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Multicentre investigation of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Bulgarian hospitals - Interregional spread of ST11 NDM-1-producing K. pneumoniae.
Infect Genet Evol. 2019 04; 69:61-67.IG

Abstract

AIM

The aim of this study was to investigate the mechanisms of beta-lactam-resistance and the clonal relatedness of carbapenem-nonsusceptible Klebsiella pneumoniae and Escherichia coli isolates, collected consecutively in eight centers in five Bulgarian cities from November 2014 to March 2018. Carbapenemase-producing enterobacteria were detected in all but one centers. Overall, 104 K. pneumoniae and one E. coli were analysed.

MATERIALS AND METHODS

Antimicrobial susceptibility and beta-lactamases were analysed. Conjugation experiments, plasmid fingerprinting and replicon typing, as well as MLST and ERIC-PCR were carried out.

RESULTS

KPC-2 (51%) and NDM-1 (47%) were the main carbapenemases identified. KPC-2 producing K. pneumoniae were classified into 10 MLST-types. The four dominating MLST-types ST29, ST15, ST336 and ST902 comprised 79% of the KPC-2 producers. All but one of the NDM-1 producing isolates belonged to the MLST-type ST11 and were found in seven centers. Furthermore, single K. pneumoniae isolates producing VIM-1 (ST147) and OXA-48 (ST15) were identified. In addition to the carbapenemases, the ESBLs CTX-M-15, CTX-M-3, and SHV-12 as well as AmpC enzyme CMY-4 were found. The FIIAs-replicon-type was found in all KPC-2 producers while the A/C-replicons dominated in NDM-1 producing isolates. The single NDM-1 producing E. coli was determined as MLST-Type ST10 (Warwick scheme).

CONCLUSION

The interregional clonal expansion of NDM-1 producing ST11 K. pneumoniae and the dissemination of blaKPC-2 carrying plasmids were responsible for the spread of carbapenemase-producing K. pneumoniae in Bulgaria. Our findings highlight the urgency to prevent dissemination of these highly transmissible and dangerous lineages.

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Authors+Show Affiliations

Markovska R
Medical University of Sofia, Medical Faculty, Department of Medical Microbiology, Bulgaria. Electronic address: markovska73@abv.bg.
Stoeva T
Medical University of Varna, Department of Microbiology and Virology, University Multiprofile Hospital for Active Treatment (UMHAT), St Marina, Varna, Bulgaria.
Boyanova L
Medical University of Sofia, Medical Faculty, Department of Medical Microbiology, Bulgaria.
Stankova P
Medical University of Sofia, Medical Faculty, Department of Medical Microbiology, Bulgaria.
Schneider I
MICOER-Institute, Munich, Germany.
Keuleyan E
Department of Clinical Microbiology, Medical Institute - Ministry of the Interior, Sofia, Bulgaria.
Mihova K
Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria.
Murdjeva M
Medical University of Plovdiv, Department of Microbiology and Immunology, UMHAT, "St George", Plovdiv, Bulgaria.
Sredkova M
Medical University of Pleven, Department of Microbiology and Virology, UMHAT "Georgi Stranski", Pleven, Bulgaria.
Lesseva M
Emergency Medical Institute "Pirogov", Sofia, Bulgaria.
Nedelcheva G
Medical University of Varna, Department of Microbiology and Virology, University Multiprofile Hospital for Active Treatment (UMHAT), St Marina, Varna, Bulgaria.
Petrova A
Medical University of Plovdiv, Department of Microbiology and Immunology, UMHAT, "St George", Plovdiv, Bulgaria.
Ivanova D
Second Multiprofile Hospital for Active Treatment, Sofia, Bulgaria.
Lazarova G
UMHAT "Prof. dr St Kirkovich" Stara Zagora, Thracian University, Stara Zagora, Bulgaria.
Kaneva R
Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria.
Mitov I
Medical University of Sofia, Medical Faculty, Department of Medical Microbiology, Bulgaria.

MeSH

Anti-Bacterial AgentsBulgariaConjugation, GeneticCross InfectionEscherichia coliEscherichia coli InfectionsGeography, MedicalHospitalsHumansKlebsiella InfectionsKlebsiella pneumoniaeMicrobial Sensitivity TestsMultilocus Sequence TypingPlasmidsbeta-Lactam Resistancebeta-Lactamases

