High-Risk Clone of Klebsiella pneumoniae Co-Harbouring Class A and D Carbapenemases in Italy (original) (raw)
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Journal of Hospital Infection, 2020
Introduction: Risk factors for carbapenemase-producing Enterobacterales (CPE) acquisition/ infection and associated clinical outcomes have been evaluated in the context of clonal, species-specific outbreaks. Equivalent analyses for complex, multi-species outbreaks, which are increasingly common, are lacking. Methods: Between December 2010 and January 2017, a caseecontrol study of Klebsiella pneumoniae carbapenemase (KPC)-producing organism (KPCO) acquisition was undertaken using electronic health records from inpatients in a US academic medical centre and longterm acute care hospital (LTACH) with ongoing multi-species KPCO transmission despite a robust CPE screening programme. Cases had a first KPCO-positive culture >48 h after admission, and included colonizations and infections (defined by clinical records). Controls had at least two negative perirectal screens and no positive cultures. Risk factors for KPCO acquisition, first infection following acquisition, and 14-day mortality following each episode of infection were identified using multi-variable logistic regression. Results: In 303 cases (89 with at least one infection) and 5929 controls, risk factors for KPCO acquisition included: longer inpatient stay, transfusion, complex thoracic pathology, mechanical ventilation, dialysis, and exposure to carbapenems and b-lactam/b-lactamase
From June to September 2011, a total of 305 ertapenem-nonsusceptible Enterobacteriaceae isolates (MICs of ertapenem > 1 g/ ml) were collected from 11 hospitals in different parts of Taiwan. The MICs of 12 antimicrobial agents against these isolates were determined using the broth microdilution method, and genes for carbapenemases were detected using PCR. Genotypes of isolates possessing carbapenemase genes were identified by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing. The ertapenem-nonsusceptible Enterobacteriaceae isolates included Klebsiella pneumoniae (n ؍ 219), Escherichia coli (n ؍ 64), Enterobacter cloacae (n ؍ 15), and other species (n ؍ 7). Seven (2.3%) of the ertapenem-nonsusceptible Enterobacteriaceae isolates exhibited colistin MICs of >4 g/ml, and 24 (7.9%) were not susceptible to tigecycline (MICs > 2 g/ml). A total of 29 (9.5%) isolates carried genes encoding carbapenemases, namely, K. pneumoniae carbapenemase-2 (KPC-2) in 16 (7.3%) isolates of K. pneumoniae (KPC-2-KP) and IMP-8 in 5 (2.3%) isolates of K. pneumoniae, 5 (33.3%) isolates of E. cloacae, 1 isolate of E. coli, 1 isolate of Klebsiella oxytoca, and one isolate of Citrobacter freundii. The 16 KPC-2-KP isolates were isolated from patients at four different hospitals in northern Taiwan. All 16 of the KPC-2-KP isolates were susceptible to amikacin and colistin and had a similar pulsotype (pulsotype 1) and the same sequence type (sequence type 11). Infections due to KPC-2-KP mainly occurred in severely ill patients in the intensive care unit (n ؍ 14, 88%). Four patients with infections due to KPC-2-KP died within 14 days of hospitalization. The findings are the first to demonstrate intrahospital and interhospital dissemination of KPC-2-KP in northern Taiwan.
Eurosurveillance
Background Preliminary unpublished results of the survey of carbapenem- and/or colistin-resistant Enterobacterales (CCRE survey) showed the expansion of carbapenemase-producing Klebsiella pneumoniae (CPKP) sequence type (ST) 39 in 12 of 15 participating Greek hospitals in 2019. Aim We conducted a rapid survey to determine the extent of spread of CPKP high-risk clones in Greek hospitals in 2022 and compare the distribution of circulating CPKP clones in these hospitals since 2013. Methods We analysed whole genome sequences and epidemiological data of 310 K. pneumoniae isolates that were carbapenem-resistant or ‘susceptible, increased exposure’ from Greek hospitals that participated in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE, 2013–2014), in the CCRE survey (2019) and in a national follow-up survey (2022) including, for the latter, an estimation of transmission events. Results Five K. pneumoniae STs including ST258/512 (n = 101 isolates), ST11 (n = 93)...
