Genetic environment of the blaKPC-2 gene in a Klebsiella pneumoniae isolate that may have been imported to Russia from Southeast Asia

The nucleotide sequence of a blaKPC-2-harboring plasmid (pKPCAPSS) from Klebsiella pneumoniae ST273 isolated in Saint Petersburg, Russia, from a patient with history of recent travel to Vietnam is presented. This 127,970-bp plasmid possessed both IncFII and IncR replicons. blaKPC-2 was localized on a hypothetical mobile element. This element was flanked by 38-bp inverted Tn3 repeats and included a Tn3-specific transposase gene, macrolide resistance operon (mphA-mrx-mphR), and a fragment of blaTEM with unique polymorphisms. © 2017 American Society for Microbiology. All Rights Reserved

The first case of revealing of Klebsiella pneumoniae ST147, producing NDM-1 carbapenemase, in trauma and orthopedic hospital in Russia

Present report describes the first case of isolation of NDM-1 carbapenemase-producing K. pneumoniae in a patient with wound infection after open tibial fracture. Identical isolates were twice detected in various microbial associations: first time during therapy with ampicillin/sulbactam, second time after the relapse of wound infection during therapy with cephoperazone/sulbactam with vancomycin. The strain of K. pneumoniae was resistant to all beta-lactams, aminoglycosides and fluoroquinolones, but retained susceptibility to tigecycline and polymyxin B. The presence of blaNDM-1 was detected by PCR and Sanger sequencing. On the basis of multilocus sequence typing K. pneumoniae isolate was classified as sequence-type 147 (ST147). Eradication of the pathogen, successful osteosynthesis of tibial bones and skin-muscle flap plasty of the extensive wound were completed together with combined dioxydin and phosphomycin therapy. Due to the danger of the emergence of nosocomial infection sources and of the development of the potentially incurable nosocomial implant-associated infection, detection of NDM-1 carbapenemase-producing K. pneumoniae strain in a trauma and orthopedic in-patient clinic is alarming

<i>Klebsiella pneumoniae</i> Susceptibility to Carbapenem/Relebactam Combinations: Influence of Inoculum Density and Carbapenem-to-Inhibitor Concentration Ratio

The inoculum effect (IE) is a well-known phenomenon with beta-lactams. At the same time, the IE has not been extensively studied with carbapenem/carbapenemase inhibitor combinations. The antibiotic-to-inhibitor concentration ratio used in susceptibility testing can influence the in vitro activity of the combination. To explore the role of these factors, imipenem/relebactam and doripenem/relebactam MICs were estimated against six Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae strains at standard inocula (SI) and high inocula (HI) by two methods: with a fixed relebactam concentration and with a fixed, pharmacokinetic-based carbapenem-to-relebactam concentration ratio. The combination MICs at HI, compared to SI, increased with most of the tested strains. However, the IE occurred with only two K. pneumoniae strains regardless of the MIC testing method. The relationship between the MICs at SI and the respective inoculum-induced MIC changes was observed when the MICs were estimated at pharmacokinetic-based carbapenem-to-relebactam concentration ratios. Thus, (1) IE was observed with both carbapenem/relebactam combinations regardless of the MIC testing method; however, IE was not observed frequently among tested K. pneumoniae strains. (2) At HI, carbapenem/relebactam combination MICs increased to levels associated with carbapenem resistance. (3) Combination MICs determined at pharmacokinetic-based carbapenem-to-inhibitor concentration ratios predict susceptibility elevations at HI in KPC-producing K. pneumoniae

Time-Dependent Shifts in Intestinal Bacteriome, <i>Klebsiella</i> Colonization and Incidence of Antibiotic-Resistance Genes after Allogeneic Hematopoietic Stem Cell Transplantation

