{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:32:31Z","timestamp":1789997551748,"version":"4.0.1"},"reference-count":30,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T00:00:00Z","timestamp":1708128000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Microbiol"],"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Colistin and carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic> (Col-CRKP) represent a significant and constantly growing threat to global public health. We report here an outbreak of Col-CRKP infections during the fifth wave of COVID-19 pandemic.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>The outbreak occurred in an intensive care unit with 22 beds at a teaching university hospital, Isfahan, Iran. We collected eight Col-CRKP strains from seven patients and characterized these strains for their antimicrobial susceptibility, determination of hypermucoviscous phenotype, capsular serotyping, molecular detection of virulence and resistance genes. Clonal relatedness of the isolates was performed using MLST.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The COVID-19 patients were aged 24\u201375\u2009years with at least 50% pulmonary involvement and were admitted to the intensive care unit. They all had superinfection caused by Col-CRKP, and poor responses to antibiotic treatment and died. With the exception of one isolate that belonged to the ST11, all seven representative Col-CRKP strains belonged to the ST16. Of these eight isolates, one ST16 isolate carried the <jats:italic>iucA<\/jats:italic> and <jats:italic>ybtS<\/jats:italic> genes was identified as serotype K20 hypervirulent Col-CRKP. The <jats:italic>bla<\/jats:italic><jats:sub>SHV<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>NDM-1<\/jats:sub> genes were the most prevalent resistance genes, followed by <jats:italic>bla<\/jats:italic><jats:sub>OXA-48<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>CTX-M-15<\/jats:sub> and <jats:italic>bla<\/jats:italic><jats:sub>TEM<\/jats:sub> genes. Mobilized colistin-resistance genes were not detected in the isolates.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions<\/jats:title>\n                <jats:p>The continual emergence of ST16 Col-CRKP strains is a major threat to public health worldwide due to multidrug-resistant and highly transmissible characteristics. It seems that the potential dissemination of these clones highlights the importance of appropriate monitoring and strict infection control measures to prevent the spread of resistant bacteria in hospitals.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12866-024-03207-6","type":"journal-article","created":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T11:03:58Z","timestamp":1708167838000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":21,"title":["Outbreak of colistin and carbapenem-resistant Klebsiella pneumoniae ST16 co-producing NDM-1 and OXA-48 isolates in an Iranian hospital"],"prefix":"10.1186","volume":"24","author":[{"given":"Rahimeh","family":"Sanikhani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mojtaba","family":"Akbari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Majid","family":"Hosseinzadeh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mansour","family":"Siavash","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Farzad","family":"Badmasti","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamid","family":"Solgi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,2,17]]},"reference":[{"key":"3207_CR1","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1093\/femsre\/fuy043","volume":"43","author":"JA Bengoechea","year":"2019","unstructured":"Bengoechea JA, Pessoa JS. Klebsiella pneumoniae infection biology: living to counteract host defences. FEMS Microbiol Rev. 2019;43:123\u201344.","journal-title":"FEMS Microbiol Rev."},{"key":"3207_CR2","doi-asserted-by":"crossref","unstructured":"Candan E, Aks\u00f6z N. Klebsiella pneumoniae: characteristics of carbapenem resistance and virulence factors. Acta Biochim Pol. 2015;867-874","DOI":"10.18388\/abp.2015_1148"},{"key":"3207_CR3","doi-asserted-by":"publisher","first-page":"105854","DOI":"10.1016\/j.ijantimicag.2019.11.011","volume":"55","author":"S Nishida","year":"2020","unstructured":"Nishida S, Y., O. Genomic analysis of a pan-resistant Klebsiella pneumoniae sequence type 11 identified in Japan in 2016. Int J Antimicrob Agents. 