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Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece.
J Antimicrob Chemother. 2009 Aug; 64(2):348-52.JA

Abstract

OBJECTIVES

KPC-possessing Klebsiella pneumoniae have been found to be widespread in several regions but are still rarely detected in Europe. We describe the characteristics of an outbreak caused by KPC producers in a tertiary care Greek hospital.

METHODS

During a 12 month period (October 2007-September 2008), 47 patients in Hippokration University Hospital yielded K. pneumoniae isolates that exhibited reduced susceptibility to carbapenems and were phenotypically positive for carbapenemase production but negative for metallo-beta-lactamase (MBL) production. Single patient isolates were tested by Vitek 2, Etest, agar dilution MICs, phenotypic assays and PFGE. Carbapenemase and other beta-lactamase genes were identified by PCR and sequencing. Patient records were retrospectively reviewed to access co-morbidities, antibiotic exposure prior to infection and outcome.

RESULTS

The 47 K. pneumoniae isolates exhibited various susceptibilities to imipenem and meropenem; all were non-susceptible to ertapenem and several other antibiotics but most were susceptible to gentamicin, colistin and tigecycline. PFGE classified the isolates into two clonal types, with the predominant type, which was closely related to that of hyperepidemic strains from the USA and Israel, comprising three subtypes. All isolates carried the bla(KPC-2) gene; 45 also carried bla(SHV-12) and 29 bla(TEM-1). Patients were hospitalized in nine different units. The median length of hospital stay prior to KPC isolation was 21 days; 38 patients (80.9%) had evidence of clinical infection due to a KPC producer and 16 (34%) had bacteraemia. The crude mortality rate was 27.7%. A beta-lactam/beta-lactamase inhibitor combination was the most frequently administered antimicrobial prior to KPC isolation (20 patients; 42.5%), whereas only nine patients (19.1%) had prior carbapenem use.

CONCLUSIONS

This study presents for the first time a wide intrahospital spread of KPC-producing K. pneumoniae clones in a European hospital. The KPC producers were rapidly disseminated in several units, indicating the difficulty in restraining such multidrug-resistant clones when they have been established in a hospital environment.

Authors+Show Affiliations

Department of Microbiology, Medical School, University of Thessaly, Larissa, Greece.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19525514

Citation

Pournaras, Spyros, et al. "Clonal Spread of KPC-2 Carbapenemase-producing Klebsiella Pneumoniae Strains in Greece." The Journal of Antimicrobial Chemotherapy, vol. 64, no. 2, 2009, pp. 348-52.
Pournaras S, Protonotariou E, Voulgari E, et al. Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece. J Antimicrob Chemother. 2009;64(2):348-52.
Pournaras, S., Protonotariou, E., Voulgari, E., Kristo, I., Dimitroulia, E., Vitti, D., Tsalidou, M., Maniatis, A. N., Tsakris, A., & Sofianou, D. (2009). Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece. The Journal of Antimicrobial Chemotherapy, 64(2), 348-52. https://doi.org/10.1093/jac/dkp207
Pournaras S, et al. Clonal Spread of KPC-2 Carbapenemase-producing Klebsiella Pneumoniae Strains in Greece. J Antimicrob Chemother. 2009;64(2):348-52. PubMed PMID: 19525514.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece. AU - Pournaras,Spyros, AU - Protonotariou,Efthimia, AU - Voulgari,Evangelia, AU - Kristo,Ioulia, AU - Dimitroulia,Evangelia, AU - Vitti,Danai, AU - Tsalidou,Maria, AU - Maniatis,Antonios N, AU - Tsakris,Athanassios, AU - Sofianou,Danai, Y1 - 2009/06/13/ PY - 2009/6/16/entrez PY - 2009/6/16/pubmed PY - 2009/9/17/medline SP - 348 EP - 52 JF - The Journal of antimicrobial chemotherapy JO - J. Antimicrob. Chemother. VL - 64 IS - 2 N2 - OBJECTIVES: KPC-possessing Klebsiella pneumoniae have been found to be widespread in several regions but are still rarely detected in Europe. We describe the characteristics of an outbreak caused by KPC producers in a tertiary care Greek hospital. METHODS: During a 12 month period (October 2007-September 2008), 47 patients in Hippokration University Hospital yielded K. pneumoniae isolates that exhibited reduced susceptibility to carbapenems and were phenotypically positive for carbapenemase production but negative for metallo-beta-lactamase (MBL) production. Single patient isolates were tested by Vitek 2, Etest, agar dilution MICs, phenotypic assays and PFGE. Carbapenemase and other beta-lactamase genes were identified by PCR and sequencing. Patient records were retrospectively reviewed to access co-morbidities, antibiotic exposure prior to infection and outcome. RESULTS: The 47 K. pneumoniae isolates exhibited various susceptibilities to imipenem and meropenem; all were non-susceptible to ertapenem and several other antibiotics but most were susceptible to gentamicin, colistin and tigecycline. PFGE classified the isolates into two clonal types, with the predominant type, which was closely related to that of hyperepidemic strains from the USA and Israel, comprising three subtypes. All isolates carried the bla(KPC-2) gene; 45 also carried bla(SHV-12) and 29 bla(TEM-1). Patients were hospitalized in nine different units. The median length of hospital stay prior to KPC isolation was 21 days; 38 patients (80.9%) had evidence of clinical infection due to a KPC producer and 16 (34%) had bacteraemia. The crude mortality rate was 27.7%. A beta-lactam/beta-lactamase inhibitor combination was the most frequently administered antimicrobial prior to KPC isolation (20 patients; 42.5%), whereas only nine patients (19.1%) had prior carbapenem use. CONCLUSIONS: This study presents for the first time a wide intrahospital spread of KPC-producing K. pneumoniae clones in a European hospital. The KPC producers were rapidly disseminated in several units, indicating the difficulty in restraining such multidrug-resistant clones when they have been established in a hospital environment. SN - 1460-2091 UR - https://www.unboundmedicine.com/medline/citation/19525514/Clonal_spread_of_KPC_2_carbapenemase_producing_Klebsiella_pneumoniae_strains_in_Greece_ L2 - https://academic.oup.com/jac/article-lookup/doi/10.1093/jac/dkp207 DB - PRIME DP - Unbound Medicine ER -