Outbreak of Infection with
            <i>Klebsiella pneumoniae</i>
            Sequence Type 258 Producing
            <i>Klebsiella pneumoniae</i>
            Carbapenemase 3 in an Intensive Care Unit in Italy

Mammina, Caterina; Palma, Daniela Maria; Bonura, Celestino; Plano, Maria Rosa Anna; Monastero, Rachele; Sodano, Concetta; Calà, Cinzia; Tetamo, Romano

doi:10.1128/jcm.00315-10

Cited by 39 publications

(36 citation statements)

References 11 publications

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“…7 Previous reports have described the epidemic spread of KPC-Kp ST258 in different healthcare settings in Sicily. 8,9 However, to the best of our knowledge, this is the first report of an outbreak of colonization by KPC-Kp in NICU. Interestingly, the emergence of the outbreak strain coincided with the admission of two neonates referred from elsewhere, but the most prominent role as the source of transmission was likely played by the third long-stay patient with malformation.…”

Section: Discussionmentioning

confidence: 80%

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Giuffrè

Bonura

Geraci

et al. 2013

Journal of Hospital Infection

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This article reports an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-Kp) sequence type (ST) 258 in a neonatal intensive care unit (NICU) in Palermo, Italy. KPC-Kp ST258 was detected by an active surveillance culture programme. Between 18th September and 14th November 2012, KPC-Kp was isolated from 10 out of 54 neonates admitted in the outbreak period. No cases of infection were recorded. Male sex was associated with colonization, whereas administration of ampicilline-sulbactam plus gentamicin was protective. Infection control interventions interrupted the spread of KPC-Kp without the need to close the NICU to new admissions. (C) 2013 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved

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Section: Discussionmentioning

confidence: 80%

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Giuffrè

Bonura

Geraci

et al. 2013

Journal of Hospital Infection

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“…KPC-3 is mainly detected in the United States, Latin America, and Israel (3,7,14,15), while reports from Europe still remain rare, mainly involving patients with a history of previous hospitalization in these regions of endemicity (2,9,23). In Italy, KPC-2-and KPC-3-producing K. pneumoniae strains have already been introduced into hospital units (8,9,13). We report the emergence of a KPC-3-producing K. pneumoniae clone in an Italian intensive care unit (ICU) and the containment of this outbreak.…”

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confidence: 99%

Containment of an Outbreak of KPC-3-Producing Klebsiella pneumoniae in Italy

et al. 2011

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, 24 carbapenem-resistant Klebsiella pneumoniae isolates were recovered from 16 patients hospitalized in an Italian intensive care unit (ICU). All isolates contained KPC-3 carbapenemase and belonged to a single pulsed-field gel electrophoresis (PFGE) clone of multilocus sequence type 258 (designated as ST258). A multimodal infection control program was put into effect, and the spread of the KPC-3-producing K. pneumoniae clone was ultimately controlled without closing the ICU to new admissions. Reinforced infection control measures and strict monitoring of the staff adherence were necessary for the control of the outbreak.

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“…Since 2008, K. pneumoniae strains producing KPC carbapenemases have been detected in many different Italian hospitals. In particular, the clones designated sequence type 258 (ST258) and ST512 are the most frequently reported K. pneumoniae clones in this country, both belonging to the clonal group CC258 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). In the period from 2010 to 2011, two surveillance studies were performed in 10 hospitals in Rome, collecting Ͼ100 KPC-3-producing K. pneumoniae strains belonging to CC258; several strains showed reduced susceptibility or resistance to tigecycline (6).…”

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confidence: 99%

Genomics of KPC-Producing Klebsiella pneumoniae Sequence Type 512 Clone Highlights the Role of RamR and Ribosomal S10 Protein Mutations in Conferring Tigecycline Resistance

Villa

Feudi

Fortini

et al. 2014

Antimicrob Agents Chemother

115

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Full genome sequences were determined for five Klebsiella pneumoniae strains belonging to the sequence type 512 (ST512) clone, producing KPC-3. Three strains were resistant to tigecycline, one showed an intermediate phenotype, and one was susceptible. Comparative analysis performed using the genome of the susceptible strain as a reference sequence identified genetic differences possibly associated with resistance to tigecycline. Results demonstrated that mutations in the ramR gene occurred in two of the three sequenced strains. Mutations in RamR were previously demonstrated to cause overexpression of the AcrABTolC efflux system and were implicated in tigecycline resistance in K. pneumoniae. The third strain showed a mutation located at the vertex of a very well conserved loop in the S10 ribosomal protein, which is located in close proximity to the tigecycline target site in the 30S ribosomal subunit. This mutation was previously shown to be associated with tetracycline resistance in Neisseria gonorrhoeae. A PCR-based approach was devised to amplify the potential resistance mechanisms identified by genomics and applied to two additional ST512 strains showing resistance to tigecycline, allowing us to identify mutations in the ramR gene.

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Outbreak of Infection with Klebsiella pneumoniae Sequence Type 258 Producing Klebsiella pneumoniae Carbapenemase 3 in an Intensive Care Unit in Italy

Cited by 39 publications

References 11 publications

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Successful control of an outbreak of colonization by Klebsiella pneumoniae carbapenemase-producing K. pneumoniae sequence type 258 in a neonatal intensive care unit, Italy

Containment of an Outbreak of KPC-3-Producing Klebsiella pneumoniae in Italy

Genomics of KPC-Producing Klebsiella pneumoniae Sequence Type 512 Clone Highlights the Role of RamR and Ribosomal S10 Protein Mutations in Conferring Tigecycline Resistance

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