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Exogenous colonization of carbapenem-resistant Klebsiella pneumoniae and vancomycin-resistant Enterococcus in preterm

Ahmet Aktaş1, Elif Seren Tanriverdi2, Tuba Demirkalp3

  • 1Department of Medical Microbiology, İstanbul Faculty of Medicine, İstanbul University, İstanbul, Türkiye.

Journal of Infection in Developing Countries
|April 16, 2026
PubMed

Insights

Carbapenem-resistant Klebsiella pneumoniae and vancomycin-resistant Enterococcus colonization in NICU infants likely originates from healthcare settings, not internal factors. Strict hygiene is vital to prevent the spread of these resistant bacteria.

Area of Science:

  • Microbiology
  • Infectious Diseases
  • Neonatal Care

Background:

  • Carbapenem-resistant Klebsiella pneumoniae (CRKP) and vancomycin-resistant Enterococcus (VRE) are critical threats in neonatal intensive care units (NICUs).
  • High transmission potential and limited treatment options for CRKP and VRE necessitate understanding colonization sources and resistance genes.
  • Effective infection control in NICUs relies on identifying the origins of antibiotic-resistant bacteria.

Purpose of the Study:

  • To investigate the sources of colonization for CRKP and VRE in preterm infants within a NICU.
  • To identify predominant antibiotic resistance genes in CRKP and VRE isolates from NICU patients.
  • To differentiate between endogenous selection and healthcare-associated transmission of resistant pathogens in neonates.

Main Methods:

  • Molecular epidemiological analysis using Pulsed-field gel electrophoresis (PFGE) and arbitrarily primed PCR (AP-PCR).
  • Analysis of carbapenem-susceptible Klebsiella pneumoniae (CSKP), Vancomycin-susceptible Enterococcus (VSE), CRKP, and VRE isolates from meconium and rectal swabs.
  • Multiplex PCR to detect carbapenemase genes (blaOXA-48, blaNDM, blaKPC) and vancomycin-resistance genes (vanA, vanB, vanC).

Main Results:

  • High genetic diversity observed in both CRKP and VRE isolates, suggesting exogenous sources of colonization.
  • PFGE revealed 24 distinct CRKP genotypes and 25 VRE genotypes, with a 57.5% clustering rate.
  • blaOXA-48 was the most frequent resistance gene in CRKP (50%), followed by blaNDM (35%). VanA was detected in 85% of VRE isolates.

Conclusions:

  • Absence of a clonal outbreak indicates healthcare-associated transmission rather than endogenous selection of CRKP and VRE.
  • Resistance genes were primarily detected on plasmids, supporting transmission via mobile genetic elements.
  • Emphasizes the critical importance of stringent hand hygiene and infection control protocols to prevent multidrug-resistant pathogen colonization in vulnerable preterm infants.
Abstract

Keywords:
AP-PCRCarbapenem-resistant Klebsiella pneumoniaePFGEfournosocomial transmissionpulsed-field gel electrophoresisvancomycin-resistant Enterococcus

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