Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016

ABSTRACT 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...

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Autores principales:	Tom J. B. de Man, Joseph D. Lutgring, David R. Lonsway, Karen F. Anderson, Julia A. Kiehlbauch, Lei Chen, Maroya Spalding Walters, Maria Sjölund-Karlsson, J. Kamile Rasheed, Alexander Kallen, Alison Laufer Halpin
Formato:	article
Lenguaje:	EN
Publicado:	American Society for Microbiology 2018
Materias:	carbapenems colistin Klebsiella pneumoniae plasmid-mediated resistance whole-genome sequencing Microbiology QR1-502
Acceso en línea:	https://doaj.org/article/4a90146e0fbd4055b72928b5beeba8fa
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spelling	oai:doaj.org-article:4a90146e0fbd4055b72928b5beeba8fa2021-11-15T15:53:27ZGenomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 201610.1128/mBio.00440-182150-7511https://doaj.org/article/4a90146e0fbd4055b72928b5beeba8fa2018-05-01T00:00:00Zhttps://journals.asm.org/doi/10.1128/mBio.00440-18https://doaj.org/toc/2150-7511ABSTRACT 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. IMPORTANCE 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.Tom J. B. de ManJoseph D. LutgringDavid R. LonswayKaren F. AndersonJulia A. KiehlbauchLei ChenMaroya Spalding WaltersMaria Sjölund-KarlssonJ. Kamile RasheedAlexander KallenAlison Laufer HalpinAmerican Society for MicrobiologyarticlecarbapenemscolistinKlebsiella pneumoniaeplasmid-mediated resistancewhole-genome sequencingMicrobiologyQR1-502ENmBio, Vol 9, Iss 2 (2018)
institution	DOAJ
collection	DOAJ
language	EN
topic	carbapenems colistin Klebsiella pneumoniae plasmid-mediated resistance whole-genome sequencing Microbiology QR1-502
spellingShingle	carbapenems colistin Klebsiella pneumoniae plasmid-mediated resistance whole-genome sequencing Microbiology QR1-502 Tom J. B. de Man Joseph D. Lutgring David R. Lonsway Karen F. Anderson Julia A. Kiehlbauch Lei Chen Maroya Spalding Walters Maria Sjölund-Karlsson J. Kamile Rasheed Alexander Kallen Alison Laufer Halpin Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016
description	ABSTRACT 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. IMPORTANCE 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.
format	article
author	Tom J. B. de Man Joseph D. Lutgring David R. Lonsway Karen F. Anderson Julia A. Kiehlbauch Lei Chen Maroya Spalding Walters Maria Sjölund-Karlsson J. Kamile Rasheed Alexander Kallen Alison Laufer Halpin
author_facet	Tom J. B. de Man Joseph D. Lutgring David R. Lonsway Karen F. Anderson Julia A. Kiehlbauch Lei Chen Maroya Spalding Walters Maria Sjölund-Karlsson J. Kamile Rasheed Alexander Kallen Alison Laufer Halpin
author_sort	Tom J. B. de Man
title	Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016
title_short	Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016
title_full	Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016
title_fullStr	Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016
title_full_unstemmed	Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016
title_sort	genomic analysis of a pan-resistant isolate of <italic toggle="yes">klebsiella pneumoniae</italic>, united states 2016
publisher	American Society for Microbiology
publishDate	2018
url	https://doaj.org/article/4a90146e0fbd4055b72928b5beeba8fa
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Genomic Analysis of a Pan-Resistant Isolate of <italic toggle="yes">Klebsiella pneumoniae</italic>, United States 2016

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