Clinical and Genomic Characteristics of Carbapenem-Resistant Klebsiella pneumoniae Isolates from Acute Pancreatitis with Infection in China

作者：Lin, Hong; Wang, Peng; Lu, Yingying; Gao, Kun; Hao, Haibin; Tong, Zhihui^*; Li, Weiqin^*

来源：Clinical Laboratory, 2023, 69(7): 1389-1397.

DOI：10.7754/Clin.Lab.2022.221017

• CRKP
• KPC-2
• NDM-5
• acute pancreatitis
• characteristic

Background: The aim of the study was to provide a clinical treatment reference for acute pancreatitis (AP) with infection, we analyzed the clinical and genomic characteristic of carbapenem-resistant Klebsiella pneumoniae (CRKP) isolates from AP with infection in China. @@@ Methods: Our clinical database was retrospectively analyzed with focus on the carbapenem-resistant characteristics among AP with infection in our Intensive Care Unit (ICU). Whole-genome sequencing (WGS) was used to analyze the antibiotic resistance gene, and antimicrobial susceptibility testing (AST) was performed to study the relevant phenotype in vitro. The CRISPR-Cas9 system was used to verify the relevant phenotype. @@@ Results: Based on 2,211 AST data of 627 AP patients with infection, CRKP had the highest proportion among carbapenem-resistant Enterobacteriaceae (CRE), at 37.8% for imipenem and 45.3% for meropenem. WGS revealed key beta-lactamase genes, specifically bla(CTX-M-15), bla(CTX-M-65), bla(KPC-2), bla(LAP-2), bla(NDM-5), bla(TEM-181), bla(OXA-1), and bla(SHV). A total of 31.3% of CRKP were NDM-5-KPC-2-producing strains, and NDM-5-producing CRKP was resistant to imipenem/meropenem combined with avibactam, with an MIC of 512 mg/L. In addition, after knocking out blaKPC-2 and blaNDM-5, NDM-5-producing and KPC-2-producing CRKP had the same resistance level to imipenem/meropenem. @@@ Conclusions: We first provided key insights into the clinical and genomic characteristic of CRKP in AP with infection and then made it clear that NDM-5 and KPC-2 had the same resistance level to carbapenems.

• 单位
  1; 南京大学; 南方医科大学