2020;55:105854.","journal-title":"Int J Antimicrob Agents."},{"key":"3207_CR4","first-page":"1","volume":"74","author":"N Bolourchi","year":"2021","unstructured":"Bolourchi N, Shahcheraghi F, Giske C, et al. Comparative genome analysis of colistin-resistant OXA-48-producing Klebsiella pneumoniae clinical strains isolated from two Iranian hospitals. Ann Clin Microbiol Antimicrob. 2021;74:1\u201311.","journal-title":"Ann Clin Microbiol Antimicrob."},{"key":"3207_CR5","doi-asserted-by":"publisher","first-page":"142","DOI":"10.1016\/j.meegid.2019.01.030","volume":"69","author":"A Bahramian","year":"2019","unstructured":"Bahramian A, Shariati A, Yasbolaghi Sharahi J, et al. First report of New Delhi metallo-\u03b2-lactamase-6 (NDM-6) among Klebsiella pneumoniae ST147 strains isolated from dialysis patients in Iran. Infect Genet Evol. 2019;69:142\u20135.","journal-title":"Infect Genet Evol."},{"key":"3207_CR6","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fmicb.2020.00936","volume":"11","author":"H Solgi","year":"2020","unstructured":"Solgi H, Nematzadeh S, Giske C, et al. Molecular epidemiology of OXA-48 and NDM-1 producing Enterobacterales species at a University Hospital in Tehran, Iran, between 2015 and 2016. Front Microb. 2020;11:1\u201313.","journal-title":"Front Microb."},{"key":"3207_CR7","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1093\/femsre\/fuab049","volume":"46","author":"U Binsker","year":"2022","unstructured":"Binsker U, K\u00e4sbohrer A, Hammerl JA. Global colistin use: a review of the emergence of resistant Enterobacterales and the impact on their genetic basis. FEMS Microbiol Rev. 2022;46:1\u201337.","journal-title":"FEMS Microbiol Rev."},{"key":"3207_CR8","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1016\/j.ijantimicag.2014.02.016","volume":"44","author":"Y-M Ah","year":"2014","unstructured":"Ah Y-M, Kim A-J, Lee J-Y. Colistin resistance in Klebsiella pneumoniae. Int J Antimicrob Agents. 2014;44:8\u201315.","journal-title":"Int J Antimicrob Agents."},{"key":"3207_CR9","first-page":"711","volume":"46","author":"LJ Rojas","year":"2017","unstructured":"Rojas LJ, Salim M, Cober E, et al. Colistin resistance in Carbapenem-resistant Klebsiella pneumoniae: laboratory detection and impact on mortality. Clin Infect Dis. 2017;46:711\u20138.","journal-title":"Clin Infect Dis."},{"key":"3207_CR10","unstructured":"Clinical and Laboratory Standards Institute [CLSI] (2017). Performance standards for antimicrobial susceptibility testing, 27th Edn, Wayne, PA: Clinical and Laboratory Standards Institute."},{"key":"3207_CR11","doi-asserted-by":"publisher","first-page":"254","DOI":"10.1016\/j.micpath.2017.01.049","volume":"104","author":"H Wu","year":"2017","unstructured":"Wu H, Li D, Zhou H, et al. Bacteremia and other body site infection caused by hypervirulent and classic Klebsiella pneumoniae. Microb Pathog. 2017;104:254\u201362.","journal-title":"Microb Pathog."},{"key":"3207_CR12","doi-asserted-by":"publisher","first-page":"697","DOI":"10.1084\/jem.20030857","volume":"199","author":"CT Fang","year":"2004","unstructured":"Fang CT, Chuang YP, Shun CT, et al. A novel virulence gene in Klebsiella pneumoniae strains causing primary liver abscess and septic metastatic complications. J Exp Med. 2004;199:697\u2013705.","journal-title":"J Exp Med."},{"key":"3207_CR13","doi-asserted-by":"publisher","first-page":"541","DOI":"10.1099\/jmm.0.015198-0","volume":"59","author":"JF Turton","year":"2010","unstructured":"Turton JF, Perry C, Elgohari S, et al. PCR characterization and typing of Klebsiella pneumoniae using capsular type-specific, variable number tandem repeat and virulence gene targets. J Med Microbiol. 2010;59:541\u20137.","journal-title":"J Med Microbiol."},{"key":"3207_CR14","doi-asserted-by":"publisher","first-page":"58","DOI":"10.1186\/s12941-021-00467-2","volume":"20","author":"R Sanikhani","year":"2021","unstructured":"Sanikhani R, Moeinirad M, Solgi H, et al. The face of hypervirulent Klebsiella pneumoniae isolated from clinical samples of two Iranian teaching hospitals. Ann Clin Microbiol Antimicrob. 