Emergence of New Non–Clonal Group 258 High-Risk Clones among Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Isolates, France (original) (raw)

Emerging Infectious Diseases

I n Klebsiella pneumoniae bacteria, resistance to carbapenems results in 2 main mechanisms: the production of an extended spectrum β-lactamase or plasmid-borne cephalosporinase associated with a decrease in permeability of the outer membrane (especially through alteration of OmpK35 and OmpK36 porins), or the production of a carbapenemase (1,2). In France, these carbapenemases are Ambler's class A KPC enzymes; class B metallo-β-lactamases of NDM-, VIM-and, to a lesser extent, IMP-type; and Ambler's class D oxacillinases of OXA-48-like type (3,4). K. pneumoniae carbapenemase (KPC) was first identified in United States in the early 2000s (5). Since then, this carbapenemase has spread and has become endemic in several countries, including the United States, Israel, Greece, China, and Italy. It has also been sporadically described in many countries of Europe (1). The worldwide spread of KPC has been linked to the dissemination of a main clone of K. pneumoniae (sequence type [ST] 258) and a singlelocus variant (ST512) (6). In Asia (especially China), ST11, another single-locus variant of ST258, is mostly reported among bla KPC-harboring K. pneumoniae isolates (7). In addition, a recently published study, conducted by the EUSCAPE working group in 2013 in Europe, revealed that the spread of carbapenemaseproducing K. pneumoniae was driven by only a few clones (8). The most prevalent carbapenemase was KPC (45.5% [311/684 isolates]), and 72.7% (229/311) of KPC-producing K. pneumoniae (KPC-Kp) belong to the same clonal group (CG) 258, including ST258 and ST512. Whole-genome sequencing (WGS) analysis has suggested that ST258 and ST512 KPC-Kp spread out in Europe from 2 KPC-endemic countries: Greece (ST258) and Italy (ST512) (6,9-11). However, that study described the epidemiology of KPC in Europe in 2013, whereas the aim of our study was to describe the genomic characteristics of KPC isolates from a more recent period.