Carbapenem-Resistant Klebsiella pneumoniae in Southwest China: Molecular Characteristics and Risk Factors Caused by KPC and NDM Producers

Figures & data

Figure 1 Distribution of 66 clinical CRKP strains. (A) Department distribution of 66 CRKP strains; (B) sample types of 66 CRKP strains.

Table 1 Antimicrobial Susceptibility Profiles of 66 Clinical CKRP Strains

Antimicrobial Agent	No.	%R	No.	%I	No.	%S
Amikacin	36	54.5	0	0	30	45.5
Cefepime	66	100	0	0	0	0
Imipenem	66	100	0	0	0	0
Piperacillin/tazobactam	66	100	0	0	0	0
Ceftriaxone	66	100	0	0	0	0
Ampicillin/sulbactam	66	100	0	0	0	0
Cefotaxime	66	100	0	0	0	0
Cefazolin	66	100	0	0	0	0
Cefuroxime	66	100	0	0	0	0
Ertapenem	66	100	0	0	0	0
Tobramycin	55	83.3	4	6.1	7	10.6
Sulperazon	63	95.5	2	3.0	1	1.5
Ceftazidime	66	100	0	0	0	0
Meropenem	66	100	0	0	0	0
Levofloxacin	54	81.9	0	0	12	18.1
Cefoxitin	66	100	0	0	0	0
Aztreonam	58	87.9	0	0	8	12.1
Ciprofloxacin	53	80.3	0	0	13	19.7
Gentamicin	55	83.3	0	0	11	16.7
Tigecycline	0	0	0	0	66	100
Compound sulfamethoxazole	43	65.2	0	0	23	34.8
Polymyxin B	0	0	0	0	66	100

Abbreviations: S, susceptible; I, intermediate; R, resistant.

Table 2 Genotypes of 66 Clinical CRKP Strains

N	Carbapenemase	ESBLs	AmpC	Int	Virulence Gene	Gene Cassette	ISCR	MLST	Replicon Type
16	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2	ISCR I	ST11	IncFII
26	NDM-1	SHV+CTX-M	DHA		entB+mrkD		ISCR I	ST4495	lncX3
27	NDM-1	SHV+CTX-M	DHA		entB+fimH+mrkD		ISCR I	ST4495	lncX3
30	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2	ISCR I	ST11	IncFII
32	NDM-1	SHV+CTX-M	DHA		entB+fimH+mrkD		ISCR I	ST4495	lncX3
34	NDM-1	SHV+CTX-M	DHA		entB+fimH+mrkD		ISCR I	ST4495	lncX3
36	NDM-1	SHV+CTX-M	DHA		entB+fimH+mrkD		ISCR I	ST4495	lncX3
37	NDM-1	SHV+CTX-M	DHA		entB+fimH+mrkD		ISCR I	ST4495	lncX3
39	NDM-1	SHV	DHA		entB+mrkD		ISCR I	ST4495	lncX3
40	NDM-1	SHV	DHA+ACC		entB+fimH		ISCR I	ST37	lncX3
45	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11
46	NDM-1	SHV+CTX-M	DHA+ACC		entB+fimH+mrkD		ISCR I	ST4495	lncX3
49	NDM-1	SHV+CTX-M	DHA+ACC		entB+fimH+mrkD		ISCR I	ST4495	lncX3
51	KPC-2	SHV+CTX-M	ACC		entB+fimH+mrkD			ST11
56	NDM-1	SHV+CTX-M	DHA+ACC		entB+fimH+mrkD		ISCR I	ST4495	lncX3
57	NDM-1	SHV+CTX-M	DHA+ACC		entB+fimH+mrkD		ISCR I	ST4495	lncX3
58	NDM-1+IMP-4	SHV+CTX-M	DHA+ACC		entB+fimH			ST4495	lncX3
101	NDM-1	SHV	ACC		entB+fimH+mrkD			ST37	lncX3
131	KPC-2	SHV+TEM	ACC	IntI	entB+fimH+mrkD+rmpA/rmpA2+iucA+terB+aerobactin+HI1B+iroN+iutA	addA2	ISCR I	ST11	IncFII
210	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
211	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
214	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
215	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
221	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2	ISCR I	ST11	IncFII
223	KPC-2	SHV+TEM+CTX-M	ACC		entB+fimH+mrkD			ST147
227	KPC-2	SHV+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
228	KPC-2	SHV+CTX-M	ACC		entB+fimH+mrkD			ST11	IncFII
230	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
232	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
233	KPC-2	SHV	ACC	IntI	entB+fimH+mrkD	dfrA12, addA2		ST147	IncFII
234	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	InFIB
241	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
244	KPC-2	SHV	ACC	IntI	entB+fimH+mrkD	dfrA12		ST23	IncFII
245	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
251	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
252	KPC-2	SHV+TEM+CTX-M		IntI	entB+fimH+mrkD	addA2		ST11	IncFII
257	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11
258	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
267	NDM-1	SHV	ACC	IntI	entB+fimH+mrkD	addA2	ISCR I	ST11	lncX3
271	KPC-2	SHV+TEM+CTX-M	ACC		entB+fimH+mrkD			ST11	IncFII
285	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
354	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
406	KPC-2	SHV+TEM	DHA	IntI	fimH+mrkD	OXA-10, addA1, aacA4	ISCR I	ST318	IncFII
436	KPC-2	SHV+TEM	DHA	IntI	entB+fimH+mrkD	addA2		ST17	IncFII
440	NDM-1	SHV+TEM	ACC	IntI	mrkD	addA2		ST307	lncX3
445	NDM-1	SHV+TEM	ACC		mrkD			ST307	lncX3
473	NDM-1+IMP-4	SHV+TEM	ACC	IntI	entB+fimH+mrkD	addA2	ISCR I	ST152	lncX3
475	NDM-1	SHV+TEM	ACC	IntI	fimH+mrkD	addA2	ISCR I	ST15	lncX3
478	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2	ISCR I	ST11	IncFII
479	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH	addA2		ST11	IncFII
480	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
483	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
489	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	dfrA12, addA2		ST11
490	KPC-2	SHV	ACC	IntI	entB+fimH+mrkD	dfrA27, arr3		ST467	IncFII
494	NDM-5	SHV+CTX-M	DHA	IntI	entB+fimH+mrkD	addA2	ISCR I	ST2407	lncX3
495	KPC-2	SHV+TEM+CTX-M		IntI	entB+fimH+mrkD	dfrA12	ISCR I	ST11	IncFII
496	KPC-2	SHV+TEM	ACC	IntI	entB+fimH+mrkD	gcuF, dfrA12		ST405
497	KPC-2	SHV+TEM		IntI	entB+fimH+mrkD+rmpA/rmpA2+iucA+ terB+wcaG+ aerobactin+HI1B+iroN+iutA	addA2		ST11	IncFII
498	KPC-2	SHV+CTX-M	ACC	IntI	entB+mrkD	dfrA12		ST11	IncFII
499	NDM-5	SHV+CTX-M	DHA	IntI	entB+fimH+mrkD	addA2	ISCR I	ST2407	lncX3
500	KPC-2	SHV+TEM+CTX-M	ACC		entB+fimH+mrkD			ST11
502	NDM-5	SHV+CTX-M	DHA	IntI	entB+fimH+mrkD	addA2		ST2407	lncX3
504	NDM-5+IMP-4	SHV+TEM+CTX-M	DHA	IntI	entB+fimH+mrkD	addA2		ST11	lncX3
505	KPC-2	SHV+TEM+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII
506	NDM-1	SHV+CTX-M	DHA	IntI	entB+fimH+mrkD	addA2		ST4495	lncX3
507	KPC-2	SHV+CTX-M	ACC	IntI	entB+fimH+mrkD	addA2		ST11	IncFII

