[Source: mBio, full page: (LINK). Abstract, edited.]
Genomic Analysis of a Pan-Resistant Isolate of Klebsiella pneumoniae, United States 2016
Tom J. B. de Man a, Joseph D. Lutgring a,b, David R. Lonsway a, Karen F. Anderson a, Julia A. Kiehlbauch c,d, Lei Chen e, Maroya Spalding Walters a, Maria Sjölund-Karlsson a, J. Kamile Rasheed a, Alexander Kallen a, Alison Laufer Halpin a
a Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA; b Department of Medicine, Division of Infectious Diseases, Emory University School of Medicine, Atlanta, Georgia, USA; c Nevada State Public Health Laboratory, Reno, Nevada, USA; d School of Community Health Sciences, University of Nevada, Reno, Reno, Nevada, USA; e Washoe County Health District, Reno, Nevada, USA
George A. Jacoby, Editor
Author Affiliations: Lahey Hospital and Medical Center
Address correspondence to Tom J. B. de Man, email@example.com.
Antimicrobial resistance is a threat to public health globally and leads to an estimated 23,000 deaths annually in the United States alone. Here, we report the genomic characterization of an unusual Klebsiella pneumoniae, nonsusceptible to all 26 antibiotics tested, that was isolated from a U.S. patient. The isolate harbored four known beta-lactamase genes, including plasmid-mediated blaNDM-1 and blaCMY-6, as well as chromosomal blaCTX-M-15 and blaSHV-28, which accounted for resistance to all beta-lactams tested. In addition, sequence analysis identified mechanisms that could explain all other reported nonsusceptibility results, including nonsusceptibility to colistin, tigecycline, and chloramphenicol. Two plasmids, IncA/C2 and IncFIB, were closely related to mobile elements described previously and isolated from Gram-negative bacteria from China, Nepal, India, the United States, and Kenya, suggesting possible origins of the isolate and plasmids. This is one of the first K. pneumoniae isolates in the United States to have been reported to the Centers for Disease Control and Prevention (CDC) as nonsusceptible to all drugs tested, including all beta-lactams, colistin, and tigecycline.
Antimicrobial resistance is a major public health threat worldwide. Bacteria that are nonsusceptible or resistant to all antimicrobials available are of major concern to patients and the public because of lack of treatment options and potential for spread. A Klebsiella pneumoniae strain that was nonsusceptible to all tested antibiotics was isolated from a U.S. patient. Mechanisms that could explain all observed phenotypic antimicrobial resistance phenotypes, including resistance to colistin and beta-lactams, were identified through whole-genome sequencing. The large variety of resistance determinants identified demonstrates the usefulness of whole-genome sequencing for detecting these genes in an outbreak response. Sequencing of isolates with rare and unusual phenotypes can provide information on how these extremely resistant isolates develop, including whether resistance is acquired on mobile elements or accumulated through chromosomal mutations. Moreover, this provides further insight into not only detecting these highly resistant organisms but also preventing their spread.
KEYWORDS: carbapenems – colistin – Klebsiella pneumoniae – plasmid-mediated resistance – whole-genome sequencing
Citation de Man TJB, Lutgring JD, Lonsway DR, Anderson KF, Kiehlbauch JA, Chen L, Walters MS, Sjölund-Karlsson M, Rasheed JK, Kallen A, Halpin AL. 2018. Genomic analysis of a pan-resistant isolate of Klebsiella pneumoniae, United States 2016. mBio 9:e00440-18. https://doi.org/10.1128/mBio.00440-18.
Received 22 February 2018 – Accepted 26 February 2018 – Published 3 April 2018
This is a work of the U.S. Government and is not subject to copyright protection in the United States. Foreign copyrights may apply.
Keywords: Antibiotics; Drugs Resistance; Colistin; Tigecycline; Klebsiella Pneumoniae; USA.