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BMC Microbiol. 2015 Sep 3;15:177. doi: 10.1186/s12866-015-0510-9.

Carbapenem-resistant and carbapenem-susceptible isogenic isolates of Klebsiella pneumoniae ST101 causing infection in a tertiary hospital.

Author information

1
Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. mcubero@bellvitgehospital.cat.
2
Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. mcubero@bellvitgehospital.cat.
3
Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. guillermo.cuervos@bellvitgehospital.cat.
4
Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. adominguez@bellvitgehospital.cat.
5
Spanish Network for Research in Infectious Diseases (RD06/0008), Instituto de Salud Carlos III, Madrid, Spain. adominguez@bellvitgehospital.cat.
6
Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. f.tubau@bellvitgehospital.cat.
7
Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. f.tubau@bellvitgehospital.cat.
8
Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. smartinm@bellvitgehospital.cat.
9
Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. smartinm@bellvitgehospital.cat.
10
Department of Immunology, Microbiology, and Parasitology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Bizkaia, Spain. elena.sevillano@ehu.es.
11
Department of Immunology, Microbiology, and Parasitology, Faculty of Medicine and Dentistry, University of the Basque Country (UPV/EHU), Bizkaia, Spain. lucia.gallego@ehu.es.
12
Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. jayats@bellvitgehospital.cat.
13
Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. jayats@bellvitgehospital.cat.
14
Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. cpena@bellvitgehospital.cat.
15
Spanish Network for Research in Infectious Diseases (RD06/0008), Instituto de Salud Carlos III, Madrid, Spain. cpena@bellvitgehospital.cat.
16
Department of Infectious Diseases, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. mpujol@bellvitgehospital.cat.
17
Spanish Network for Research in Infectious Diseases (RD06/0008), Instituto de Salud Carlos III, Madrid, Spain. mpujol@bellvitgehospital.cat.
18
Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. fina.linares@bellvitgehospital.cat.
19
Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. fina.linares@bellvitgehospital.cat.
20
Department of Microbiology, Hospital Universitari de Bellvitge, University of Barcelona-IDIBELL, Barcelona, Spain. c.ardanuy@bellvitgehospital.cat.
21
Centro de Investigacion Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, Spain. c.ardanuy@bellvitgehospital.cat.

Abstract

BACKGROUND:

In this study we describe the clinical and molecular characteristics of an outbreak due to carbapenem-resistant Klebsiella pneumoniae (CR-KP) producing CTX-M-15 and OXA-48 carbapenemase. Isogenic strains, carbapenem-susceptible K. pneumoniae (CS-KP) producing CTX-M-15, were also involved in the outbreak.

RESULTS:

From October 2010 to December 2012 a total of 62 CR-KP and 23 CS-KP were isolated from clinical samples of 42 patients (22 had resistant isolates, 14 had susceptible isolates, and 6 had both CR and CS isolates). All patients had underlying diseases and 17 of them (14 patients with CR-KP and 3 with CS-KP) had received carbapenems previously. The range of carbapenem MICs for total isolates were: imipenem: 2 to >32 μg/ml vs. <2 μg/ml; meropenem: 4 to >32 μg/ml vs. <2 μg/ml; and ertapenem: 8 to >32 μg/ml vs. <2 μg/ml. All the isolates were also resistant to gentamicin, ciprofloxacin, and cotrimoxazole. Both types of isolates shared a common PFGE pattern associated with the multilocus sequence type 101 (ST101). The bla CTX-M-15 gene was detected in all the isolates, whereas the bla OXA-48 gene was only detected in CR-KP isolates on a 70 kb plasmid.

CONCLUSIONS:

The clonal spread of K. pneumoniae ST101 expressing the OXA-48 and CTX-M-15 beta-lactamases was the cause of an outbreak of CR-KP infections. CTX-M-15-producing isolates lacking the bla OXA-48 gene coexisted during the outbreak.

PMID:
26335352
PMCID:
PMC4559076
DOI:
10.1186/s12866-015-0510-9
[Indexed for MEDLINE]
Free PMC Article

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