Emergence of blaKPC-3-Tn4401a associated with a pKPN3/4-like plasmid within ST384 and ST388 Klebsiella pneumoniae clones in Spain

Curião, Tânia; Morosini, María Isabel; Ruíz-Garbajosa, Patricia; Robustillo, Ana; Baquero, Fernando; Coque, Teresa M.; Cantón, Rafael

doi:10.1093/jac/dkq174

Cited by 75 publications

(55 citation statements)

References 37 publications

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“…Unlike in other South European countries such as Greece and Italy, the prevalence of CPE in Spain remains low and is mainly related to VIM-producing isolates (13,28,31,35). Nevertheless, KPC-2-, KPC-3-, NDM-1-, and OXA-48-producing Enterobacteriaceae were recently detected in our country (6,10,24,30).Fecal carriage of CPE isolates has been investigated rarely compared with carriage of isolates producing extended-spectrum ␤-lactamases (ESBLs) (17,18,35,36), particularly among patients not selected for their relation to outbreak cases. In addition, few surveillance culture recommendations are available for detecting CPE (1,26,36).…”

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confidence: 57%

Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

et al. 2012

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bFecal carriage of carbapenemase-producing Enterobacteriaceae (CPE) has not been extensively investigated, except in the cases of selected patients at risk, mostly during outbreaks. A total of 1,100 fecal samples randomly collected in our institution in two different periods in 2006 (n ‫؍‬ 600) and 2009 -2010 (n ‫؍‬ 500) from hospitalized (26.8%) and nonhospitalized (73.2%) patients were screened for CPE. The first period coincided with an outbreak of VIM-1-producing Enterobacteriaceae, and the second one coincided with the emergence of KPC enzymes in our hospital. Diluted samples in saline were cultured in Luria-Bertani broth with 1 g/ml imipenem and subcultured in MacConkey agar plates with 4 g/ml ceftazidime. Growing colonies were screened for CPE (modified Hodge test and EDTA and boronic acid synergy tests). Carbapenemase genes, plasmids in which they are located, and clonal relatedness were determined. Individuals who exhibited fecal carriage of CPE (11/1,043, 1.1%; 95% confidence interval [CI], 0.53 to 1.88) included 8 hospitalized (carriage rate, 2.9%; 95% CI, 1.24 to 5.55) and 3 nonhospitalized patients (carriage rate, 0.4%; 95% CI, 0.08 to 1.14), the latter being identified in 2009. Eighty-two percent of colonized patients were not infected with CPE. Isolates harboring bla VIM-1 with or without bla SHV-12 were identified as Klebsiella pneumoniae (n ‫؍‬ 8; ST39, ST688, ST253, and ST163), Enterobacter cloacae (n ‫؍‬ 3; two pulsed-field gel electrophoresis [PFGE] types), Escherichia coli (n ‫؍‬ 2; ST155 and ST2441), and Citrobacter freundii (n ‫؍‬ 1). Some of these lineages had previously been detected in our institution. The bla VIM-1 gene was a member of the class 1 integrons In110 (bla VIM-1 -aacA4-aadA1) and In113 (bla VIM-1 -aacA4-dhfrII) located on plasmids IncN (n ‫؍‬ 11; 30 to 50 kb) and IncHI2 (n ‫؍‬ 3; 300 kb), respectively. Dissemination of bla VIM-1 class-1 integrons within highly transferable plasmids in a polyclonal population has potentially contributed to the maintenance and spread of CPE. With the exception of OXA-48, these enzymes confer high-level resistance to most ␤-lactam compounds, such as penicillins and cephalosporins, but variably affect susceptibility to carbapenems (20,32). Unlike in other South European countries such as Greece and Italy, the prevalence of CPE in Spain remains low and is mainly related to VIM-producing isolates (13,28,31,35). Nevertheless, KPC-2-, KPC-3-, NDM-1-, and OXA-48-producing Enterobacteriaceae were recently detected in our country (6,10,24,30).Fecal carriage of CPE isolates has been investigated rarely compared with carriage of isolates producing extended-spectrum ␤-lactamases (ESBLs) (17,18,35,36), particularly among patients not selected for their relation to outbreak cases. In addition, few surveillance culture recommendations are available for detecting CPE (1,26,36).The objectives of the present study were to evaluate the prevalence of intestinal colonization with CPE in nonselected hospitalized and nonhospitalized patients from the same geographi...

