Genomic characterization of an emerging bla(KPC-2) carrying Enterobacteriaceae clinical isolates in Thailand

The rapidly increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) over the past decade has increased concern in healthcare facilities and the impact on public health. The prevalence of bla(KPC) (KPC) in Thailand remains very low; only bla(KPC-13) has been described previously. This study is the first to describe the characteristics of bla(KPC-2)-carrying Klebsiella pneumoniae, Escherichia coli, and Enterobacter asburiae in Thailand. The prevalence rate of bla(KPC-2)-carrying isolates was 0.13% among CRE isolates in our study. Based on carbapenem susceptibility testing, K. pneumoniae C1985 was resistant to meropenem and ertapenem, E. coli C1992 was resistant to meropenem, imipenem, and ertapenem, and E. asburiae C2135 was only resistant to imipenem. K. pneumoniae C1985 carried bla(KPC-2), bla(SHV-11), fosA, oqxA, and oqxB, while E. coli C1992 contained bla(KPC-2) and mdf(A) and E. asburiae C2135 harbored bla(KPC-2), bla(ACT-2), and qnrE1. The genetic features of bla(KPC-2) in the 3 isolates revealed identical rearrangement and flanking regions. Analysis of genomic sequences from these 3 isolates revealed that the sequence types of K. pneumoniae C1985, E. coli C1992, and E. asburiae C2135 were ST4008, ST7297, and ST1249, respectively. The 3 bla(KPC-2) isolates were from individual living cases. Two cases were colonization for K. pneumoniae C1985 and E. asburiae C2135 and the third case was hospital-acquired infection of E. coli C1992. Although the prevalence of bla(KPC-2)-carrying CRE is relatively low in this study, continued surveillance and close monitoring are warranted. In addition, prompt or early detection of CRE and strict implementation of infection control are essential to prevent outbreaks or rapid spread in hospitals.