Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece

Objectives KPC-possessing Klebsiella pneumoniae have been found to be widespread in several regions but are still rarely detected in Europe. We describe the characteristics of an outbreak caused by KPC producers in a tertiary care Greek hospital. Methods During a 12 month period (October 2007–Septem...

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Bibliographic Details
Published in:Journal of antimicrobial chemotherapy 2009-08, Vol.64 (2), p.348-352
Main Authors: Pournaras, Spyros, Protonotariou, Efthimia, Voulgari, Evangelia, Kristo, Ioulia, Dimitroulia, Evangelia, Vitti, Danai, Tsalidou, Maria, Maniatis, Antonios N., Tsakris, Athanassios, Sofianou, Danai
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
antibiotic exposure
Antibiotics
Antibiotics. Antiinfectious agents. Antiparasitic agents
Bacterial Typing Techniques
beta-Lactamases - biosynthesis
beta-Lactamases - genetics
Biological and medical sciences
Cloning
Cluster Analysis
crude mortality
Disease Outbreaks
DNA Fingerprinting
DNA, Bacterial - genetics
Drug resistance
Drug Resistance, Multiple, Bacterial
Electrophoresis, Gel, Pulsed-Field
extended-spectrum β-lactamases
Female
Genotype
Greece - epidemiology
Humans
Klebsiella Infections - epidemiology
Klebsiella Infections - microbiology
Klebsiella pneumoniae
Klebsiella pneumoniae - classification
Klebsiella pneumoniae - enzymology
Klebsiella pneumoniae - genetics
Klebsiella pneumoniae - isolation & purification
length of hospital stay
Male
Medical sciences
Microbial Sensitivity Tests
Middle Aged
Nosocomial infections
Pharmacology. Drug treatments
Pneumonia
Polymerase Chain Reaction - methods
Sequence Analysis, DNA
SHV-12
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Summary:Objectives KPC-possessing Klebsiella pneumoniae have been found to be widespread in several regions but are still rarely detected in Europe. We describe the characteristics of an outbreak caused by KPC producers in a tertiary care Greek hospital. Methods During a 12 month period (October 2007–September 2008), 47 patients in Hippokration University Hospital yielded K. pneumoniae isolates that exhibited reduced susceptibility to carbapenems and were phenotypically positive for carbapenemase production but negative for metallo-β-lactamase (MBL) production. Single patient isolates were tested by Vitek 2, Etest, agar dilution MICs, phenotypic assays and PFGE. Carbapenemase and other β-lactamase genes were identified by PCR and sequencing. Patient records were retrospectively reviewed to access co-morbidities, antibiotic exposure prior to infection and outcome. Results The 47 K. pneumoniae isolates exhibited various susceptibilities to imipenem and meropenem; all were non-susceptible to ertapenem and several other antibiotics but most were susceptible to gentamicin, colistin and tigecycline. PFGE classified the isolates into two clonal types, with the predominant type, which was closely related to that of hyperepidemic strains from the USA and Israel, comprising three subtypes. All isolates carried the blaKPC-2 gene; 45 also carried blaSHV-12 and 29 blaTEM-1. Patients were hospitalized in nine different units. The median length of hospital stay prior to KPC isolation was 21 days; 38 patients (80.9%) had evidence of clinical infection due to a KPC producer and 16 (34%) had bacteraemia. The crude mortality rate was 27.7%. A β-lactam/β-lactamase inhibitor combination was the most frequently administered antimicrobial prior to KPC isolation (20 patients; 42.5%), whereas only nine patients (19.1%) had prior carbapenem use. Conclusions This study presents for the first time a wide intrahospital spread of KPC-producing K. pneumoniae clones in a European hospital. The KPC producers were rapidly disseminated in several units, indicating the difficulty in restraining such multidrug-resistant clones when they have been established in a hospital environment.
ISSN:0305-7453
1460-2091
DOI:10.1093/jac/dkp207