Abbreviations: ESBL, extended-spectrum β-lactamase; Int, integron; ISCR, insertion sequence common region.

Figure 2 Comparison of the genetic elements surrounding the bla_KPC-2 and bla_NDM-1 genes identified in this study. (A) Comparison of the genetic environments of bla_KPC-2, reference sequences: K. pneumoniae (pKP048, GenBank Accession No.FJ628167); (B) comparison of the genetic environments of bla_NDM-1, reference sequences: A. lwoffii (pNDM-BJ01, GenBank accession NO. JQ001791).

Table 3 Clinical Characteristics of CRKP and CSKP Strains

Variable	CRKP (n=66)	CSKP (n=66)	P-value
Demographic, n (%) or IQR
Age (years)	44.5 (0,60)	46.5 (0.61)	0.754
Sex (male)	47 (71.2%)	46 (69.7%)	0.894
Length of hospital stays	15 (7, 27)	25 (10, 38)	0.1
Admission to ICU	14 (21.1%)	7 (10.6%)	0.096
Co-morbidity, n (%)
Malignant disease	7 (10.6%)	15 (22.7%)	0.062
Diabetes mellitus	11 (16.7%)	12 (18.2%)	0.819
Hypertension	16 (24.2%)	16 (24.2%)	1
Heart disease	9 (13.6%)	11 (16.7%)	0.627
Hepatobiliary disease	12 (18.2%)	15 (22.7%)	0.517
Respiratory disease	45 (68.2%)	33 (50%)	0.034
Renal disease	7 (10.6%)	16 (24.2%)	0.039
Urinary tract infection	10 (15.2%)	9 (13.6%)	0.804
Craniocerebral disease	15 (22.7%)	9 (13.6%)	0.176
Hematological disease	32 (48.5%)	19 (28.8%)	0.02
Gastrointestinal disease	8 (12.1%)	5 (7.6%)	0.381
Invasive procedures and devices
Tracheal cannula	24 (36.4%)	7 (10.6%)	<0.001
Central venous catheter	5 (7.6%)	12 (18.2%)	0.069
Foreign material in the body	14 (21.2%)	7 (10.6%)	0.096
Surgical operations after admission	9 (13.6%)	16 (24.2%)	0.12
Colostomy	3 (4.5%)	1 (1.5%)	0.612
Gastrostomy	2 (3%)	0	0.476
Antibiotic treatment, n (%)
Penicillins	2 (3%)	5 (7.6%)	0.437
First, second-generation cephalosporins	7 (10.6%)	15 (22.7%)	0.21
Third, fourth-generation cephalosporins	17 (25.8%)	19 (28.8%)	0.696
Aminoglycosides	4 (6.1%)	1 (1.5%)	0.362
Quinolones	20 (30.3%)	21 (31.8%)	0.851
Metronidazole	0	1 (1.5%)	1
Carbapenems	30 (45.5%)	32 (48.5%)	0.727
β-lactams and β-lactamase inhibitor combination	40 (60.6%)	25 (37.9%)	0.009
Clinical outcomes, n (%)
Patient outcome: mortality	5 (7.6%)	0	0.068

Note: Bold indicates P < 0.05.

Abbreviations: IQR, interquartile range; CR, carbapenem-resistant; CS, carbapenem-susceptible; ICU, intensive care unit.