Emergence of a Minor Clonal Dissemination of Klebsiella Pneumoniae Coproducing KPC-2 and IMP-4 Clone Among Pediatric Patients from China

Background: 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. 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: : Overall, bla KPC-2 (79.8%) was the predominant carbapenemase gene, followed by bla NDM-1 (14.9%), bla IMP-4 (5.3%) and bla NDM-5 (4.3%). Notably, two isolates coharbored bla KPC-2 and bla IMP-4, and two isolates coharbored bla KPC-2 and bla NDM-5 . MLST analysis revealed that fourteen 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 minor clonal dissemination of CRKP ST716 coproducing KPC-2 and IMP-4 and CRKP ST1140 producing NDM-5. Conclusions: : Clonal dissemination of KPC-2-producing CRKP ST11 was observed in multiple departments. Moreover, two novel STs (ST4854 and ST4855) were identified, which indicates increased diversity of CRKP strains. To our knowledge, this is the first report that identified a minor clonal 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.