Molecular Analysis and Antimicrobial Resistance Pattern of Tigecycline-Non-Susceptible K. pneumoniae Isolated from a Tertiary Care Hospital of East Asia

Figures & data

Figure 1 A concise flow chart about this study.

Figure 2 PFGE results for 34 TNSKP strains. The adjacent information shown on the right represents ST, K-type of the sequenced isolates, wards, source, and cluster in turn.

Abbreviations: PFGE, pulsed-field gel electrophoresis; UN, unknown; ICU, intensive care unit; EICU, emergency intensive care unit; BICU, burn intensive care unit; RICU, respiratory intensive care unit; PICU, pediatric intensive care unit.

Table 1 Antibiotic Susceptibilities of TNSKP Strains (n=34)

Strain No	MIC (μg/mL)^a
	Amoxicillin/Clavulanic Acid	Piperacillin/Tazobactam	Ceftazidime	Ceftriaxone	Ertapenem	Imipenem	Meropenem	Amikacin	Ciprofloxacin	Tigecycline
1	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
2	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
4	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
5	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
6	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
7	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
8	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
9	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
10	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
11	≥32/R	16/S	≥16/R	≥32/R	>4/R	≤0.5/S	≤0.5/S	≤8/S	≥4/R	≥8/R
13	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
14	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
15	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
16	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
18	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
20	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
21	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
23	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
24	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
25	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
26	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
27	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
28	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
29	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
30	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
35	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	16/S	≥4/R	≥8/R
36	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
37	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
38	≥32/R	8/S	8/I	≥32/R	≤0.25/S	≤0.5/S	≤0.5/S	≤8/S	≥4/R	4/I
43	≥32/R	≥128/R	≥16/R	≥32/R	≤0.25/S	≤0.5/S	≤0.5/S	≤8/S	≤0.25/S	≥8/R
44	≥32/R	8/S	≤2/S	≤1/S	≤0.25/S	≤0.5/S	≤0.5/S	≤8/S	≤0.25/S	4/I
45	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R
53	≥32/R	8/S	≥16/R	≥32/R	≤0.25/S	≤0.5/S	≤0.5/S	≤8/S	≥4/R	4/I
63	≥32/R	≥128/R	≥16/R	≥32/R	>4/R	>8/R	>8/R	≥64/R	≥4/R	≥8/R

Note: ^aMICs of amoxicillin/clavulanic acid, piperacillin/tazobactam, ceftazidime, ceftriaxone, ertapenem, imipenem, meropenem, amikacin, ciprofloxacin, and tigecycline were determined using the broth microdilution methodology.

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

Table 2 Resistance Determinants and Virulence Genotype Were Examined in the Present Study

Strain No.	Resistance Determinants (Mutations Occurring in the Protein Sequence)												Virulence Genotype
	tet(A)	tet(X)	tet(L)	tet(M)	rpsJ	oqxR	ramR	Carbapenem	β-Lactamase Resistance				rmpA	aero	uge	iroN	mrkD	kpn
1	+	+	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
2	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
4	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
5	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
6	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
7	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
8	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
9	+	–	–	–	+	–	–	blaKPC–2	blaSHV–158	–	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
10	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
11	+	–	–	–	+	–	–	–	blaSHV–158	–	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
13	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
14	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
15	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
16	+	+	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
18	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
20	+	+	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
21	+	+	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
23	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
24	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
25	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	+	–	+	–	+	+
26	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
27	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
28	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
29	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
30	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
35	+	+	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
36	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
37	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
38	+	–	–	–	+	+	–	–	blaSHV–187	blaTEM–1	blaCTX–M–3	–	–	–	–	–	+	+
43	+	–	–	–	+	+	+(Q160stop)	–	blaSHV–187	blaTEM–235	blaCTX–M–14	–	–	–	–	–	+	+
44	–	–	–	–	–	+	+(Q6stop)	–	–	–	–	–	–	–	+	–	+	–
45	+	+	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+
53	+	–	–	–	+	–	+(S29L)	–	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	–	–	+	+
63	+	–	–	–	+	–	–	blaKPC–2	blaSHV–12	blaTEM–1	blaCTX–M–65	blaLAP–2	–	–	+	–	+	+

Notes: +, presence of PCR product and no change in the nucleotide/amino acid sequences; −, absence of PCR product.