Whole-Genome Analysis of KPC-Producing Klebsiella Pneumoniae Isolates from Hospital Acquired Post-Neurosurgical Meningitis

Background: Nosocomial bacterial infections from carbapenem-resistant Klebsiella pneumoniae (CRKP) are associated with high mortality in neurosurgical patients. This study examined the post-neurosurgical meningitis outbreak caused by CRKP of patients with nervous system tumours，and analysed the molecular characteristics of the causative strain.Methods: Neurosurgical cancer patients with meningitis caused by CRKP between 2017–2019 were retrospectively analysed. Identification of strains and antimicrobial susceptibilities was conducted using BD Phoenix-100, 16S rRNA gene sequencing and broth microdilution. Multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were used to identify the subtypes of K. pneumoniae. The genotype correlation, resistance genes and plasmid of isolates were assessed by whole-genome sequencing (WGS).Results: Isolates were resistant to almost all of the tested antimicrobial agents except polymyxin and tigecycline. The PFGE and MLST revealed all isolates were the same strain - ST11–while WGS phylogenetic analysis indicated they were closely related. The isolates harboured blaKPC-2 and an IncFII-type plasmid; the blaKPC-2 gene had a similar genetic environment across isolates.Conclusions: The results of molecular analysis showed that ST11 and IncFII-type plasmid in CRKP have close correlations and indicate a long-term retrospective genomic study throughout the hospital for KPC-producing K. pneumoniae is necessary.