In Medellin, Colombia, three Pseudomonas aeruginosa isolates with high-level carbapenem resistance (MIC ≥ 256 μg/ml) and an isolate of Citrobacter freundii with reduced susceptibility to imipenem produced the plasmid-mediated class A carbapenemase KPC-2. This is the first report of a KPC-type β-lactamase identified outside of the family Enterobacteriaceae.

Ten bla KPC-2 -harboring Pseudomonas aeruginosa isolates from hospitals located in five different Colombian cities have been characterized. Isolates were multidrug resistant, belonged to five different pulsotypes, and possessed naturally chromosome-encoded bla AmpC and bla OXA-50 genes and the acquired bla KPC-2 gene. In most cases, the bla KPC-2 genes were carried by plasmids of different sizes and were associated with Tn4401b or a new structure containing only part of the Tn4401 sequence. This study revealed that several clones of P. aeruginosa producing bla KPC-2 are disseminating in Colombia.

In 2006, the first isolate of KPC-2-producing Pseudomonas aeruginosa in the world was identified in Colombia. Recently, similar strains have been reported in Puerto Rico. We now report KPC-2-producing P. aeruginosa in Trinidad and Tobago. Surveillance for similar strains is warranted, considering their wide geographic spread and known association with mobile genetic elements. CASE REPORTA 63-year-old male patient was admitted to a hospital in Mount Hope, Trinidad and Tobago, with hematuria, dysuria, fever, and chills. He had no history of travel abroad. Four months prior to his presentation, he had a left hip fracture caused by a fall and was hospitalized at another regional hospital for 10 weeks without any surgical intervention but with conservative care. He had remained bedridden since the fracture.Upon physical examination, he appeared chronically ill, was stuporous, febrile (38°C), severely pale, and dehydrated, had bedsores on the buttocks and sacral area, and had a urinary catheter. He had swelling of the left thigh, which was tender and warm to the touch, with subcutaneous emphysema.Blood and urine specimens were submitted for culture. Radiological investigations of the pelvis and legs revealed a fracture of the neck of the left femur, with subcutaneous emphysema and fluid collection along the lateral compartment of the thigh, extending to the inguinal region, hip joint, and left lower abdominal wall.He was given gentamicin, ceftazidime, and metronidazole. A fasciotomy was performed, revealing gas gangrene. Two liters of greenish yellow pus from the anterior compartment of the left thigh, extending to the left lower abdomen, was drained. This pus was cultured.Blood and urine cultures were negative. However, the culture of the pus from surgery yielded Pseudomonas aeruginosa. Antimicrobial susceptibility testing using the MicroScan WalkAway 96 SI system (Siemens) revealed that the isolate was resistant to all tested antimicrobials, including gentamicin, ceftazidime, ciprofloxacin, and carbapenems. Meropenem monotherapy was given despite in vitro resistance, while efforts were made to procure polymyxin B or colistin; unfortunately, these efforts were unsuccessful, and the patient died 10 days postadmission.The P. aeruginosa isolate was sent to the International Center for Medical Research and Training, Cali, Colombia, where the MIC was determined using the Clinical and Laboratory Standards Institute (CLSI)-approved broth microdilution method (2). Ertapenem, imipenem, and meropenem MICs were Ͼ128 g/ml. This isolate was also resistant to ceftazidime (MIC, 128 g/ml), cefepime (MIC, Ͼ128 g/ml), aztreonam (MIC, Ͼ128 g/ml), piperacillin-tazobactam (MICs, Ͼ256 and 4 g/ml), and ciprofloxacin (MIC, Ͼ8 g/ml) and remained susceptible only to polymyxin B (MIC, 2 g/ml).A three-dimensional test to screen for carbapenemases was performed as reported previously (10) with some modifications. This test uses a carbapenem-susceptible organism as an indicator for carbapenemases in a cellular extract. To detect the carbapenemase...

In 2008, an increase in the prevalence of carbapenem-resistant Klebsiella pneumoniae was noted in a 286-bed tertiary case hospital in Colombia, where 84 patients (32 infected and 52 colonized) had positive cultures. The identified index patient came from Israel for a liver transplantation. High level carbapenem resistance was observed. Polymyxin B and tigecycline were the only two antibiotics that remained active. PCR-restriction fragment length polymorphism analysis and sequencing revealed blaKPC-3 in the major clone, which was indistinguishable from the K. pneumoniae carbapenemase-3-producing clone described previously in Israel. This exemplifies the threat posed by the global spread of K. pneumoniae carbapenemase-producing pathogens.