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Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

et al. 2012

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“…In the present study, we assessed the performance of the ␤Lacta test for rapid detection of ␤-lactamasehydrolyzing extended-spectrum cephalosporins in two groups of Enterobacteriaceae clinical isolates. The first group (Table 1) consisted of 338 contemporary clinical isolates collected prospectively (in January to March 2012), and the second group (Table 2) included 106 clinical isolates with ␤-lactamase-mediated resistance mechanisms that were characterized at the molecular level and affected broad-spectrum cephalosporins (12)(13)(14)(15). All isolates were recovered at the Ramón y Cajal University Hospital and were identified using both a MicroScan system (Siemens, West Sacramento, CA) and MALDI-TOF MS (Bruker Daltonics, Germany).…”

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confidence: 99%

“…Molecular characterization of bla genes was performed as described previously (12)(13)(14)(15), for both contemporary clinical isolates (first group) with discrepant results in the ␤Lacta test and isolates with well-characterized resistance mechanisms (second group). The ␤Lacta test was performed according to the manufacturer's instructions.…”

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confidence: 99%

Rapid Detection of β-Lactamase-Hydrolyzing Extended-Spectrum Cephalosporins in Enterobacteriaceae by Use of the New Chromogenic βLacta Test

et al. 2014

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The chromogenic ␤Lacta test developed for the rapid detection of ␤-lactamase-hydrolyzing extended-spectrum cephalosporins in Enterobacteriaceae revealed good performance with extended-spectrum ␤-lactamase (ESBL) producers (97.5% true-positive results). However, false-negative results occurred with chromosomal AmpC hyperproducers and plasmid AmpC producers, whereas uninterpretable results were mostly due to VIM-1 carbapenemase producers and possibly low levels of expressed ESBLs. Detection of Enterobacteriaceae resistant to broad-spectrum cephalosporins, mostly due to production of extended-spectrum ␤-lactamases (ESBL), plasmid AmpC ␤-lactamases, and/or carbapenemases, has become a challenge in clinical microbiology laboratories because of important clinical consequences for infection control purposes and guidance of antimicrobial therapy (1-3). Methods routinely used to detect these organisms are primarily based on susceptibility testing results, either MICs or disk diffusion inhibition zones, as well as on ancillary testing using disk synergy tests with different ␤-lactamase inhibitors or MIC-gradient strips combining ␤-lactams and ␤-lactamase inhibitors (4). Molecular methods based on PCR or microarray hybridization techniques have been also developed (5, 6). In addition, mass spectrometry-based protocols using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and in-house colorimetric tests have been developed to detect the production of ESBLs in less than 4 h (7,8). Increased interest in rapid colorimetric assays has been observed, because of their easy implementation in the routine workflow of clinical laboratories (8).The ␤Lacta test (Bio-Rad, Marnes la Coquette, France) is a new chromogenic method based on the use of a yellow substrate (HMRZ-86) that turns to red when hydrolyzed by ESBLs, AmpC ␤-lactamases, and most carbapenemases (9-11). According to the manufacturer, reading of the results can be performed visually in less than 15 min. In the present study, we assessed the performance of the ␤Lacta test for rapid detection of ␤-lactamasehydrolyzing extended-spectrum cephalosporins in two groups of Enterobacteriaceae clinical isolates. The first group (Table 1) consisted of 338 contemporary clinical isolates collected prospectively (in January to March 2012), and the second group (Table 2) included 106 clinical isolates with ␤-lactamase-mediated resistance mechanisms that were characterized at the molecular level and affected broad-spectrum cephalosporins (12-15). All isolates were recovered at the Ramón y Cajal University Hospital and were identified using both a MicroScan system (Siemens, West Sacramento, CA) and MALDI-TOF MS (Bruker Daltonics, Germany). In addition, the Escherichia coli ATCC 35218 strain (TEM-1 producer) was used as a negative control, whereas the Klebsiella pneumoniae ATCC 700603 strain (SHV-18 producer) was used as a positive control. Susceptibility testing of ␤-lactam antibiotics, including broad-spectrum cephalosporins (cefotaxime, ceftazi...

