Molecular Epidemiology, Sequence Types, and Plasmid Analyses of KPC-Producing Klebsiella pneumoniae Strains in Israel

Abstract

Medical Center during 2005 and 2006, parallel to the emergence of the KPC-3-producing K. pneumoniae sequence type 258 (ST 258). We aimed to study the molecular epidemiology of these isolates and to characterize their bla KPC -carrying plasmids and their origin. Ten isolates (8 KPC-2 and 2 KPC-3 producing) were studied. All isolates were extremely drug resistant. They possessed the bla KPC gene and varied in their additional beta-lactamase contents. The KPC-2-producing strains belonged to three different sequence types: ST 340 (n ‫؍‬ 2), ST 277 (n ‫؍‬ 2), and a novel sequence type, ST 376 (n ‫؍‬ 4). Among KPC-3-producing strains, a single isolate (ST 327) different from ST 258 was identified, but both strains carried the same plasmid (pKpQIL). The KPC-2-encoding plasmids varied in size (45 to 95 kb) and differed among each of the STs. Two of the Klebsiella bla KPC-2 -carrying plasmids were identical to plasmids from Escherichia coli, suggesting a common origin of these plasmids. These data indicate that KPC evolution in K. pneumoniae is related to rare events of interspecies spread of bla KPC-2 -carrying plasmids from E. coli followed by limited clonal spread, whereas KPC-3 carriage in this species is related almost strictly to clonal expansion of ST 258 carrying pKpQIL.

Population Structure of Klebsiella pneumoniae Causing Bloodstream Infections at a New York City Tertiary Care Hospital: Diversification of Multidrug-Resistant Isolates

“…A bla KPC-3 -encoding wzi154 clone was recently documented in another New York City hospital (11), raising the possibility of local expansion or interhospital spreading of isolates. However, a study conducted in Israel also noted restriction of bla KPC-3 to ST258 isolates carrying a common plasmid (pKpQIL), while bla KPC-2 was present in several different plasmids associated with different K. pneumoniae STs (27). This supports the hypothesis that bla KPC-2 might be present on mobile resistance determinants that are more readily transmissible.…”

A Swordless Knight: Epidemiology and Molecular Characteristics of the bla KPC -Negative Sequence Type 258 Klebsiella pneumoniae Clone

“…S1 in the supplemental material). The results were confirmed by PFGE (28). MLST was performed on representative PFGE clone Q isolates (17) and analyzed using the K. pneumoniae MLST website (http://www.pasteur.fr/recherche/genopole/PF8 /mlst/Kpneumoniae.html).…”

“…Patient-unique, KPC-producing or ertapenem-susceptible K. pneumoniae isolates were randomly collected from June 2010 to December 2011 in the two centers. KPC-producing ST-258 control strains were available from our collection (28).…”

“…In 2006, a strain of KPC-3-producing K. pneumoniae, exhibiting resistance to nearly all antimicrobial agents, spread in all major Israeli hospitals (28,35). This strain, designated pulsed-field gel electrophoresis (PFGE) clone Q, ultimately identified as sequence type (ST)-258, was identical to the epidemic strain that has spread across the United States (26), Europe, and South America (3,4,13).…”

Laboratory and Clinical Evaluation of Screening Agar Plates for Detection of Carbapenem-Resistant Enterobacteriaceae from Surveillance Rectal Swabs

“…In 2006, an epidemic strain of KPC-3-producing Klebsiella pneumoniae, exhibiting resistance to nearly all antimicrobial agents, spread in all major Israeli hospitals (11,16). This strain, identified as sequence type (ST) 258, is identical to the epidemic strain that had spread across the United States (9,12) and is characterized by high MIC values of carbapenem antibiotics (16).…”