Microbiological and molecular characteristics of carbapenemase-producing Klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010

Abstract

We report 570 carbapenemase-producing Klebsiella pneumoniae (CPKP) clinical isolates in a 1,040-bed Greek tertiary hospital during 2004 to 2010. The first CPKP (VIM-producing) was isolated in September 2004. Despite initial containment, VIM producers have become endemic since 2006. KPC-producing K. pneumoniae was first isolated in August 2007 from a patient who came from Israel, spread rapidly, and outcompeted VIM. Overall, 267 (47%) VIM-producing and 301 (53%) KPC-producing strains were isolated, including 141 (24.7%) from patients with bacteraemia. Two isolates carrying both VIM and KPC were isolated in two consecutive months in 2009, but not since. The prevalence of CPKP increased from 0% in 2003 to 38.3% in 2010 (p<0.0001). All genotyped KPC producers harboured blaKPC-2 and belonged to two clones, among which the hyperepidemic Greek clone, related to those from the United States and Israel, predominated. Most metallo-beta-lactamase (MBL) producers carried the blaVIM-1 gene and belonged to several clones, whereas all but one isolate with blaVIM-12 were clustered within a five-month period, arising from one clone. Resistance to non-beta-lactam antibiotics was also increased among CPKP. They were almost invariably resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Resistance to colistin increased from 3.5% (4/115) in 2008 to 20.8% (25/120) in 2010, and resistance to tigecycline also increased. Following reinforcement of infection control measures, prevalence of CPKP (mainly KPC) has been reduced since mid-2009 (from 46% in 2009 to 38.3% in 2010). In view of the exhaustion of available therapies, investment in infection control resources and optimal antibiotic use is urgently required.

Polyclonal Endemicity of Carbapenemase-Producing Klebsiella pneumoniae in ICUs of a Greek Tertiary Care Hospital

“…A similar pattern of carbapenemases was observed in Hippokration General Hospital of Thessaloniki, Greece where KPC carbapenemases have prevailed among CRKP since 2009 outnumbering the VIM-type carbapenemases that predominated previously [44].…”

Performance of polymyxin B agar‐based tests among carbapenem‐resistant Enterobacterales

“…Polymyxins have been used as a last resort in infections due to carbapenem-resistant K. pneumoniae (Nabarro and Veeraraghavan 2015). However, in the last decades, polymyxins resistance has risen in countries of Europe, with rates near 21, 32 and 43%, respectively, in Greece, Spain and Italy (Zagorianou et al 2012;Monaco et al 2014;Pena et al 2014). In Brazil, polymyxins resistance rates are near 27% in CRE isolates (Sampaio and Gales 2016).…”

“…However, in the last decades, polymyxins resistance has risen in countries of Europe, with rates near 21, 32 and 43%, respectively, in Greece, Spain and Italy (Zagorianou et al . 2012; Monaco et al . 2014; Pena et al .…”

Κλινικοεργαστηριακή Διερεύνηση Της Φορείας Και Των Λοιμώξεων Από Πολυανθεκτικά Στελέχη Σε Ασθενείς Της Μονάδας Εντατικής Θεραπείας Και Των Μονάδων Αυξημένης Φροντίδας

“…pneumoniae πνπ παξάγεη θαξβαπελεκάζε VIM [47][48][49][50][51][52][53][54][55][56][57][58][59][60][61][62]. Θεσξείηαη πιένλ ελδεκηθή ζηελ Διιάδα θαη ηελ Ηηαιία, ελώ κεκνλσκέλα πεξηζηαηηθά ή επηδεκίεο έρνπλ παξαηεξεζεί ζε αξθεηέο Δπξσπατθέο ρώξεο, ζπλήζσο ζε αζζελείο πνπ είραλ πξνεγνπκέλσο λνζειεπζεί ζε ρώξεο κε απμεκέλε επίπησζε [47,54,56,[59][60][61][63][64][65].…”