Extensively Drug-Resistant Klebsiella pneumoniae Associated with Complicated Urinary Tract Infection in Northern India

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  • Kaza Parinitha
    Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, India
  • Xavier Basil Britto
    Laboratory of Medical Microbiology, Vaccine & Infectious Disease Institute, University of Antwerp, Belgium
  • Mahindroo Jaspreet
    Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, India
  • Singh Nisha
    Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, India
  • Baker Stephen
    Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), Department of Medicine, University of Cambridge, UK
  • Nguyen To Nguyen Thi
    The Hospital for Tropical Diseases, Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Vietnam
  • Mavuduru Ravimohan Suryanarayana
    Department of Urology, Postgraduate Institute of Medical Education and Research, India
  • Mohan Balvinder
    Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, India
  • Taneja Neelam
    Department of Medical Microbiology, Postgraduate Institute of Medical Education and Research, India

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  • Extensively Drug-Resistant <i>Klebsiella pneumoniae</i> Associated with Complicated Urinary Tract Infection in Northern India

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<p>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.</p>

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