Bloodstream Infections Caused by Klebsiella pneumoniae Carbapenemase–Producing P. aeruginosa Sequence Type 463, Associated With High Mortality Rates in China: A Retrospective Cohort Study

• DOI: 10.3389/fcimb.2021.756782
• Publication Date: 2021-11-01T05:38:03Z
• Authors: Hangbin Hu; Yan Zhang; Piaopiao Zhang; Jie Wang; Qing Yuan; Weixiao Shi; Sheng Zhang; Haiting Feng; Yunbo Chen; Meihong Yu; Hongchao Chen; Yan Jiang; Qing Yang; Tingting Qu
• Keywords: Bacteremia; Galleria mellonella

Recently, KPC-producing P. aeruginosa has rapidly emerged and expanded in East China. Here we described the clinical impact characteristics of bloodstream infections (BSIs) from dominant CRPA belonging to Sequence Type (ST) 463.Retrospective cohort study was performed with BSI cases 2019 2020 a hospital Clinical characteristics, risk factors, all-course mortality were evaluated. All isolates had whole-genome sequencing, antimicrobial susceptibility testing, serum resistance assay. Representative tested for virulence Galleria mellonella infection model.Among 50 cases, ST463 predominated (48.0%). In multivariate analysis, found three independent factors fatal outcome: KPC carriage (OR 4.8; CI95% 1.0-23.7; P = 0.05), Pitt bacteremia score 1.3; 1.0-1.6; 0.02), underlying hematological disease 8.5; 1.6-46.4; 0.01). The baseline variables not statistically different across STs, however 28-day significantly higher than that non-ST463 (66.7% vs 33.3%, 0.03). ExoU exoS genes coexisted all isolates, carbapenem resistant gene blaKPC produced almost group(95.8% 7.7%, P<0.001). also showed rates antipseudomonal cephalosporins, monobactam, fluoroquinolones. And confirmed hypervirulence larvae model. genome one strain blaKPC-2 sole located on 41,104bp plasmid pZYPA01, carried 7-kb composite transposon-like element flanked by two IS26 elements (IS26-Tn3-tnpA-ISKpn27-blaKPC-2-ISKpn6-IS26). Plasmid various species presented core franked mobile genetic ISKpn27 ISKpn6.In cohort, those BSI. clone coharboring exoU/exoS spread China, which might develop new threat clinic. Our results suggest surveillance high-risk clone, CRPA, should be strengthened even worldwide future.