Clinical Molecular Epidemiology of Carbapenem-Resistant Klebsiella pneumoniae Among Pediatric Patients in Jiangsu Province, China

Ziyan Kong,1,2,* Xuemei Liu,3,* Chenxi Li,1,* Siyun Cheng,1 Fei Xu,3 Bing Gu1,4 1Medical Technology School, Xuzhou Medical University, Xuzhou, Jiangsu Province, People’s Republic of China; 2Department of Laboratory Medicine, The First People’s Hospital of Lianyungang, Lianyungang, Jiangsu Province, People’s Republic of China; 3Department of Laboratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing, Jiangsu Province, People’s Republic of China; 4Department of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou, Jiangsu Province, People’s Republic of China*These authors contributed equally to this workCorrespondence: Fei XuDepartment of Laboratory Medicine, Children’s Hospital of Nanjing Medical University, Nanjing 210009, People’s Republic of ChinaEmail 350826448@qq.comBing GuDepartment of Laboratory Medicine, Affiliated Hospital of Xuzhou Medical University, Xuzhou 221006, People’s Republic of ChinaEmail gb20031129@163.comPurpose: The continuous emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a serious public health problem globally, especially for children, but data on CRKP infection in pediatric patients are limited. This study aimed to identify epidemiological and molecular patterns of CRKP among pediatric patients in Jiangsu province, China.Patients and Methods: CRKP were consecutively collected from the Children’s Hospital of Nanjing Medical University in China from July 2018 to May 2019. Then, CRKP strains were performed for further study: antimicrobial susceptibility testing, drug-resistance determinants screening and homology analysis.Results: We collected 94 CRKP from 94 children. Overall, blaKPC-2 (79.8%) was the predominant carbapenemase gene, followed by blaNDM-1(14.9%), blaIMP-4 (5.3%) and blaNDM-5(4.3%). Notably, two isolates coharbored blaKPC-2 and blaIMP-4, and two isolates coharbored blaKPC-2 and blaNDM-5. MLST analysis revealed that 14 distinct sequence types (STs) were identified, of which ST11 was the most common sequence type identified. Moreover, two novel STs, ST4854 and ST4855, were detected in this study. PFGE revealed that a predominant cluster consisting of KPC-2-producing CRKP ST11 clone isolates was identified and was distributed mainly in the pediatric intensive care unit (PICU) and cardiac intensive care unit (CCU). Moreover, this is the first report to identify the dissemination of ST716 CRKP coproducing KPC-2 and IMP-4 clones.Conclusion: Clonal dissemination of KPC-2-producing CRKP ST11 was observed in multiple departments. Moreover, two novel STs (ST4854 and ST4855) were identified, which indicates an increased diversity of CRKP strains. To our knowledge, this is the first report that identified the dissemination of Klebsiella pneumoniae coproducing KPC-2 and IMP-4 clones among children, which represents a significant health risk to pediatric patients. Active surveillance and effective control measures are urgently needed to prevent further transmission of these strains among children.Keywords: Klebsiella pneumoniae, carbapenemase, KPC-2, ST11, clonal dissemination, children