Identification of a KPC-9-producing Klebsiella pneumoniae ST258 cluster among KPC-2-producing isolates of an ongoing outbreak in Northwestern Greece: a retrospective study

Abstract

KPC-2-producing Klebsiella pneumoniae (KPC-2-KP) of MLST type ST258 has been extensively implicated in outbreaks in Greece, expanding rapidly to a nationwide epidemic [1]. In contrast, outbreaks with KPC-KP carrying subtypes other than bla KPC-2 have not yet been reported in Greece. Timely identification of KPC variants is critical to identify routes of transmission, which may require specific outbreak containment measures [2], especially in cases of highly virulent or resistant sublineages. The KPC subtype KPC-9 has to the best of our knowledge only been described in a single case report on a patient in Israel [3]. This letter describes an outbreak cluster with KPC-9-KP, which is closely related to the KPC-2-KP outbreak in Greece.We retrospectively assessed KPC-KP isolates from patients from a haematology ward in a hospital in northwestern Greece from April 2014 to July 2015. All stored Enterobacteriaceae strains non-susceptible to carbapenems, and KPC-positive by meropeneme phenylboronic acid double-disc synergy testing were molecularly characterized by next-generation sequencing (NGS) using Illumina MiSeq. Publicly available sequences of ST258 genomes and NGS data of ST258 isolates associated with Greece were searched for in the NCBI and Institut Pasteur NGS databases, respectively. CgMLST comparison and assignment of clonal clusters were provided by SeqSphereþ 3.5.0 software (Ridom, Germany). The capsular types of the isolates were derived from the NGS data. Plasmid sequences were reconstructed using CONTIGuator with plasmid pKpQIL (GI:294496685) as a reference [4]. Single representatives of the plasmids with KPC variants were compared. Plasmid replicons were typed using PlasmidFinder [5].A total of 12 KPC-KP isolates were recovered from ten patients. Six patients (eight isolates) were infected and/or colonized with KPC-9-KP, and four with KPC-2-KP. The patients were hospitalized on the same hospital ward. All eight KPC-9-KP isolates carried the extended spectrum b-lactamase bla SHV-11 , within these isolates five also carried the acquired b-lactamases bla OXA-9 and bla TEM-1a .

Emergence of New Non–Clonal Group 258 High-Risk Clones among Klebsiella pneumoniae Carbapenemase–Producing K. pneumoniae Isolates, France

“…Because KPC is not widely disseminated in France, we did not expect to observe such clonal diversity. Indeed, the epidemiology of KPC in France is not comparable to what was reported in nearby countries in Europe where KPC is endemic, such as Greece and Italy, and where the spread of bla KPC-2/-3 is clearly linked to CG258 (24,25). Among the 8 isolates we identified that belonged to CG258, 3 were recovered from patients with travel history in Greece (isolate 175C3 and isolate 177H5) and Italy (isolate 160C2).…”

Genomic characterization of a KPC-23-producing Klebsiella pneumoniae ST258 clinical isolate resistant to ceftazidime-avibactam

“…KPC-23 appears to be the complete version of KPC-9 (GenBank accession number: ACM91559.1) (https://www.lahey.org/Studies/), which was first described in a single case report on a patient in Israel [13]. Recently, an outbreak of ST258 KPC-9-producing K. pneumoniae was described in a hospital in Ioannina (Northwestern Greece) [14]. Presently, we do not have data on the extent of dissemination of KPC-23 variant in Greece as sequencing of bla KPC is rarely carried out in clinical microbiology laboratories other than for research purposes.…”

First Description of Colistin and Tigecycline-Resistant Acinetobacter baumannii Producing KPC-3 Carbapenemase in Portugal

“…The MLST International clone ST-258 has been recognized as the prevalent ST of carbapenem-resistant K. pneumoniae isolates worldwide [45,46,47,48]. Herein, we described an isolate that belongs to sequence type ST-14 which has been associated with pan resistant isolates and the production of OXA-48 and NDM carbapenemases with a higher colistin rate of resistance when compared with isolates outside the cluster (37.1% vs. 27.1%) [49].…”