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A Polyclonal Spread Emerged: Characteristics of Carbapenem-Resistant Klebsiella pneumoniae Isolates from the Intensive Care Unit in a Chinese Tertiary Hospital

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Fig. 1.

Percentage of CRKP isolates resistant to a panel of antibiotics (30 isolates).The X-axis displays the percentage of the isolates resistant to a given antibiotic (Y-axis). Distribution of the MICs of antibiotics were as follows: Ertapenem (MIC ≥ 2 μg/ml, n = 30), Amoxicillin/clavulanic acid (MIC ≥ 32/16 μg/ml, n = 30), Cefoperazone (MIC ≥ 64 μg/ml, n = 30), Cefazolin (MIC ≥ 8 μg/ml, n = 30), Cefoxitin (MIC ≥ 32 μg/ml, n = 30), Ampicillin (MIC ≥ 32 μg/ml, n = 30), Aztreonam (MIC ≥ 16 μg/ml, n = 29), Ceftriaxone (MIC ≥ 4 μg/ml, n = 29), Piperacillin-tazobactam (MIC ≥ 128/4 μg/ml, n = 29), Nitrofurantoin (MIC ≥ 128 μg/ml, n = 28), Ciprofloxacin (MIC ≥ 1 μg/ml, n = 25), Cefepime (MIC ≥ 16 μg/ml, n = 25), Imipenem (MIC ≥ 4 μg/ml, n = 25), Trimethoprim/sulfamethoxazole (MIC ≥ 4/76 μg/ml, n = 25), Levofloxacin (MIC ≥ 2 μg/ml, n = 22), Gentamicin (MIC ≥ 16 μg/ml, n = 11), Tigecycline (MIC ≥ 8 μg/ml, n = 9), Tobramycin (MIC ≥ 16 μg/ml, n = 8), Amikacin (MIC ≥ 64 μg/ml, n = 5).
Percentage of CRKP isolates resistant to a panel of antibiotics (30 isolates).The X-axis displays the percentage of the isolates resistant to a given antibiotic (Y-axis). Distribution of the MICs of antibiotics were as follows: Ertapenem (MIC ≥ 2 μg/ml, n = 30), Amoxicillin/clavulanic acid (MIC ≥ 32/16 μg/ml, n = 30), Cefoperazone (MIC ≥ 64 μg/ml, n = 30), Cefazolin (MIC ≥ 8 μg/ml, n = 30), Cefoxitin (MIC ≥ 32 μg/ml, n = 30), Ampicillin (MIC ≥ 32 μg/ml, n = 30), Aztreonam (MIC ≥ 16 μg/ml, n = 29), Ceftriaxone (MIC ≥ 4 μg/ml, n = 29), Piperacillin-tazobactam (MIC ≥ 128/4 μg/ml, n = 29), Nitrofurantoin (MIC ≥ 128 μg/ml, n = 28), Ciprofloxacin (MIC ≥ 1 μg/ml, n = 25), Cefepime (MIC ≥ 16 μg/ml, n = 25), Imipenem (MIC ≥ 4 μg/ml, n = 25), Trimethoprim/sulfamethoxazole (MIC ≥ 4/76 μg/ml, n = 25), Levofloxacin (MIC ≥ 2 μg/ml, n = 22), Gentamicin (MIC ≥ 16 μg/ml, n = 11), Tigecycline (MIC ≥ 8 μg/ml, n = 9), Tobramycin (MIC ≥ 16 μg/ml, n = 8), Amikacin (MIC ≥ 64 μg/ml, n = 5).

Fig. 2.

The minimum spanning tree.The relationships between different clones of six unique sequence types (ST290, ST11, ST722, ST1446, ST111, and ST896 emerging in the ICU. The graph was analyzed by PHYLOVIZ using the goeBURST algorithm at single-locus variant (SLV) level. ST11 node was colored in light green; other ST nodes were colored in dark green and manually dragged to the selected positions that were represented in red.
The minimum spanning tree.The relationships between different clones of six unique sequence types (ST290, ST11, ST722, ST1446, ST111, and ST896 emerging in the ICU. The graph was analyzed by PHYLOVIZ using the goeBURST algorithm at single-locus variant (SLV) level. ST11 node was colored in light green; other ST nodes were colored in dark green and manually dragged to the selected positions that were represented in red.

