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Nosocomial Infections in ICU · Journal article
Infection and Drug Resistance · August 1, 2026
Early or partial results. Treat as a signal, not a conclusion.
This is a single-centre cross-sectional genomic characterization of 20 CRKP isolates collected in 2024, identifying ST11 as the predominant clone (65%) and describing a rare plasmid co-harbouring bla NDM-1 and bla OXA-232 with confirmed conjugative transfer capability. The study demonstrates CRKP dissemination across hospital departments, particularly surgery, and suggests both clonal expansion and plasmid-mediated horizontal gene transfer as drivers; however, it is limited to a single hospital and lacks longitudinal or comparative data to establish causation or generalizability.
Cross-sectional descriptive study with genomic characterization and in vitro conjugation assays. Twenty K. pneumoniae isolates collected from a teaching hospital in 2024; predominantly CRKP. Isolates recovered mainly from sputum (25%, 5/20) and peritoneal drainage fluid (25%, 5/20). Origin: Surgery department (60%, 12/20), ICU (20%, 4/20), and other departments (20%, 4/20).. Intervention: Whole-genome sequencing, antimicrobial susceptibility testing, conjugation assays, and resistance gene characterization. n = 20. Single teaching hospital (location not specified).
ST11 was the predominant CRKP clone at 65% (13/20), followed by ST15 at 10% (2/20) Most isolates originated from Surgery department (60%, 12/20) and ICU (20%, 4/20) Thirteen isolates carried bla KPC-2, while two harbored bla NDM-1
No clinical outcome data (infection source, patient outcomes, mortality) reported; study is laboratory-based only.
This descriptive study suggests that CRKP disseminates beyond traditional ICU reservoirs and is driven by both clonal (ST11) and plasmid-mediated mechanisms. Clinicians should be aware of CRKP risk in surgical and other non-ICU settings, and the identification of a rare multi-carbapenemase-harbouring plasmid highlights the potential for accumulation of resistance. However, the single-centre, small sample limits generalizability and does not establish clinical outcomes or guide practice changes.
Single-centre, cross-sectional descriptive study of 20 isolates characterizing CRKP epidemiology and plasmid structure; generates hypotheses about resistance dissemination but lacks comparative design, temporal follow-up, or clinical outcome data.
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This descriptive study suggests that CRKP disseminates beyond traditional ICU reservoirs and is driven by both clonal (ST11) and plasmid-mediated mechanisms. Clinicians should be aware of CRKP risk in surgical and other non-ICU settings, and the identification of a rare multi-carbapenemase-harbouring plasmid highlights the potential for accumulation of resistance. However, the single-centre, small sample limits generalizability and does not establish clinical outcomes or guide practice changes.
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Background: Carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a major threat to global public health. Although intensive care units (ICUs) are traditionally regarded as the main reservoirs for CRKP, CRKP has been widely reported across multiple hospital departments; however, department-specific molecular epidemiology and resistance gene dissemination remain incompletely characterized. Moreover, CRKP isolates co-harboring multiple carbapenemase genes, such as bla NDM-1 and bla OXA-232, are rare and insufficiently characterized. Methods: Twenty K. pneumoniae isolates were collected from a teaching hospital in 2024. Antimicrobial susceptibility testing was performed to determine minimum inhibitory concentrations. Conjugation assays were conducted to evaluate the transferability of bla NDM-1 Whole-genome sequencing was performed using Illumina and Oxford Nanopore platforms, followed by hybrid assembly. Resistance genes, insertion sequences, and virulence factors were identified using ABRicate with ResFinder, ISFinder, and VFDB. MLST, plasmid replicon typing, cgMLST, and comparative genomic analyses were performed using BacWGSTdb. Results: The isolates were mainly recovered from sputum and peritoneal drainage fluid, each accounting for 25% (5/20). Most isolates originated from the Surgery department (60%, 12/20), followed by the ICU (20%, 4/20). ST11 was the predominant clone (65%, 13/20), followed by ST15 (10%, 2/20), with ST638, ST1049, ST4573, ST23, and ST3332 detected at low frequencies. Thirteen isolates carried bla KPC-2, while two harbored bla NDM-1 Conjugation assays confirmed the transferability of bla NDM-1. Genomic analysis of the ST638 isolate KP1226 identified a 173,720-bp plasmid, pKP1226-1, carrying bla NDM-1, bla OXA-232, and multiple T4SS-related genes, suggesting a conjugative structure. Conclusion: This study describes CRKP dissemination outside ICUs in this single tertiary hospital, driven by both ST11 clonal expansion and plasmid-mediated horizontal gene transfer. The rare bla NDM-1 -positive plasmid co-harboring bla OXA-232 highlights the accumulation of resistance determinants and potential enhanced multidrug resistance transmission. Keywords: CRKP, whole-genome sequencing, plasmid structure
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