Emergence of four cases of KPC-2 and KPC-3-carrying Klebsiella pneumoniae introduced to Switzerland, 2009–10

Abstract

We report four epidemiologically unrelated cases of KPC-carrying Klebsiella pneumoniae identified in Switzerland between May 2009 and November 2010. Three cases were transferred from Italy (two KPC-3, one KPC-2) and one from Greece (KPC-2). Resistance to colistin and doxycycline emerged in one KPC-3carrying K. pneumoniae strain during therapy. These results demonstrate ongoing dissemination of KPC throughout Europe. Rapid and reliable identification of KPC and implementation of control measures is essential to limit spread.

Using Nucleic Acid Microarrays To Perform Molecular Epidemiology and Detect Novel β-Lactamases: a Snapshot of Extended-Spectrum β-Lactamases throughout the World

“…KPC-2 and KPC-3 are widespread and are the most frequently identified carbapenemases in Enterobacteriaceae. KPC-producing bacteria were identified first in the United States and subsequently on almost every continent (2,9,22,23,29,30,39). Detection of these enzymes remains difficult because the MICs of carbapenems for some bla KPC -producing isolates at times remain in the susceptible range, especially when automated systems are used.…”

First documented outbreak of KPC-2-producing Klebsiella pneumoniae in Switzerland: infection control measures and clinical management

“…Many cases and outbreaks of CRE in other countries have been attributed to patient transfers from Italy [6,9].…”

“…MICs of colistin and tigecycline were 4 determined with Etest® (BioMérieux, Marcy-l'Etoile, France). KPC-specific conventional polymerase chain reaction (PCR) was followed by direct sequencing as previously described [9]. Molecular typing of KPC-KP was done using PFGE using restriction endonuclease XbaI according to Babouee et al [14], with the exception of calculating percent similarities based on the Pearson instead of the Dice coefficient.…”

“…Growing colonies of different morphotypes were identified by MALDI-TOF (Bruker, Billerica, MA) and susceptibility testing was performed with the BD Phoenix™-100 (BD Bioscience, San Jose, CA) system according to CLSI guidelines [13]. Multiresistant K. pneumoniae with elevated MICs for carbapenems were further tested with Etest® containing imipenem (with and without EDTA), double disk synergy test with boronic acid as well as with the modified Hodge test [9,13]. MICs of colistin and tigecycline were 4 determined with Etest® (BioMérieux, Marcy-l'Etoile, France).…”

“…Subsequently, four unrelated cases of KPC-2 and KPC-3 K. pneumoniae were reported from the University Hospital of Basel. All four cases were related to endemic countries [9].…”