The emergence of multidrug-resistantKlebsiella pneumoniaeof international clones ST13, ST16, ST35, ST48 and ST101 in a teaching hospital in the Paris region

Abstract

Despite infection control measures, an important increase in the extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae incidence density occurred in our hospital from 2006 onwards. This study, focusing on the 2005-2007 period, was performed in an attempt to explain this increase. ESBLs were characterized, isolates were typed by ERIC2-PCR, and sequence type (ST) of clustered isolates was determined. Temporal-spatial relationships of patients were analysed to assess possible cross-contamination. Of the 74 ESBL-producing isolates, 30 (40%) were detected at admission, 53 (71∙5%) produced CTX-M enzymes, 40 displayed unique ERIC2-PCR profiles and 34 were assigned into six clusters: ST16 (n=21), ST101, ST48, ST35, ST13, and ST436. Relationships were identified in 22 of the 34 patients harbouring clustered isolates. This study highlights the complex epidemiology of ESBL-producing K. pneumoniae in the mid-2000s with potential cross-contamination for only 30% of the 74 patients in our hospital, and the emergence of clones that are currently spreading worldwide.

Identification and characterization of CTX-M-15 producing Klebsiella pneumoniae clone ST101 in a Hungarian university teaching hospital

“…Beside several minor clones, three internationally disseminated CTX-M-15 producing K. pneumoniae clones, namely ST15, ST101 and ST147 were present in the Clinical Centre University of Pécs, of which ST15 and ST147 are considered to be epidemic clones in Hungary [6,[32][33][34][35][36].…”

“…This sequence type was associated with various β-lactam resistance mechanisms in different parts of the world: CTX-M-15 production in France, Greece and Italy; SHV-12 production in the Czech Republic; OXA-48 production in Spain, Libya, France, Tunisia, Morocco, Switzerland and South Africa; KPC-2 production in Italy and Spain [32,[35][36][37][38][39][40][41][42]. In our institution the presence of CTX-M-15 producing ST101 seemed to be restricted both timely and spatially, as the majority of the isolates originated from a single department with a decreasing incidence ( Tables II and III).…”

Outbreak Caused by an Ertapenem-Resistant, CTX-M-15-Producing Klebsiella pneumoniae Sequence Type 101 Clone Carrying an OmpK36 Porin Variant

“…Previous reports implicating ST101 in the European and wider Mediterranean region have derived from Italy (involving KPC-2 producers), Spain and Tunisia (with OXA-48-and CTX-M-15-harboring isolates), and France and the Czech Republic (with ESBL-producing strains) (36,37).…”

Antibiotic-Resistant Klebsiella pneumoniae and Escherichia coli High-Risk Clones and an IncFII k Mosaic Plasmid Hosting Tn 1 ( bla TEM-4 ) in Isolates from 1990 to 2004

“…These results suggest the existence of highly adapted populations of K. pneumoniae and E. coli able to acquire antimicrobial resistance genes since at least the early 1990s. The sudden decrease of TEM-4 producers in all countries where it had been reported for years (17,18,20,21,35,36) parallels the shift in the epidemiology of beta-lactamases that involves the emergence of CTX-M, KPC (class A), and NDM (class B) and the drop in TEM-ESBL producers (22). Comparative genomics studies recently demonstrated the existence of intraclonal variants with enhanced epidemicity that can successfully spread at the global level as H30 ST131 E. coli or ST258/ST11 K. pneumoniae within clonal group (CG) 258 (37)(38)(39).…”