Characterizing Mobilized Virulence Factors and Multidrug Resistance Genes in Carbapenemase-Producing Klebsiella pneumoniae in a Sri Lankan Hospital

Abstract

Limited data is available on the epidemiology and characteristics of carbapenem-resistant <i>Enterobacteriaceae</i> (CRE) and their associated plasmids or virulence determinants from Sri Lanka. Through whole genome sequencing of CREs from the intensive care units of a Sri Lankan teaching hospital, we identified a carbapenemase gene, <i>bla</i>_OXA-181 in 10 carbapenemase-producing <i>Klebsiella pneumoniae</i> isolates (two strains of ST437 and eight strains of ST147) from 379 respiratory specimens. <i>bla</i>_OXA-181 was carried in three variants of ColE-type plasmids. <i>K. pneumoniae</i> strains with <i>ompK36</i> variants showed high minimum inhibitory concentrations to carbapenem. Furthermore, genes encoding for extended spectrum β-lactamases (ESBL), plasmid-mediated quinolone resistance (PMQR) determinants (<i>qnr</i>, <i>aac(6')-Ib-cr</i>, and <i>oqxAB</i>) were present in all 10 strains. Amino acid substitution in chromosomal quinolone resistance-determining regions (QRDRs) <i>gyrA</i> (Ser83Ile) and <i>parC</i> (Ser80Ile) were also observed. All strains had yersiniabactin genes on mobile element ICE<i>kp</i>. Strict infection control practices and judicious use of antibiotics are warranted to prevent further spread of multidrug-resistant <i>K. pneumoniae</i>.