Emergence of Klebsiella pneumoniae clinical isolates producing KPC-2 carbapenemase in Cuba

Abstract

The emergence of Klebsiella pneumoniae producing carbapenemase (KPC) has now become a global concern. As a part of a nationwide multicentre surveillance study in Cuba, three K. pneumoniae clinical isolates resistant to carbapenems were detected for a 1-month period (September to October 2011). PCR and sequence analysis revealed that the three strains harboured blaKPC-2. They showed resistance or intermediate susceptibility to expanded-spectrum cephalosporins, other β-lactams, a β-lactam/β-lactamase inhibitor combination, and gentamicin. Two strains were susceptible only to colistin, whereas the other strain showing colistin resistance was susceptible to fluoroquinolones. These blaKPC-2-positive K. pneumoniae strains were classified into ST1271 (CC29), a novel clone harbouring blaKPC-2, and were revealed to be genetically identical by PCR-based DNA fingerprinting. The three patients infected with the KPC-producing K. pneumoniae had common risk factors, and had no overseas travel experience outside Cuba, suggesting local acquisition of the resistant pathogen. This is the first report of a KPC-producing K. pneumoniae in Cuba. Although detection of KPC in Enterobacteriaceae is still rare in Cuba, our finding indicated that KPC-producing bacteria are a global concern and highlighted the need to identify these microorganisms in clinical laboratories.

Genetic Diversity of KPC-ProducingEscherichia coli, Klebsiella oxytoca, Serratia marcescens, andCitrobacter freundiiIsolates from Argentina

“…1, C, No. [8][9][10][11][12][13][14]. This arrangement was found in 17 isolates (19%) and we observed 7 different variable regions defined between ISKpn8 and bla KPC-2 .…”

“…29 Nevertheless, this geographical difference is not exclusive: Puerto Rico has reported the novel variant bla KPC-8 and bla KPC-2 , and Cuba has reported the emergence of bla KPC-2 . 10,12 In our study, no major clones were detected, demonstrating that the spread of KPC-2 in non-K. pneumoniae isolates in Argentina is not driven by clonal dissemination, unlike K. pneumoniae ST258. 8 Previous reports, although infrequent, have documented the emergence of KPC enzymes in other ETB different from K. pneumoniae, including Salmonella enterica, K. oxytoca, Enterobacter species, E. coli, C. freundii, and S. marcescens.…”

“…4 Since then, the expansion of bla KPC harbored by K. pneumoniae ST258 in LA hospitals has been increasingly reported in Brazil, 5,6 Argentina, 7,8 Uruguay, 9 Puerto Rico, 10,11 and Cuba. 12 KPC enzymes have been detected in other ETB, including Salmonella spp., Enterobacter spp., Klebsiella oxytoca, Serratia marcescens, Citrobacter freundii, Escherichia coli, and Proteus mirabilis. 13 Nevertheless, KPC production in these species is less prevalent, but is increasingly reported in our continent, presumably as bla KPC -carrying plasmids are acquired from K. pneumoniae by these species and then disseminated.…”

Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods

“…The emergence of KPCs in Argentina was characterized by two patterns of dispersion: the first was the irregular occurrence of diverse Enterobacteriaceae harboring bla KPC-2 in the IncL/M transferable plasmid in distant regions and the second was the sudden clonal spread of K. pneumoniae ST258 harboring bla KPC-2 in Tn 4401a ( Gomez et al, 2011 ). KPC-producing K. pneumoniae was recently also detected in Cuba ( Quinones et al, 2014 ), Mexico ( Garza-Ramos et al, 2014 ), Uruguay ( Marquez et al, 2014 ), and Puerto Rico ( Gregory et al, 2010 ).…”