Clinical and Genomic Characterization of Carbapenem-Resistant Klebsiella pneumoniae with Concurrent Production of NDM and OXA-48-like Carbapenemases in Southern California, 2016–2022

The global emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) has become a critical public healthcare concern due to treatment challenges and high mortality. In recent years, there been an increase in cases CRKP co-producing New Delhi metallo-β-lactamases (NDM) oxacillinase 48 (OXA-48)-like carbapenemases the US. aim this study was correlate clinical genomic characteristics NDM OXA-48-like isolated from patients Southern California since 2016. Whole-genome sequencing performed on isolates obtained various sources, including blood, abdominal fluid, wounds, urine. Genetic diversity observed these CRKP, ST-14, ST-16, ST-167, ST-437, ST-2096, ST-2497 lineages. Phylogenetic analysis revealed two closely related clusters (ST-14 ST-2497), with single nucleotide polymorphism (SNP) differences ranging 0 36, suggesting possible local spread CRKP. Significant antimicrobial resistance (AMR) genes were identified blaNDM-1, blaNDM-5, blaOXA-232, blaOXA-181, blaCTX-M-15, armA, tet(A), tet(D). Moreover, pColKP3-type Inc-type plasmids known harbor AMR also detected isolates. Most infected rare type died, although their severe comorbidities played important roles demise. Our highlighted extremely limited options poor outcomes associated dual-carbapenemase-producing Real-time surveillance unusual deadly can provide information for infection prevention guidance.