Background: Emergence of bla_KPC and bla_NDM co-harboring Klebsiella pneumoniae has escalated the threat of Carbapenem-resistant Klebsiella pneumoniae (CRKP) to healthcare. It remains unknown the prevalence and molecular characteristics of CRKP co-producing KPC and NDMs carbapenemases in Henan.
Methods and Results: Twenty-seven CRKP strains isolated from different times were selected randomly in affiliated cancer hospital of Zhengzhou University from January 2019 to January 2021, among which one KPC-2 and NDM-5 positive CRKP named K9 was isolated from an abdominal pus sample of a 63-year-old male patient with leukemia. Sequencing of K9 determined that K9 belonged to ST11-KL47, which is resistant to antibiotics such as meropenem, ceftazidime-avibactam and tetracycline. K9 carried two different plasmids that contained bla_{NDM− 5} and bla_{KPC− 2}. Both plasmids were shown to be novel hybrid plasmids and IS 26 played an important role in generation of two plasmids. Gene bla_KPC-2 was flanked by the NTEKPC-Ib-like genetic structure (IS 26 -ΔTn 3 -ISKpn8-bla_KPC-2-ISKpn6 -IS 26 ) and was located on a conjugative IncFII/R/N type hybrid plasmid.
Conclusion: The resistance gene bla_{NDM− 5} located on a region organized as IS 26-bla_{NDM– 5}-ble-trpF-dsbD-ISCR1-sul1-aadA2-dfrA12-IntI1 -IS 26 was carried by a phage-plasmid. We described a clinical CRKP co-producing KPC-2 and NDM-5 and emphasized an urgent need to control their further spread.
Keywords: carbapenem-resistant Klebsiella pneumoniae , KPC-2, NDM-5, beta-lactamases, hybrid plasmid, IS 26