2021;20:58.","journal-title":"Ann Clin Microbiol Antimicrob."},{"key":"3207_CR15","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s13099-019-0282-0","volume":"11","author":"Z Pishnian","year":"2019","unstructured":"Pishnian Z, Haeili M, Feizi A, et al. Prevalence and molecular determinants of colistin resistance among commensal Enterobacteriaceae isolated from poultry in northwest of Iran. Gut Pathog. 2019;11:1\u20138.","journal-title":"Gut Pathog."},{"key":"3207_CR16","doi-asserted-by":"publisher","first-page":"37","DOI":"10.1016\/S1473-3099(17)30489-9","volume":"18","author":"D Gu","year":"2018","unstructured":"Gu D, Dong N, Zheng Z, et al. A fatal outbreak of ST11 carbapenem-resistant hypervirulent Klebsiella pneumoniae in a Chinese hospital: a molecular epidemiological study. Lancet Infect Dis. 2018;18:37\u201346.","journal-title":"Lancet Infect Dis."},{"key":"3207_CR17","doi-asserted-by":"publisher","first-page":"1234","DOI":"10.3201\/eid2704.204036","volume":"27","author":"A Patel","year":"2021","unstructured":"Patel A, Emerick M, Cabunoc M, et al. Rapid spread and control of multidrug-resistant gram-negative Bacteria in COVID-19 patient care units. Emerg Infect Dis. 2021;27:1234\u20136.","journal-title":"Emerg Infect Dis."},{"key":"3207_CR18","doi-asserted-by":"publisher","first-page":"1","DOI":"10.3389\/fmicb.2021.609840","volume":"12","author":"M Azam","year":"2021","unstructured":"Azam M, Gaind R, Yadav G, et al. Colistin resistance among multiple sequence types of Klebsiella pneumoniae is associated with diverse resistance mechanisms: A report from India. Front Microbiol. 2021;12:1\u20133.","journal-title":"Front Microbiol."},{"key":"3207_CR19","doi-asserted-by":"publisher","first-page":"e0249668","DOI":"10.1371\/journal.pone.0249668","volume":"16","author":"S He","year":"2021","unstructured":"He S, Liu W, Jiang M, et al. Clinical characteristics of COVID-19 patients with clinically diagnosed bacterial co-infection: A multi-center study. PLoS One. 2021;16:e0249668.","journal-title":"PLoS One."},{"key":"3207_CR20","doi-asserted-by":"publisher","first-page":"67","DOI":"10.4103\/jgid.jgid_358_20","volume":"13","author":"JL Moore","year":"2021","unstructured":"Moore JL, Stroever SL, Rondain PE, et al. Incidence of secondary bacterial infections following utilization of tocilizumab for the treatment of COVID-19 \u2013 A matched retrospective cohort study. J Global Infect Dis. 2021;13:67\u201371.","journal-title":"J Global Infect Dis."},{"key":"3207_CR21","doi-asserted-by":"publisher","first-page":"e533","DOI":"10.1093\/cid\/ciaa1239","volume":"72","author":"VM Vaughn","year":"2021","unstructured":"Vaughn VM, Gandhi T, Petty L, et al. Empiric antibacterial therapy and community-onset bacterial coinfection in patients hospitalized with coronavirus disease 2019 (COVID-19): A multi-hospital cohort study. Clini Infect Disea. 2021;72:e533\u201341.","journal-title":"Clini Infect Disea."},{"key":"3207_CR22","doi-asserted-by":"publisher","first-page":"104507","DOI":"10.1016\/j.micpath.2020.104507","volume":"149","author":"H Solgi","year":"2020","unstructured":"Solgi H, Shahcheraghi F, Bolourchi, e al. Molecular characterization of carbapenem-resistant serotype K1 hypervirulent Klebsiella pneumoniae ST11 harbouring blaNDM-1 and blaOXA-48 carbapenemases in Iran. Microb Pathog. 2020;149:104507.","journal-title":"Microb Pathog."},{"key":"3207_CR23","doi-asserted-by":"publisher","first-page":"53","DOI":"10.1016\/j.jgar.2017.11.016","volume":"12","author":"H Solgi","year":"2018","unstructured":"Solgi H, Badmasti F, Aminzadeh Z, et al. Gastrointestinal colonization with three different NDM-1-producing enterobacterial species isolated from an inpatient in Tehran Iran. J Glob Antimicrob Resist. 2018;12:53\u20134.","journal-title":"J Glob Antimicrob Resist."},{"key":"3207_CR24","doi-asserted-by":"publisher","first-page":"966","DOI":"10.1089\/mdr.2017.0173","volume":"24","author":"H Guducuoglu","year":"2018","unstructured":"Guducuoglu H, Gursoy NC, Yakupogullari Y, et al. Hospital outbreak of a colistin-resistant, NDM-1-and OXA-48-producing Klebsiella pneumoniae: high mortality from pandrug resistance. Microb Drug Resist. 