Journal of infection in developing countries, 2017
INTRODUCTION The emergence of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kpn) isolates is attracting significant attention in nosocomial infection settings. K. pneumoniae is the main pathogen that harbours blaKPC genes. METHODOLOGY This study evaluated 54 K. pneumoniae carbapenem-resistant isolates from patients hospitalized at the University Hospital of Londrina, between July 2009 and July 2010. The isolates were phenotypically screened for carbapenemase production and submitted for genotypic confirmation by polymerase chain reaction (PCR) for KPC, metallo-β-lactamases, OXA-48, and extended-spectrum beta-lactamase genes. The absence of outer membrane proteins (OMP) was investigated by SDS-PAGE. The susceptibility profile was determined by broth microdilution, according to Clinical and Laboratory Standards Institute protocol. RESULTS All isolates were phenotypically positive for class A carbapenemase production, but negative for metallo-β-lactamase activi...
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.
Antibiotics, 2022
Carbapenemase-producing Klebsiella pneumoniae (CPKP) emerged in Greece in 2002 and became endemic thereafter. Driven by a notable variability in the phenotypic testing results for carbapenemase production in K. pneumoniae isolates from the intensive care units (ICUs) of our hospital, we performed a study to assess the molecular epidemiology of CPKP isolated between 2016 and 2019 using pulse-field gel electrophoresis (PFGE) including isolates recovered from 165 single patients. We investigated the molecular relatedness among strains recovered from rectal surveillance cultures and from respective subsequent infections due to CPKP in the same individual (48/165 cases). For the optimal interpretation of our findings, we carried out a systematic review regarding the clonality of CPKP isolated from clinical samples in ICUs in Europe. In our study, we identified 128 distinguishable pulsotypes and 17 clusters that indicated extended dissemination of CPKP within the hospital ICU setting thro...
Journal of Medical Microbiology, 2016
Resistance patterns and carbapenemase gene presence among Klebsiella pneumoniae isolates from the University General Hospital of Patras, Greece during a ten-year period were analysed under a surveillance programme for multi-drug-resistant bacteria. From 2005 to 2014, K. pneumoniae isolates from clinically significant specimens were identified by the Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the agar disc diffusion method and Etest. The strains were tested for the presence of bla VIM , bla IMP , bla KPC , bla NDM and bla OXA-48 genes by PCR. PFGE of chromosomal Xbal DNA digests was performed. A total of 3449 K. pneumoniae isolates were recovered during the last decade. Among them, 1668 (48 %) were carbapenemase-producing: 1333 (80 %) K. pneumoniae carbapenemase (KPC)-, 286 (17 %) Verona imipenemase (VIM), 45 (3 %) KPC-and VIM-, and four New Delhi metallo-beta-lactamase (NDM)-producing. Their resistance rates to gentamicin, colistin and tigecycline were 41 %, 23 % and 16 %, respectively. VIM-producing K. pneumoniae were isolated in 2005 and since 2008 have been endemic. KPC-producing K. pneumoniae (KPC-Kp) isolates were introduced in 2008 and until now represent the predominant carbapenemase-producing K. pneumoniae in our institution. PFGE of 97 KPC-Kp strains identified three types: A, 84 (87 %); B, 11 (11 %); and E, two (2 %). Eleven co-producing KPC and VIM K. pneumoniae isolates belonged to PFGE B. The four NDM-positives were classified to type F. The number of K. pneumoniae bacteraemias increased during the study period, which may be solely attributed to the increase of carbapenemase-producing isolates. The threat of carbapenemase-producing K. pneumoniae emphasizes the urgent need for implementation of infection control measures and budgetary allocations to infection control.