The corresponding bacterial characteristics and medical records of patients with CRKP acquisition.

Bacterial strainAgeIsolation siteSTCarbapenemasesUnderlying conditionsInvasive proceduresAntimicrobial treatmentThe length of stayOutcomes
102561WoundNANDM-5Septic shock, MODS, necrotizing fasciitisNasogastric tube, central venous catheter, surgical procedureIMP, AMC, FEP, MXF, ISE23 daysSurvived
102981WoundST722NAPulmonary infection, hypertension, diabetes mellitus,PICC catheter, mechanical ventilation heart disease, encephalorrhagiaIMP, TZP, SCF46 daysStable, discharged
105073BloodST11NDM-5Septic shock, biliary tract infection, COPD, MODS, pulmonary failureMechanical ventilation, urinary catheter, deep vein catheterTZP, IMP, MEM, SCF, TGC55 daysDiscontinuing treatment
105189SputumST11NDM-5Pulmonary infection, septic shock, pulmonary failure, hypertension, chronic renal failure, MDS, diabetes mellitus, hypertensive heart diseaseMechanical ventilation, urinary catheter, gastric tubeSCF, TGC20 dTaysDeath
105273SputumST11NDM-5Septic shock, biliary tract infection, COPD, MODS, pulmonary failureMechanical ventilation, urinary catheter, deep vein catheterTZP, IMP, MEM, SCF, TGC34 daysDiscontinuing treatment
105546Drainage fluidST1446NAPulmonary infection, pyothorax, septic shock, pulmonary failure, renal insufficiency, liver cirrhosisMechanical ventilation, urinary catheter, deep vein catheter, gastric tubeIMP, TZP, SCF38 daysDiscontinuing treatment
106279Bronchial perfusateST290NDM-5Pulmonary infection, chronic bronchitis, pulmonary failure, hypertension, cerebral infarction, pleural effusionMechanical ventilation, urinary catheter, deep vein catheter, gastric tubeSCF, AMC, FEP26 daysSurvived
106379SputumST290NDM-5Pulmonary infection, chronic bronchitis, pulmonary failure, hypertension, cerebral infarction, pleural effusionMechanical ventilation, urinary catheter, deep vein catheter, gastric tubeSCF, AMC, FEP26 daysSurvived
106461UrineST290NDM-5Spinal cord injury, high falling injury, electric injury, pulmonary infection, pulmonary failure, fractureMechanical ventilation, urinary catheter, deep vein catheter, gastric tubeTZP, MEM, SCF83 daysStable, discharged
107642SputumST290NDM-5Craniocerebral trauma, pulmonary contusion, hemorrhagic shock, deep venous thrombosis, renal failureMechanical ventilation, urinary catheter, deep vein catheterTZP, AMC, FEP, ISE, MEM, SCF136 daysDeath
110279SputumST290NDM-5Pulmonary infection, pulmonary failure, chronic bronchitis, parkinsonMechanical ventilation, urinary catheter, deep vein catheter, gastric tube, surgical procedureSCF, IMP, TZP123 daysSurvived
116576Drainage fluidST11KPCGastric perforation, peritonitis, fistulo of colon, pulmonary infection, liver cirrhosisMechanical ventilation, urinary catheter, deep vein catheterTZP, IMP, AMC, FEP, TGC, SCF18 daysDiscontinuing treatment
123338Drainage fluidST290NARetroperitoneal abscess, acute necrotizing pancreatitis, hepatic insufficiency, hyperlipemiaMechanical ventilation, urinary catheter, deep vein catheter, central venous catheter, drainage tubeTZP, LEV, IMP46 daysDiscontinuing treatment
124772Urinary catheterST11KPCNMS, pulmonary infection, pulmonary failure, diabetes mellitus, hypertension, renal or hepatic insufficiency, hyperlipemiaMechanical ventilation, urinary catheter, deep vein catheterTZP27 daysStable, discharged
176257SputumST11KPCSeptic shock, pulmonary encephalopathy, COPD, pulmonary failure, hypertension, fungal infectionMechanical ventilation, urinary catheter, deep vein catheterSCF, IMP, AMK, FEP45 daysDeath
177388Urinary catheterST11NAPulmonary infection, pulmonary failure, cerebral infarction, hypertension, diabetes mellitus, alzheimer diseaseMechanical ventilation, urinary catheter, gastric tubeTZP, IMP35 daysStable, discharged
