First Description of KPC-2-Producing Pseudomonas putida in Brazil

Abstract

cThis work reports the identification of the first case of a K⌹C-2-producing Pseudomonas putida isolate (PP36) in Brazil. The PP36 isolate was resistant to all the antimicrobials tested except polymyxin B. In addition to the discovered bla KPC-2 gene, genetic analysis showed the presence of a class 1 integron containing the dhfrXVb gene and the new allele arr-6, which codes for resistance to rifampin. These elements were found in an IncFI 65-kb plasmid. Since the first detection of a Klebsiella pneumoniae isolate harboring the bla KPC gene in a large plasmid in 1996 in North Carolina (15) and until 2005, the geographic distribution of these K. pneumoniae carbapenemase (KPC) enzymes in Enterobacteriaceae, mainly K. pneumoniae, was limited to the eastern part of the United States (6). Nowadays, the worldwide spread of KPC-producing, Gram-negative pathogens represents a potential clinical threat with devastating effects on patient outcomes (13).Although KPCs are mostly identified in K. pneumoniae, they have recently been observed among other Gram-negative pathogens, such as Pseudomonas spp. in America (11,14) and Acinetobacter baumannii in Puerto Rico (12). KPC-2-producing K. pneumoniae and Escherichia coli clinical isolates were also identified in Brazil (8,9). Besides these, to date, only one report describes the isolation of Pseudomonas putida producing KPC-2 in Texas (2). Those few reports show the spreading of the KPC-2 enzyme among potential pathogenic bacteria, an observation which might be of great concern for infection control programs. In the present study, we report the identification of the first case of a KPC-2-producing P. putida isolate in Brazil and highlight the importance of this finding in terms of hospital infection control.An 8-year-old boy was admitted to the Oncology Pediatric Center at the University Hospital Oswaldo Cruz, Recife, Brazil, in July 2008 to initiate a new cycle of chemotherapy for Burkitt's lymphoma. Ten days following admission, he presented fever and diarrhea and was sent to the Pediatric Intensive Care Unit and given a further 10 days of empirical intravenous antibiotic therapy with meropenem (1 g every 8 h) and vancomycin (500 mg every 6 h). The patient evolved with febrile neutropenia and gastrointestinal bleeding. Due to fungal sepsis by Candida spp., he received voriconazole (7 mg/kg of body weight every 12 h) for 21 days. Transcatheter bloodstream cultures showed the presence of a carbapenem-resistant P. putida isolate (herein named PP36). Since the patient has no history of traveling abroad, we assumed that this infection was acquired at the hospital. The bacterial identification was performed by a mini-Api ID32 GN card (bioMeriéux, Marcy l'Etoile, France). Meropenem therapy (1 g every 8 h) was restarted, and the catheter was removed. After the removal, the patient evolved to negative bloodstream cultures until the 67th day of internment when he was discharged.Broth microdilution assays (Table 1) showed that the PP36 isolate was resistant to all antimicrobials tested a...

Carbapenemase-producing Klebsiella pneumoniae: molecular and genetic decoding

“…bla KPC is typically plasmid-borne, and is carried on plasmids of different incompatibility (Inc) groups, including IncFII, FIA, I2, A/C, N, X, R, P, U, W, L/M and ColE [40, 42, 44, 50–55]. Unlike other carbapenemase genes, bla KPC is present mainly in plasmids in Enterobacteriaceae.…”

Identification of Klebsiella pneumoniae Carbapenemase-producing Klebsiella oxytoca in Clinical Isolates in Tehran Hospitals, Iran by Chromogenic Medium and Molecular Methods

“…KPCs are not just limited to the K. pneumoniae strain, and nowadays KPCs are also found extensively in other bacteria such as Escherichia coli , Enterobacter spp., Serratia spp., Morganella morganii , Citrobacter freundii , Salmonella enterica , Klebsiella oxytoca , Acinetobacter spp., Pseudomonas aeruginosa , and Pseudomonas putida 3, 4. To date, a total of 24 genotypes have been identified [5], and KPC-2 and KPC-3 are the most common genotypes isolated from clinical specimens.…”

Carriage of blaNDM-1 in Pseudomonas aeruginosa through multiple Inc type plasmids in a tertiary referral hospital of northeast India

“…The plasmids were classified by PCR based replicon typing, carried out for determining the incompatibility group type of the plasmid in all bla NDM-1 harbouring strains. A total of 18 different replicon types such as FIA, FIB, FIC, HI1, HI2, I1/Iγ, L/M, N, P, W, T, A/C, K, B/O, X, Y, F and FIIA were targeted as described previously11. The antibiotic susceptibility was done by Kirby-Bauer disc-diffusion method10 against antibiotics viz .…”