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30654179

Citation

Markovska, Rumyana, et al. "Multicentre Investigation of Carbapenemase-producing Klebsiella Pneumoniae and Escherichia Coli in Bulgarian Hospitals - Interregional Spread of ST11 NDM-1-producing K. Pneumoniae." Infection, Genetics and Evolution : Journal of Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases, vol. 69, 2019, pp. 61-67.
Markovska R, Stoeva T, Boyanova L, et al. Multicentre investigation of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Bulgarian hospitals - Interregional spread of ST11 NDM-1-producing K. pneumoniae. Infect Genet Evol. 2019;69:61-67.
Markovska, R., Stoeva, T., Boyanova, L., Stankova, P., Schneider, I., Keuleyan, E., Mihova, K., Murdjeva, M., Sredkova, M., Lesseva, M., Nedelcheva, G., Petrova, A., Ivanova, D., Lazarova, G., Kaneva, R., & Mitov, I. (2019). Multicentre investigation of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Bulgarian hospitals - Interregional spread of ST11 NDM-1-producing K. pneumoniae. Infection, Genetics and Evolution : Journal of Molecular Epidemiology and Evolutionary Genetics in Infectious Diseases, 69, 61-67. https://doi.org/10.1016/j.meegid.2019.01.013
Markovska R, et al. Multicentre Investigation of Carbapenemase-producing Klebsiella Pneumoniae and Escherichia Coli in Bulgarian Hospitals - Interregional Spread of ST11 NDM-1-producing K. Pneumoniae. Infect Genet Evol. 2019;69:61-67. PubMed PMID: 30654179.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Multicentre investigation of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Bulgarian hospitals - Interregional spread of ST11 NDM-1-producing K. pneumoniae. AU - Markovska,Rumyana, AU - Stoeva,Temenuga, AU - Boyanova,Lyudmila, AU - Stankova,Petya, AU - Schneider,Ines, AU - Keuleyan,Emma, AU - Mihova,Kalina, AU - Murdjeva,Marianna, AU - Sredkova,Mariya, AU - Lesseva,Magdalena, AU - Nedelcheva,Gergana, AU - Petrova,Atanaska, AU - Ivanova,Dobrinka, AU - Lazarova,Grozdanka, AU - Kaneva,Radka, AU - Mitov,Ivan, Y1 - 2019/01/14/ PY - 2018/10/03/received PY - 2018/12/09/revised PY - 2019/01/11/accepted PY - 2019/1/18/pubmed PY - 2020/1/16/medline PY - 2019/1/18/entrez KW - Bulgaria KW - Carbapenemases KW - E. coli KW - K. pneumoniae KW - KPC KW - NDM SP - 61 EP - 67 JF - Infection, genetics and evolution : journal of molecular epidemiology and evolutionary genetics in infectious diseases JO - Infect Genet Evol VL - 69 N2 - AIM: The aim of this study was to investigate the mechanisms of beta-lactam-resistance and the clonal relatedness of carbapenem-nonsusceptible Klebsiella pneumoniae and Escherichia coli isolates, collected consecutively in eight centers in five Bulgarian cities from November 2014 to March 2018. Carbapenemase-producing enterobacteria were detected in all but one centers. Overall, 104 K. pneumoniae and one E. coli were analysed. MATERIALS AND METHODS: Antimicrobial susceptibility and beta-lactamases were analysed. Conjugation experiments, plasmid fingerprinting and replicon typing, as well as MLST and ERIC-PCR were carried out. RESULTS: KPC-2 (51%) and NDM-1 (47%) were the main carbapenemases identified. KPC-2 producing K. pneumoniae were classified into 10 MLST-types. The four dominating MLST-types ST29, ST15, ST336 and ST902 comprised 79% of the KPC-2 producers. All but one of the NDM-1 producing isolates belonged to the MLST-type ST11 and were found in seven centers. Furthermore, single K. pneumoniae isolates producing VIM-1 (ST147) and OXA-48 (ST15) were identified. In addition to the carbapenemases, the ESBLs CTX-M-15, CTX-M-3, and SHV-12 as well as AmpC enzyme CMY-4 were found. The FIIAs-replicon-type was found in all KPC-2 producers while the A/C-replicons dominated in NDM-1 producing isolates. The single NDM-1 producing E. coli was determined as MLST-Type ST10 (Warwick scheme). CONCLUSION: The interregional clonal expansion of NDM-1 producing ST11 K. pneumoniae and the dissemination of blaKPC-2 carrying plasmids were responsible for the spread of carbapenemase-producing K. pneumoniae in Bulgaria. Our findings highlight the urgency to prevent dissemination of these highly transmissible and dangerous lineages. SN - 1567-7257 UR - https://www.unboundmedicine.com/medline/citation/30654179/Multicentre_investigation_of_carbapenemase_producing_Klebsiella_pneumoniae_and_Escherichia_coli_in_Bulgarian_hospitals___Interregional_spread_of_ST11_NDM_1_producing_K__pneumoniae_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1567-1348(18)30767-6 DB - PRIME DP - Unbound Medicine ER -