177939Urinary catheterST111NAMODS, pulmonary failure, traumatic shock, multiple fracture, sepsis, pulmonary infection, fungal infectionMechanical ventilation, urinary catheter, deep vein catheterIMP, SCF, ISE, MXF183 daysSurvived
178572Urinary catheterST11KPCSCAP, pulmonary failure, urinary tract infection, diabetes mellitus, septic shock, fungal infection, pleural effusionMechanical ventilation, urinary catheter, deep vein catheterIMP, SCF, TGC, AZM, MXF31 daysDiscontinuing treatment
179370Urinary catheterNANAPulmonary infection, pulmonary failure, septic shock, fungal infection, cerebral infarction, hypertension, diabetes mellitus, gastrointestinal hemorrhageMechanical ventilation, urinary catheter, deep vein catheter, gastrointestinal tubeTZP, SCF, CIP, FEP40 daysSurvived
193275SputumST11NALung cancer, pulmonary infection, bronchiectasis, CHD, hypertension, diabetes mellitusMechanical ventilation, urinary catheter, deep vein catheterTZP, SCF, IMP, TGC87 daysSurvived
194878SputumST896KPCCerebral aneurysm, subarachnoid hemorrhage, intracranial infection, pulmonary infection, deep venous thrombosis, fungal infectionMechanical ventilation, urinary catheterTZP, MEM, LEV, ISE, IMP, PB63 daysStable, discharged
197585SputumST11KPCPulmonary infection, pulmonary failure, cardiac failure, cerebral infaction, hypertensionMechanical ventilation, urinary catheter, deep vein catheter, PICC catheterIMP, TZP, TGC66 daysStable, discharged
197785SputumST11KPCCOPD, pneumonia, pulmonary failure, pulmonary encephalopathy, cardiac failure, renal failure, pulmonary arterial hypertensionMechanical ventilation, urinary catheter, deep vein catheter, PICC catheterIMP, SCF, TGC, PB, CAZ/AVI46 daysDeath
197878SputumST11KPCPulmonary infection, severe pneumonia, pulmonary failure, renal failure, hypertension, hepatic insufficiency, gastrointestinal hemorrhage, deep venous thrombosisMechanical ventilation, urinary catheter, deep vein catheterSCF, MXF, MEM, IMP, TGC, AMK, PB, CAZ/AVI, MH51 daysDiscontinuing treatment
198270SputumST11NDM-1, KPCTonsil carcinoma, hypertension, hyperlipemia, interstitial pneumonia, pulmonary failure, fungal infectionMechanical ventilation, urinary catheter, deep vein catheterIMP47 daysStable, discharged
198382Urinary catheterST11KPCCOPD, pulmonary failure, pulmonary encephalopathy, diabetes mellitus, hypertension, fracture, septic shock, gastrointestinal hemorrhageMechanical ventilation, urinary catheter, deep vein catheter, PICC catheterTZP, IMP, SCF37 daysDeath
198466Drainage fluidNANDM-1Peritonitis, septic shock, pulmonary failure, renal failure, hypertension, fungal infection, intestinal perforationMechanical ventilation, urinary catheter, deep vein catheter, PICC catheter, drainage tubeIMP, TGC, TZP, SCF43 daysStable, discharged
198789SputumST11KPCSevere pneumonia, pulmonary failure, CHD, hypertension, rectal cancer, myocardial infarction, fungal infectionMechanical ventilation, urinary catheter, deep vein catheterTZP, MEM, SCF, PB, TGC, CAZ/AVI22 daysSurvived
199085BloodST11KPCCOPD, pneumonia, pulmonary failure, pulmonary encephalopathy, cardiac failure, renal failure, pulmonary arterial hypertensionMechanical ventilation, urinary catheter, deep vein catheter, PICC catheterIMP, SCF, TGC, PB, CAZ/AVI46 daysDeath
199782BloodST11KPCCOPD, pulmonary failure, pulmonary encephalopathy, diabetes mellitus, hypertension, fracture, septic shock, gastrointestinal hemorrhageMechanical ventilation, urinary catheter, deep vein catheter, PICC catheterTZP, IMP, SCF37 daysDeath
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Life Sciences, Microbiology and Virology