article · Microbiology Spectrum
Routine surveillance in a tertiary teaching hospital burns unit identified multidrug-resistant and hypervirulent Klebsiella pneumoniae ST147 strains. Isolated from burn wound infections between May 2020 and July 2021, these bacteria carried the blaNDM-1 gene, which breaks down beta-lactam antibiotics used for severe bacterial infections. Analysis revealed that the blaNDM-1 gene was flanked by an IS26 element and an open reading frame within a conserved genetic background, indicating potential mechanisms for gene mobilisation. The associated plasmid also contained predicted resistance regions covering nearly all routinely prescribed antibiotics alongside hypervirulence genes. This marks the first report of this high-risk, hypervirulent, multidrug-resistant clone in Ghana. The findings underline the necessity of tracking resistance genes and mobile genetic elements to improve molecular epidemiology and outbreak tracking.
Multidrug-resistant and hypervirulent bacterial strains pose severe threats to vulnerable patients, including those with burn injuries, where treatment options are minimal and mortality is high. Identifying how these dangerous bacteria evolve and spread mobile resistance genes helps hospitals design targeted infection control measures and antimicrobial stewardship programmes, especially in resource-constrained settings.
The findings support the integration of whole-genome sequencing and molecular surveillance tools into routine hospital diagnostics and outbreak detection protocols. Potential end users include clinical diagnostic laboratories, hospital infection control units, and public health surveillance bodies. This represents early-stage surveillance research, providing genetic insights and diagnostic targets rather than a ready-to-deploy commercial product.
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The spread of hypervirulent (hv) and carbapenem-/multidrug-resistant <i>Klebsiella pneumoniae</i> is an emerging problem in healthcare settings. The New Delhi metallo-β-lactamase-1 (<i>bla</i><sub>NDM-1</sub>) is found in Enterobacteriaceae including <i>K. pneumoniae.</i> The <i>bla</i><sub>NDM-1</sub> is capable of hydrolyzing β-lactam antibiotics which are used for treatment of severe infections caused by multidrug-resistant Gram-negative bacteria. This is associated with the unacceptably high mortality rate in immunocompromised burn injury patients. This study reports on the characterization of <i>bla</i><sub>NDM-1</sub> gene and virulence factors in hv carbapenem-/multidrug-resistant <i>K. pneumoniae</i> ST147 in the burns unit of a tertiary teaching hospital during routine surveillance. Two <i>K. pneumoniae</i> strains were obtained from wounds of burn-infected patients from May 2020 to July 2021. The hypervirulence genes and genetic context of the <i>bla</i><sub>NDM-1</sub> gene and mobile genetic elements potentially involved in the transposition of the gene were analyzed. We identified a conserved genetic background and an IS<i>26</i> and open reading frame flanking the <i>bla</i><sub>NDM-1</sub> gene that could suggest its involvement in the mobilization of the gene. The plasmid harbored additional antibiotic resistance predicted regions that were responsible for resistance to almost all the routinely used antibiotics. To ensure the identification of potential outbreak strains during routine surveillance, investigations on resistance genes and their environment in relation to evolution are necessary for molecular epidemiology.IMPORTANCEData obtained from this study will aid in the prompt identification of disease outbreaks including evolving resistance and virulence of the outbreak bacteria. This will help establish and implement antimicrobial stewardship programs and infection prevention protocols in fragile health systems in countries with limited resources. Integration of molecular surveillance and translation of whole-genome sequencing in routine diagnosis will provide valuable data for control of infection. This study reports for the first time a high-risk clone <i>K. pneumoniae</i> ST147 with hypervirulence and multidrug-resistance features in Ghana.
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DOI: 10.1128/spectrum.03017-23
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