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"Silent" dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio.
Clin Infect Dis. 2012 May; 54(9):1314-21.CI

Abstract

BACKGROUND

Klebsiella pneumoniae isolates harboring the K. pneumoniae carbapenemase gene (bla(KPC)) are creating a significant healthcare threat in both acute and long-term care facilities (LTCFs). As part of a study conducted in 2004 to determine the risk of stool colonization with extended-spectrum cephalosporin-resistant gram-negative bacteria, 12 isolates of K. pneumoniae that exhibited nonsusceptibility to extended-spectrum cephalosporins were detected. All were gastrointestinal carriage isolates that were not associated with infection.

METHODS

Reassessment of the carbapenem minimum inhibitory concentrations using revised 2011 Clinical Laboratory Standards Institute breakpoints uncovered carbapenem resistance. To further investigate, a DNA microarray assay, PCR-sequencing of bla genes, immunoblotting, repetitive-sequence-based PCR (rep-PCR) and multilocus sequence typing (MLST) were performed.

RESULTS

The DNA microarray detected bla(KPC) in all 12 isolates, and bla(KPC-3) was identified by PCR amplification and sequencing of the amplicon. In addition, a bla(SHV-11) gene was detected in all isolates. Immunoblotting revealed "low-level" production of the K. pneumoniae carbapenemase, and rep-PCR indicated that all bla(KPC-3)-positive K. pneumoniae strains were genetically related (≥98% similar). According to MLST, all isolates belonged to sequence type 36. This sequence type has not been previously linked with bla(KPC) carriage. Plasmids from 3 representative isolates readily transferred the bla(KPC-3) to Escherichia coli J-53 recipients.

CONCLUSIONS

Our findings reveal the "silent" dissemination of bla(KPC-3) as part of Tn4401b on a mobile plasmid in Northeast Ohio nearly a decade ago and establish the first report, to our knowledge, of K. pneumoniae containing bla(KPC-3) in an LTCF caring for neurologically impaired children and young adults.

Authors+Show Affiliations

Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA. robert.bonomo@va.govNo 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 availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

22492318

Citation

Viau, Roberto A., et al. ""Silent" Dissemination of Klebsiella Pneumoniae Isolates Bearing K. Pneumoniae Carbapenemase in a Long-term Care Facility for Children and Young Adults in Northeast Ohio." Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 54, no. 9, 2012, pp. 1314-21.
Viau RA, Hujer AM, Marshall SH, et al. "Silent" dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. Clin Infect Dis. 2012;54(9):1314-21.
Viau, R. A., Hujer, A. M., Marshall, S. H., Perez, F., Hujer, K. M., Briceño, D. F., Dul, M., Jacobs, M. R., Grossberg, R., Toltzis, P., & Bonomo, R. A. (2012). "Silent" dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 54(9), 1314-21. https://doi.org/10.1093/cid/cis036
Viau RA, et al. "Silent" Dissemination of Klebsiella Pneumoniae Isolates Bearing K. Pneumoniae Carbapenemase in a Long-term Care Facility for Children and Young Adults in Northeast Ohio. Clin Infect Dis. 2012;54(9):1314-21. PubMed PMID: 22492318.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Silent" dissemination of Klebsiella pneumoniae isolates bearing K. pneumoniae carbapenemase in a long-term care facility for children and young adults in Northeast Ohio. AU - Viau,Roberto A, AU - Hujer,Andrea M, AU - Marshall,Steven H, AU - Perez,Federico, AU - Hujer,Kristine M, AU - Briceño,David F, AU - Dul,Michael, AU - Jacobs,Michael R, AU - Grossberg,Richard, AU - Toltzis,Philip, AU - Bonomo,Robert A, PY - 2012/4/12/entrez PY - 2012/4/12/pubmed PY - 2013/1/30/medline SP - 1314 EP - 21 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin Infect Dis VL - 54 IS - 9 N2 - BACKGROUND: Klebsiella pneumoniae isolates harboring the K. pneumoniae carbapenemase gene (bla(KPC)) are creating a significant healthcare threat in both acute and long-term care facilities (LTCFs). As part of a study conducted in 2004 to determine the risk of stool colonization with extended-spectrum cephalosporin-resistant gram-negative bacteria, 12 isolates of K. pneumoniae that exhibited nonsusceptibility to extended-spectrum cephalosporins were detected. All were gastrointestinal carriage isolates that were not associated with infection. METHODS: Reassessment of the carbapenem minimum inhibitory concentrations using revised 2011 Clinical Laboratory Standards Institute breakpoints uncovered carbapenem resistance. To further investigate, a DNA microarray assay, PCR-sequencing of bla genes, immunoblotting, repetitive-sequence-based PCR (rep-PCR) and multilocus sequence typing (MLST) were performed. RESULTS: The DNA microarray detected bla(KPC) in all 12 isolates, and bla(KPC-3) was identified by PCR amplification and sequencing of the amplicon. In addition, a bla(SHV-11) gene was detected in all isolates. Immunoblotting revealed "low-level" production of the K. pneumoniae carbapenemase, and rep-PCR indicated that all bla(KPC-3)-positive K. pneumoniae strains were genetically related (≥98% similar). According to MLST, all isolates belonged to sequence type 36. This sequence type has not been previously linked with bla(KPC) carriage. Plasmids from 3 representative isolates readily transferred the bla(KPC-3) to Escherichia coli J-53 recipients. CONCLUSIONS: Our findings reveal the "silent" dissemination of bla(KPC-3) as part of Tn4401b on a mobile plasmid in Northeast Ohio nearly a decade ago and establish the first report, to our knowledge, of K. pneumoniae containing bla(KPC-3) in an LTCF caring for neurologically impaired children and young adults. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/22492318/"Silent"_dissemination_of_Klebsiella_pneumoniae_isolates_bearing_K__pneumoniae_carbapenemase_in_a_long_term_care_facility_for_children_and_young_adults_in_Northeast_Ohio_ L2 - https://academic.oup.com/cid/article-lookup/doi/10.1093/cid/cis036 DB - PRIME DP - Unbound Medicine ER -