretive Categories^c
Cefazolin^a	≥64	R
Ceftriaxone^a	≥64	R
Cefepime^a	≥64	R
Cefoxitin^a	≥64	R
Aztreonam^a	≥64	R
Piperacillin/tazobatam^a	≥128	R
Imipenem^b	>128	R
Meropenem^b	>128	R
Amikacin^a	≥64	R
Ciprofloxacin^a	≥4	R
Levofloxacin^a	≥8	R
Tigecycline^b	32	R
Colistin^b	>64	R

Notes: ^aTested by AST-GN16. ^bTested by standard broth microdilution tests. ^cMIC, minimum inhibitory concentration.

Abbreviation: R, resistant.

Table 2 Antimicrobial Resistance Genes and Plasmid Replicons in Isolates K. pneumoniae Strain KP65

Antimicrobial Resistance Gene	Contig	Identity (%)	Position	Antimicrobial Resistance Category
blaCTX-M-65	pKPC-2-KP65	100.00	5660..6535	Beta-lactam
fosA3	pKPC-2-KP65	100.00	12397..12813	Fosfomycin
blaTEM-1B	pKPC-2-KP65	100.00	15580..16440	Beta-lactam
rmtB	pKPC-2-KP65	100.00	16610..17365	Aminoglycoside
blaKPC-2	pKPC-2-KP65	100.00	92566..93447	Beta-lactam
blaSHV-11	1	100.00	2783701..2784561	Beta-lactam
fosA	1	99.27	4752290..4752701	Fosfomycin
Plasmid replicon	Contig	Identity (%)	Position	Annotation
IncR	pKPC-2-KP65	99.20	27677..27927	Gram-negative
IncFII	pKPC-2-KP65	100.00	144166..144422	Gram-negative
ColRNAI	3	98.46	5781..5910	Gram-negative

Figure 1 Circular comparison between the bla_KPC-2-carrying plasmid pKPC-2-KP65 and similar plasmids. p283747-KPC: K pneumoniae strain 283747 plasmid p283747-KPC, accession no. MF168406, size 148,021 bp. p283149-KPC: K pneumoniae strain 283149 plasmid p283149-KPC, accession no. MK036886, size 136,186 bp. pKPC2_09508: K. pneumoniae strain WCHKP2080 plasmid pKPC2_095080, accession no. CP036362, size 120,195 bp. p3_L382: K pneumoniae strain L482 plasmid p3_L382, accession no. CP033962, size 136,159 bp. pKPC2_020098: K. pneumoniae strain WCHKP020098 plasmid pKPC2_020098, accession no. CP036306, size 149,519 bp.

Figure 2 Phylogenetic relationship between K. pneumoniae strain KP65 and closely related K. pneumoniae strains currently available in BacWGSTdb. Clonal relationships between different isolates are depicted by the line length connecting each circle. The numbers given in square brackets indicate the number of isolates from each country.