Molecular Epidemiology, Clinical Characteristics and Risk Factors for Bloodstream Infection of Multidrug-Resistant Klebsiella pneumoniae Infections in Pediatric Patients from Tianjin, China

Figures & data

Table 1 Primers and Reaction Conditions Used for the Detection of Carbapenem Resistance Genes

Ambler Class	Primer^a	Sequence (5’-3’)^b	Gene	Product Size	Annealing Temperature
A	KPC-F	CATTCAAGGGCTTTCTTGCTGC	blaKPC	538bp	55℃
	KPC-R	ACGACGGCATAGTCATTTGC
A	GES-F	AGTCGGCTAGACCGGAAAG	blaGES	399bp	57℃
	GES-R	TTTGTCCGTGCTCAGGAT
B	IMP-F	TTGACACTCCATTTACDG	blaIMP	139bp	55℃
	IMP-R	GATYGAGAATTAAGCCACYCT
B	VIM-F	GTTTGGTCGCATATCGCAAC	blaVIM	389bp	54℃
	VIM-R	AATGCGCAGCACCAGGATAG
B	NDM-F	GGTTTGGCGATCTGGTTTTC	blaNDM	621bp	52℃
	NDM-R	CGGAATGGCTCATCACGATC
B	GIM-F	TCGACACACCTTGGTCTGAA	blaGIM	477bp	52℃
	GIM-R	AACTTCCAACTTTGCCATGC
B	DIM-F	GCTTGTCTTCGCTTGCTAACG	blaDIM	699bp	52℃
	DIM-R	CGTTCGGCTGGATTGATTTG
B	SIM-F	TACAAGGGATTCGGCATCG	blaSIM	570bp	52℃
	SIM-R	TAATGGCCTGTTCCCATGTG
B	SPM-F	AAAATCTGGGTACGCAAACG	blaSPM	271bp	52℃
	SPM-R	ACATTATCCGCTGGAACAGG
D	OXA48-F	GCTTGATCGCCCTCGATT	blaOXA-48	281bp	57℃
	OXA48-R	GATTTGCTCCGTGGCCGAAA

Notes: ^aF: Forward Primer, R: Reverse Primer. ^bD = A or G or T; Y = C or T.

Table 2 Results of Antimicrobial Susceptibility of MDR Klebsiella pneumoniae

Type of Antibiotic	Antibiotic	Resistance Rate (%)	Mediation Rate (%)	Sensitivity Rate (%)
Penicillin	Ampicillin	100.00 (61/61)	0.00 (0/61)	0.00 (0/61)
	Amoxicillin/clavulanate	96.72 (59/61)	1.64 (1/61)	1.64 (1/61)
Cephalosporins	Cefazolin	100.00 (61/61)	0.00 (0/61)	0.00 (0/61)
	Ceftriaxone	100.00 (61/61)	0.00 (0/61)	0.00 (0/61)
	Cefepime	88.52 (54/61)	9.84 (6/61)	1.64 (1/61)
β-lactams/Penicillin	Piperacillin/tazobactam	96.72 (59/61)	1.64 (1/61)	1.64 (1/61)
Carbapenems	Ertapenem	96.72 (59/61)	0.00 (0/61)	3.28 (2/61)
	Meropenem	96.72 (59/61)	0.00 (0/61)	3.28 (2/61)
	Imipenem	93.44 (57/61)	3.28 (2/61)	3.28 (2/61)
Monoamides	Aztreonam	90.16 (55/61)	1.64 (1/61)	8.20 (5/61)
Quinolones	Levofloxacin	59.02 (36/61)	6.56 (4/61)	34.43 (21/61)
	Ciprofloxacin	63.93 (39/61)	11.48 (7/61)	24.59 (15/61)
Aminoglycosides	Gentamicin	49.18 (30/61)	0.00 (0/61)	50.82 (31/61)
	Amikacin	37.70 (23/61)	0.00 (0/61)	62.30 (38/61)
	Tobramycin	37.70 (23/61)	29.51 (18/61)	32.79 (20/61)
Sulfonamides	Cotrimoxazole	27.87 (17/61)	0.00 (0/61)	72.13 (44/61)
Glycylcyclines	Tigecycline	8.20 (5/61)	1.64 (1/61)	90.16 (55/61)

Figure 1 The minimum spanning tree constructed from the MLST results in this study.

Figure 2 Differences in antibiotic resistance between ST11 Co-carrying bla_KPC-2 and bla_NDM-5 and ST11 carrying bla_KPC-2 only.

Abbreviations: AMP, Ampicillin; AMC, Amoxicillin/clavulanate; KZ, cefazolin; CRO, Ceftriaxone; CPM, cefepime; TZP, Piperacillin/tazobactam; ETP, Ertapenem; MEM, Meropenem; IPM, imipenem; ATM, Aztreonam; LEV, Levofloxacin; CIP, Ciprofloxacin; GEN, Gentamicin; AK, amikacin; TOB, Tobramycin; SXT, cotrimoxazole; TGC, tigecycline.

Table 3 Risk Factors for BSIs in Children with CRKP

	Number of CRKP Infected, n (%)	Number of BSIs, n (%)	Positive Rate of BSIs (%)	χ^2	p-value
Gender
Male	35 (63.64)	7 (63.63)	20.00	<0.001	1.000
Female	20 (36.36)	4 (36.36)	20.00
Age
0–3 Months	29 (52.73)	4 (36.36)	13.79	5.906	0.015
4–12 Months	18 (32.73)	3 (16.72)	16.67
1–3 Year	2 (3.64)	0 (0.00)	0.00
>3 Year	6 (10.91)	4 (36.36)	66.67
Premature	12 (21.82)	2 (18.18)	16.67	<0.001	1.000
Pneumonia	38 (69.09)	5 (45.45)	13.16	3.597	0.058
Urinary tract infection	17 (30.91)	1 (9.09)	5.88	3.636	0.057
Chemotherapy	7 (12.73)	4 (36.36)	57.14	4.512	0.034
Operation	15 (27.27)	4 (36.36)	26.67	0.143	0.705