2018;24:966\u201372.","journal-title":"Microb Drug Resist."},{"key":"3207_CR25","doi-asserted-by":"publisher","first-page":"90","DOI":"10.1016\/j.ijantimicag.2018.03.003","volume":"52","author":"CA Moubareck","year":"2018","unstructured":"Moubareck CA, Mouftah SF, P\u00e1l T, et al. Clonal emergence of Klebsiella pneumoniae ST14 co-producing OXA-48-type and NDM carbapenemases with high rate of colistin resistance in Dubai, United Arab Emirates. Int J Antimicrob Agents. 2018;52:90\u20135.","journal-title":"Int J Antimicrob Agents."},{"key":"3207_CR26","doi-asserted-by":"crossref","unstructured":"Talebzadeh H, Melali SH. Association of fluoroquinolone resistance and ESBL production in hypervirulent Klebsiella pneumoniae ST11 and ST893 in Iran. Acta Microbiol Immunol Hung. 2022:135\u201343.","DOI":"10.1556\/030.2022.01638"},{"key":"3207_CR27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12879-021-05790-9","volume":"21","author":"A Boonyasiri","year":"2021","unstructured":"Boonyasiri A, Jauneikaite E, Brinkac LM, et al. Genomic and clinical characterisation of multidrug-resistant carbapenemase-producing ST231 and ST16 Klebsiella pneumoniae isolates colonising patients at Siriraj hospital, Bangkok, Thailand from 2015 to 2017. BMC Infect Dis. 2021;21:1\u201311.","journal-title":"BMC Infect Dis."},{"issue":"385","key":"3207_CR28","first-page":"e381e385","volume":"25","author":"P Espinal","year":"2019","unstructured":"Espinal P, Nucleo E, Caltagirone M, et al. Genomics of Klebsiella pneumoniae ST16 producing NDM-1, CTX-M-15, and OXA-232. Clinic Microbiol Infect. 2019;25(385):e381e385.","journal-title":"Clinic Microbiol Infect."},{"key":"3207_CR29","doi-asserted-by":"publisher","first-page":"dlac084","DOI":"10.1093\/jacamr\/dlac084","volume":"16","author":"R Abe","year":"2022","unstructured":"Abe R, Akeda U, Takeuchi D, et al. Clonal dissemination of carbapenem-resistant Klebsiella pneumoniae ST16 co-producing NDM-1 and OXA-232 in Thailand. JAC Antimicrob Resist. 2022;16:dlac084.","journal-title":"JAC Antimicrob Resist."},{"key":"3207_CR30","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s40545-023-00547-y","volume":"16","author":"S Pourajam","year":"2023","unstructured":"Pourajam S, Zafarbakhsh A, Hosseinzadeh M, et al. Secondary bacterial infection caused by ST16 NDM-1 and OXA-48-producing colistin and carbapenem-resistant Klebsiella pneumoniae treated with tigecycline in a pregnant woman with COVID-19. J Pharm Policy Pract. 2023;16:1\u20134.","journal-title":"J Pharm Policy Pract."}],"container-title":["BMC Microbiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-024-03207-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12866-024-03207-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12866-024-03207-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,17]],"date-time":"2024-02-17T11:07:42Z","timestamp":1708168062000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmcmicrobiol.biomedcentral.com\/articles\/10.1186\/s12866-024-03207-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,2,17]]},"references-count":30,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2024,12]]}},"alternative-id":["3207"],"URL":"https:\/\/doi.org\/10.1186\/s12866-024-03207-6","relation":{},"ISSN":["1471-2180"],"issn-type":[{"value":"1471-2180","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,2,17]]},"assertion":[{"value":"10 August 2023","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"28 January 2024","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"17 February 2024","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was approved by the Ethical Committee of the Isfahan University of Medical Sciences (approval number IR.ARI.MUI.REC.1402.014). We can confirm that all methods in this study were performed in accordance with the relevant guidelines and regulations. A waiving of the patient informed consent was approved from the Isfahan University Research ethics committee since the collected isolates were obtained from the discharged clinical specimens of unidentified patients and there was no any type of contact with patients<b>.<\/b>","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"59"}}