Multidrug-resistant Klebsiella pneumoniae clinical isolates producing NDM- and OXA-type carbapenemase in Nepal

Abstract

Objectives

The emergence of multidrug-resistant Klebsiella pneumoniae has become a serious problem in medical settings worldwide.

Methods

A total of 46 isolates of multidrug-resistant K. pneumoniae were obtained from 2 hospitals in Nepal from October 2018 to April 2019.

Results

Most of these isolates were highly resistant to carbapenems, aminoglycosides, and fluoroquinolones with the minimum inhibitory concentrations (MICs) of more than 64 µg/mL. These isolates harboured carbapenemase-encoding genes, including bla_NDM-1, bla_NDM-5, bla_OXA-181 and bla_OXA-232, and 16S rRNA methyltransferase-encoding genes, including armA, rmtB, rmtC, and rmtF. Multilocus sequence typing revealed that 44 of 46 isolates were high-risk clones such as ST11 (2%), ST14 (4%), ST15 (11%), ST37 (2%), ST101 (2%), ST147 (28%), ST231 (13%), ST340 (4%), and ST395 (28%). In particular, ST395 isolates, which spread across medical settings in Nepal, co-harboured bla_NDM-5 and rmtB on IncFII plasmids and co-harboured bla_OXA-181/-232 and rmtF on ColKP3 plasmids. Several isolates harboured bla_OXA-181 or bla_NDM-5 on their chromosomes and multi-copies of bla_NDM-1 or genes encoding 16S rRNA methyltransferases on their plasmids.

Conclusions

The presented study demonstrates that the high-risk clones of multidrug-resistant K. pneumoniae spread in a clonal manner across hospitals in Nepal.