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“…In Spain, several outbreaks caused by members of the Enterobacteriaceae producing carbapenemases have been recently reported, mostly due to VIM-1 (Tato et al, 2010;Oteo et al, 2010;Sánchez-Romero et al, 2012), OXA-48 and KPC (Curiao et al, 2010).…”

Section: Resultsmentioning

confidence: 99%

Abdominal abscess due to NDM-1-producing Klebsiella pneumoniae in Spain

Oteo

Domingo-García

Fernández-Romero

et al. 2012

Journal of Medical Microbiology

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We describe a clinical case of an abdominal abscess due to NDM-1-producing Klebsiella pneumoniae in a 35-year-old Spanish patient after hospitalization in India for perforated appendicitis and peritonitis. The strain belonged to the MLST type 231 and had multiple additional antibiotic resistance genes such as bla CTX-M-15 , armA methylase, aac(69)-Ib-cr, dfrA12, sul1 and qnrB and lack of porin genes ompK35 and ompK36. The patient was cured after abscess drainage. IntroductionAcquired carbapenemases are increasingly reported in Gram-negative pathogens (Miriagou et al., 2010). Metallob-lactamases belong to the class B carbapenemases and confer resistance to all b-lactams, including carbapenems, except aztreonam. Spread of metallo-b-lactamases among members of the Enterobacteriaceae represents a public health threat. Although VIM and KPC types are the most common carbapenemases in Europe, the class D OXA-48 carbapenemase is also spreading, and the New Delhi metallo-blactamase 1 (NDM-1) has been described in Sweden (Yong et al., 2009) We describe a clinical case of NDM-1-producing Klebsiella pneumoniae in Spain causing an abdominal abscess after surgery for perforated appendicitis. To the best of our knowledge, this is the first case of NDM-1-producing K. pneumoniae in our country. Case reportA 35-year-old white male was admitted to a third level teaching hospital in Madrid (Spain) in August of 2010 due to acute abdominal pain in the right iliac fossa. In the previous 9 days, the patient had been hospitalized in India because of acute perforating appendicitis followed by peritonitis. The patient underwent a laparoscopic appendectomy and peritoneal cavity washing. Pseudomonas aeruginosa and Escherichia coli were cultured from the peritoneal fluid, both susceptible to levofloxacin and meropenem, and treatment with one unidentified antibiotic was prescribed for 5 days.The patient returned to Spain, and 2 days after completing antibiotic treatment started to have pain in the right iliac fossa and had a temperature of 38.8 u C. A haemogram revealed leukocytosis and an abdominal echography showed a pus collection in the right iliac fossa. Blood cultures were obtained, and antimicrobial therapy with amoxicillin/ clavulanic acid (1 g t.i.d.) was prescribed. Three days later, leukocytosis continued, treatment was changed to meropenem (1 g t.i.d.) and the abscess was then drained. The purulent exudate was cultured onto conventional media for aerobic and anaerobic bacteria following standard methodologies. Growth was positive for Enterococcus faecium and carbapenem-resistant K. pneumoniae but anaerobic cultures were negative. Blood cultures were also negative.Although the patient was not specifically treated with antibiotics active against carbapenem-resistant K. pneumoniae, his health condition improved over the next 2 weeks, probably due to the pus drainage. A control echography did not reveal any pus collection and the patient was discharged 16 days after pus drainage. No secondary clinical cases were observed. MethodsAn...

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Emergence of blaKPC-3-Tn4401a associated with a pKPN3/4-like plasmid within ST384 and ST388 Klebsiella pneumoniae clones in Spain

Cited by 75 publications

References 37 publications

Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

Rapid Detection of β-Lactamase-Hydrolyzing Extended-Spectrum Cephalosporins in Enterobacteriaceae by Use of the New Chromogenic βLacta Test

Abdominal abscess due to NDM-1-producing Klebsiella pneumoniae in Spain

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