ABSTRACT
AIM: We report the first outbreak caused by Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae sequence type 258 (ST 258) clone that occurred in Croatia from May to December 2012. MATERIALS & METHODS: 23 carbapenem-resistant K. pneumoniae isolates were recovered from clinical and screening specimens of 12 patients hospitalized in a regional hospital. The first isolates from the 12 patients were typed using pulsed-field gel electrophoresis and multilocus sequence typing. RESULTS: PCR detection showed that all isolates harbored the bla KPC-2 gene, together with bla TEM-116 and bla SHV-11. CONCLUSION: The rapid detection of KPC-producing K. pneumoniae and vigorous implementation of infection control measures were necessary to successfully control the outbreak.
Subject(s)
Disease Outbreaks , Klebsiella Infections/epidemiology , Klebsiella pneumoniae/enzymology , Klebsiella pneumoniae/genetics , beta-Lactamases/genetics , beta-Lactamases/isolation & purification , Bacterial Proteins/genetics , Bacterial Proteins/isolation & purification , Bacterial Typing Techniques , Carbapenems/pharmacology , Croatia/epidemiology , DNA, Bacterial , Drug Resistance, Bacterial , Electrophoresis, Gel, Pulsed-Field , Genes, Bacterial/genetics , Hospitals , Humans , Klebsiella Infections/diagnosis , Klebsiella pneumoniae/isolation & purification , Klebsiella pneumoniae/pathogenicity , Microbial Sensitivity Tests , Molecular Epidemiology , Multilocus Sequence Typing , Polymerase Chain Reaction , beta-Lactam Resistance/geneticsABSTRACT
BACKGROUND: In the last few years, Klebsiella pneumoniae strains producing K. pneumoniae carbapenemase (KPC) enzymes have emerged as important multidrug-resistant pathogens in hospitalized patients. This report describes KPC-producing isolates collected through the Croatian antimicrobial resistance surveillance program in the early stage of their dissemination in Croatia. MATERIALS AND METHODS: Forty-eight KPC-producing K. pneumoniae isolates, collected during a period from February 2011 to August 2013, were analyzed in this study. Antimicrobial susceptibility profiles were determined using disk diffusion and E-test. Pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) were used for epidemiological analysis. Identification of ß-lactamase genes and associated antibiotic resistance mechanisms was performed by polymerase chain reaction and positive products were sequenced. Localization of blaKPC was investigated by S1 PFGE and Southern hybridization. RESULTS: Of 40 participating centers in Croatia, KPC isolates were recorded in 9 of them. They all had multidrug-resistant phenotype, but showed varying levels of resistance to carbapenems. All isolates displayed ST258, and PFGE showed that all but one were closely related. All isolates harbored blaKPC-2. Isolate with a unique PFGE pattern produced TEM-1, while others produced TEM-116. All isolates harbored blaSHV-11, but were negative for blaCTX-M and blaAmpC genes. All isolates contain one KPC-harboring plasmid, ranging in size from â¼60 to â¼210 kb, characterized as FIIs and IncR. CONCLUSION: This report describes that the early stage of KPC-producing K. pneumoniae dissemination in Croatia is associated with a prolific PFGE type belonging to ST258. So far, the spread of an outbreak strain is limited to the northwest region of the country.