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Outbreak caused by an ertapenem-resistant, CTX-M-15-producing Klebsiella pneumoniae sequence type 101 clone carrying an OmpK36 porin variant.
J Clin Microbiol. 2013 Oct; 51(10):3176-82.JC

Abstract

Although numerous studies have documented outbreaks of carbapenem-resistant Klebsiella pneumoniae (CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum β-lactamases (ESBLs) and/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal K. pneumoniae strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant K. pneumoniae isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining β-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the blaCTX-M-15 gene on a conjugative 100-kb plasmid, disruption in the expression of the ompK35 gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental K. pneumoniae isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak.

Authors+Show Affiliations

Department of Microbiology, Serres General Hospital, Serres, Greece.No 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

23850951

Citation

Poulou, Aggeliki, et al. "Outbreak Caused By an Ertapenem-resistant, CTX-M-15-producing Klebsiella Pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant." Journal of Clinical Microbiology, vol. 51, no. 10, 2013, pp. 3176-82.
Poulou A, Voulgari E, Vrioni G, et al. Outbreak caused by an ertapenem-resistant, CTX-M-15-producing Klebsiella pneumoniae sequence type 101 clone carrying an OmpK36 porin variant. J Clin Microbiol. 2013;51(10):3176-82.
Poulou, A., Voulgari, E., Vrioni, G., Koumaki, V., Xidopoulos, G., Chatzipantazi, V., Markou, F., & Tsakris, A. (2013). Outbreak caused by an ertapenem-resistant, CTX-M-15-producing Klebsiella pneumoniae sequence type 101 clone carrying an OmpK36 porin variant. Journal of Clinical Microbiology, 51(10), 3176-82. https://doi.org/10.1128/JCM.01244-13
Poulou A, et al. Outbreak Caused By an Ertapenem-resistant, CTX-M-15-producing Klebsiella Pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant. J Clin Microbiol. 2013;51(10):3176-82. PubMed PMID: 23850951.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Outbreak caused by an ertapenem-resistant, CTX-M-15-producing Klebsiella pneumoniae sequence type 101 clone carrying an OmpK36 porin variant. AU - Poulou,Aggeliki, AU - Voulgari,Evangelia, AU - Vrioni,Georgia, AU - Koumaki,Vasiliki, AU - Xidopoulos,Grigorios, AU - Chatzipantazi,Vasiliki, AU - Markou,Fani, AU - Tsakris,Athanassios, Y1 - 2013/07/12/ PY - 2013/7/16/entrez PY - 2013/7/16/pubmed PY - 2014/4/8/medline SP - 3176 EP - 82 JF - Journal of clinical microbiology JO - J Clin Microbiol VL - 51 IS - 10 N2 - Although numerous studies have documented outbreaks of carbapenem-resistant Klebsiella pneumoniae (CRKP) possessing various carbapenemases, reports on outbreaks due to CRKP possessing extended-spectrum β-lactamases (ESBLs) and/or AmpCs with porin lesions have been limited. Here, we describe an outbreak caused by an ertapenem-resistant, CTX-M-15-producing clonal K. pneumoniae strain expressing an OmpK36 porin variant. From May 2012 to November 2012, 37 ertapenem-resistant K. pneumoniae isolates phenotypically negative for carbapenemase production were recovered from 19 patients hospitalized in the intensive care unit of a Greek hospital. The isolates were either susceptible or intermediate to other carbapenems and resistant to all remaining β-lactams but cefotetan. Phenotypic and molecular analysis revealed the presence in all isolates of the blaCTX-M-15 gene on a conjugative 100-kb plasmid, disruption in the expression of the ompK35 gene, and the production of an Ompk36 porin variant. The index case was a patient admitted from another hospital. Active surveillance upon admission and on a weekly basis was immediately initiated; environmental samples were also periodically tested. Molecular typing showed that all clinical isolates as well as two ertapenem-resistant environmental K. pneumoniae isolates belonged to the same clonal type and were assigned to multilocus sequence typing (MLST) sequence type 101 (ST101). As all colonized/infected patients were hospitalized during overlapping periods, cross-infection was considered the main route for the dissemination of the outbreak strain. Despite reinforcement of infection control measures and active surveillance, the outbreak lasted approximately 7 months. Identification of hidden carriers upon admission and by screening on a weekly basis was found valuable for early recognition and subsequent successful management of the outbreak. SN - 1098-660X UR - https://www.unboundmedicine.com/medline/citation/23850951/Outbreak_caused_by_an_ertapenem_resistant_CTX_M_15_producing_Klebsiella_pneumoniae_sequence_type_101_clone_carrying_an_OmpK36_porin_variant_ L2 - http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=23850951 DB - PRIME DP - Unbound Medicine ER -