Abstract：
Klebsiella pneumoniae (Kp), which is associated with hospital-acquired infections, is extensively drug-resistant (XDR), making treatment difficult. Understanding the genetic epidemiology of XDR-Kp can help determine its potential to be hypervirulent (hv) through the presence of siderophores. We characterized the genomes of 18 colistin-resistant XDR-Kp isolated from 14 patients with complicated tract infection at an Indian healthcare facility. The 18 organisms comprised the following sequence types (STs): ST14 (n = 9), ST147 (n = 5), ST231 (n = 2), ST2096 (n = 1), and ST25 (n = 1). Many patients in each ward were infected with the same ST, suggesting a common source of infection. Some patients had recurrent infections with multiple STs circulating in the ward, providing evidence of hospital transmission. β-lactamase genes (blaCTX-M-1, blaSHV, and blaampH) were present in all isolates. blaNDM-1 was present in 15 isolates, blaOXA-1 in 16 isolates, blaTEM-1D in 13 isolates, and blaOXA-48 in 3 isolates. Disruption of mgrB by various insertion sequences was responsible for colistin resistance in 6 isolates. The most common K-type among isolates was K2 (n = 10). One XDR convergent hvKp ST2096 mutation (iuc+ybt+blaOXA-1+blaOXA-48) was associated with prolonged hospitalization. Convergent XDR-hvKp has outbreak potential, warranting effective antimicrobial stewardship and infection control.
摘要：
与医院获得性感染相关的肺炎克雷伯菌（Kp）具有广泛耐药性（XDR），使治疗有问题。了解XDR-Kp的遗传流行病学可以通过铁载体的存在确定它们具有高毒力（hv）的潜力。我们对印度医疗机构中14例复杂尿路感染患者中分离出的18种粘菌素抗性XDR-Kp的基因组进行了表征。18种生物包括STs：ST14（9/18），ST147(5/18),ST231(2/18),ST2096(1/18),和ST25（1/18）。一个病房的许多患者感染了相同的ST，这是一个常见的感染源。一些患者反复感染了在该病房中循环的多种STs，为医院传播提供证据。β内酰胺酶基因（blaCTX-M-1，blaSHV，和blaampH）存在于所有分离物中。blaNDM-1存在于分离株15/18中，blaOXA-1存在于分离株16/18中，blaTEM-1D存在于分离株13/18中，blaOXA-48存在于分离株14、19和30中。用各种IS元素破坏mgrB是6个分离株中粘菌素抗性的原因。这些分离株中最常见的K型是K2(10/18)。一个XDR趋同hv-KpST2096与住院时间延长相关(iuc+ybt+blaOXA-1+blaOXA-48)。检测到的聚合XDR-hv-Kp具有爆发潜力，保证有效的抗菌药物管理和感染控制。