PubMed, 2014
Carbapenem-resistant K. pneumoniae has recently been reported as a new multidrug-resistant nosocomial pathogen. This study reports the emergence of carbapenem-resistant K. pneumoniae strains in Brescia Civic Hospital, Italy. Different samples, collected from April 2012 to February 2013, showed that 29 patients presented infections from multidrug-resistant K. pneumoniae and three of these patients were intestinal carriers. In total, 40 carbapenem-resistant K. pneumoniae strains were isolated from multiple specimens of these patients. In 39 out of 40 samples, we identified the bla(KPC-3) carbapenemase gene variant responsible for bacterial carbapenem resistance. The DiversiLab analysis showed four different genetic patterns within multidrug-resistant K. pneumoniae isolates, with pattern 1 and 2 including 95% of the bacterial strains. Carbapenem-resistant K. pneumoniae strains belonging to patterns 1 and 2 were also detected in the intestinal tract of the three asymptomatic carriers. Moreover, isolation of the same strains in other body sites of the same patients and in bronchial fluid of a non-colonized patient in the same ward indicates an initial dissemination of this pathogen. Our results highlight the emergence of carbapenemase-producing K. pneumoniae strains in different hospital wards and the urgent need for infection control, antibiotic stewardship programmes and utilization of a surveillance and prevention system.
27 Aim 28 To describe the phenotypic and genotypic profiles of Klebsiella pneumonia 29 carbapenemase-producing K. pneumonia (KPC-Kp) strains isolated from patients with 30 invasive infections at an Italian university hospital in order to assess the 31 epidemiological trend. 32 Methods 33 An observational prospective study was carried out at the University Hospital of 34 Sassari, Italy, to detect KPC-Kp strains in patients with invasive bacteraemia. Isolates 35 were identified phenotypically; carbapenemase production was assessed using 36 phenotypic and genotypic methods. Sequencing of blaKPC genes, pulsed-field gel 37 electrophoresis, and multi locus sequence typing were performed. 38 Results 39 During the period 2015-2017 46 cases of invasive infection with K. pneumoniae 40 were recorded. 67.4% of patients were male; mean age was 69.4 years. Most patients 41 had at least one comorbidity (56.5%) and/or had been previously hospitalized (70.5%). 42 81.8% had current or recent medical device use and 85.4% had recent antibiotic 43 exposure. Mortality rate was 52.3%. A multi-drug resistant pattern (including 44 carbapenems, fluoroquinolones, third/fourth generation cephalosporins) was showed 45 for all K. pneumoniae isolates. KPC-3 and -2 were produced by all strains. The most 46
International journal of advanced biological and biomedical research, 2020
Background: The prevalence of carbapenem-resistant Enterobacteriaceae, especially Klebsiella pneumoniae carbapenemase (KPC), has been recently reported worldwide. Therefore, there is an indispensable need for precise and rapid detection of these carbapenemases. Objectives: This study was aimed to propose an accurate and rapid method for detecting K. pneumoniae carbapenemase genes from clinical samples, using reverse transcriptionpolymerase chain reaction (RT-PCR) and to evaluate the expression of these genes in the presence of β-lactam antibiotic by real-time PCR assay. Methods: One hundred and eighty-one K. pneumoniae strains were collected from patients presenting to Firoozgar Hospital of Tehran, Iran. The strains were tested using the disk diffusion method, the modified Hodge test (MHT), and E-test minimum inhibitory concentration (MIC). Next, reverse transcription-PCR method was applied for the identification of bla OXA-23 and bla OXA-48 genes. Finally, expression of genes was measured by real-time PCR assay in the presence and absence of β-lactam antibiotic. Results:Phenotypic testing showed a high level of antibiotic resistance, while the genotypic methods indicated the presence and expression of carbapenemase genes. Conclusions: The findings suggest revisions in the current antibiotic therapy protocols, considering the high expression level of resistant carbapenemases to K. pneumoniae strains.