Dose-intensive cytostatic therapy and antibiotic treatment in allogeneic hematopoietic stem cell transplantation (allo-HSCT) cause severe abnormalities in a composition of gut microbiota as well as the emergence of antibiotic resistance. The data on the longitudinal recovery of major bacterial phyla and the expansion of genes associated with antibiotic resistance are limited. We collected regular stool samples during the first year after allo-HSCT from 12 adult patients with oncohematological disorders after allo-HSCT and performed 16SrRNA sequencing, multiplex PCR, conventional bacteriology and CHROMagar testing. We observed a decline in Shannon microbiota diversity index as early as day 0 of allo-HSCT (p = 0.034) before any administration of antibiotics, which persisted up to 1 year after transplantation, when the Shannon index returned to pre-transplant levels (p = 0.91). The study confirmed the previously shown decline in Bacillota (Firmicutes) genera and the expansion of E. coli/Shigella, Klebsiella and Enterococci. The recovery of Firmicutes was slower than that of other phyla and occurred only a year post-transplant. A positive correlation was observed between the expansion of E. coli/Shigella genera and blaKPC, blaCTX-M-1 and blaTEM (p Klebsiella spp. and blaOXA-48-like, blaNDM, blaCTX-M-1, blaTEM, and blaSHV (p Pseudomonas spp. and blaNDM (p = 0.002), Enterococcus spp. and blaOXA-48-like, blaNDM, blaCTX-M-1, blaSHV (p p K. pneumoniae strains in fecal samples proved to be resistant to the main antibiotic groups (carbapenems, aminoglycosides, fluoroquinolones, third-generation cephalosporins). One year after HSCT, we documented the spontaneous decolonization of K. pneumoniae. The sensitivity of molecular biology techniques in the search for total and antibiotic-resistant Klebsiella seems to be superior to common bacteriological cultures. Future studies should be focused on searching for novel approaches to the efficient reconstitution and/or maintenance of strictly anaerobic microbiota in oncological patients

Изменения в серотиповом составе Streptococcus pneumoniae, циркулирующих среди детей в Российской Федерации, после внедрения 13-валентной пневмококковой конъюгированной вакцины

During a prospective multicenter non-interventional observational study, a comparative assessment was made of the serotype structure of pneumococci circulating among healthy children under the age of 5 years and children of the same age group with signs of respiratory infections in the periods 2016-2018 and 2020-2022. Data on the serotype structure of pneumococci in the period from 2016-2018 were obtained from our previous works. In 2020-2022 the study included 2066 healthy children and 603 children with respiratory infections. Streptococcus pneumoniae and their DNA were detected in nasopharyngeal swabs by classical culture and molecular methods. Typing was carried out by molecular methods. On the territory of the Russian Federation, pneumococci belonging to the serotypes included in the 13-valent vaccine are being forced out of circulation and replaced by non-vaccine serotypes. Before the introduction of mass antipneumococcal vaccination (until 2015), the 13-valent conjugate vaccine covered from 66.2% to 92% of pneumococci, after the start of mass anti-pneumococcal vaccination in the period 2016-2018, coverage decreased to 57.3%. Between 2020 and 2022, coverage was less than 40%. The main “non-vaccine” serotypes/serogroups circulating in the Russian Federation are 15AF, 11AD, 23A, 9LN and 16F.В ходе проспективного многоцентрового не интервенционного обсервационного исследования была проведена сравнительная оценка серотиповой структуры пневмококков, циркулирующих среди здоровых детей в возрасте до 5 лет и детей этой же возрастной группы с признаками респираторных инфекций в периоды 2016–2018 гг. и 2020–2022 гг. Данные о серотиповой структуры пневмококков в период 2016–2018 гг. были получены из наших предыдущих работ. В 2020–2022 гг. в исследование было включено 2066 здоровых детей и 603 ребенка с респираторными инфекциями. Streptococcus pneumoniae и их ДНК детектировали в назофарингеальных мазках классическими культуральными и молекулярными методами. Типирование проводили молекулярными методами. На территории Российской Федерации происходят процесс вытеснения из циркуляции пневмококков, относящихся к серотипам, входящим в 13-валентную вакцину, и их замещение невакцинными серотипами. Перед внедрением массовой антипневмококковой вакцинации (до 2015 г.) конъюгированная 13-валентная вакцина обеспечивала на тот момент охват от 66,2% до 92% пневмококков, после начала массовой антипневмококковой вакцинации в период 2016–2018 гг. охват снизился до 57,3%. В период с 2020 по 2022 г. охват составил менее 40%. К основным «невакцинным» серотипам/серогруппам, циркулирующим на территории Российской Федерации, относятся 15AF, 11AD, 23A, 9LN, 16F