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Infect Genet Evol. 2019 Jan 14;69:61-67. doi: 10.1016/j.meegid.2019.01.013. [Epub ahead of print]

Multicentre investigation of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in Bulgarian hospitals - Interregional spread of ST11 NDM-1-producing K. pneumoniae.

Author information

1
Medical University of Sofia, Medical Faculty, Department of Medical Microbiology, Bulgaria. Electronic address: markovska73@abv.bg.
2
Medical University of Varna, Department of Microbiology and Virology, University Multiprofile Hospital for Active Treatment (UMHAT), St Marina, Varna, Bulgaria.
3
Medical University of Sofia, Medical Faculty, Department of Medical Microbiology, Bulgaria.
4
MICOER-Institute, Munich, Germany.
5
Department of Clinical Microbiology, Medical Institute - Ministry of the Interior, Sofia, Bulgaria.
6
Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria.
7
Medical University of Plovdiv, Department of Microbiology and Immunology, UMHAT, "St George", Plovdiv, Bulgaria.
8
Medical University of Pleven, Department of Microbiology and Virology, UMHAT "Georgi Stranski", Pleven, Bulgaria.
9
Emergency Medical Institute "Pirogov", Sofia, Bulgaria.
10
Second Multiprofile Hospital for Active Treatment, Sofia, Bulgaria.
11
UMHAT "Prof. dr St Kirkovich" Stara Zagora, Thracian University, Stara Zagora, Bulgaria.

Abstract

AIM:

The aim of this study was to investigate the mechanisms of beta-lactam-resistance and the clonal relatedness of carbapenem-nonsusceptible Klebsiella pneumoniae and Escherichia coli isolates, collected consecutively in eight centers in five Bulgarian cities from November 2014 to March 2018. Carbapenemase-producing enterobacteria were detected in all but one centers. Overall, 104 K. pneumoniae and one E. coli were analysed.

MATERIALS AND METHODS:

Antimicrobial susceptibility and beta-lactamases were analysed. Conjugation experiments, plasmid fingerprinting and replicon typing, as well as MLST and ERIC-PCR were carried out.

RESULTS:

KPC-2 (51%) and NDM-1 (47%) were the main carbapenemases identified. KPC-2 producing K. pneumoniae were classified into 10 MLST-types. The four dominating MLST-types ST29, ST15, ST336 and ST902 comprised 79% of the KPC-2 producers. All but one of the NDM-1 producing isolates belonged to the MLST-type ST11 and were found in seven centers. Furthermore, single K. pneumoniae isolates producing VIM-1 (ST147) and OXA-48 (ST15) were identified. In addition to the carbapenemases, the ESBLs CTX-M-15, CTX-M-3, and SHV-12 as well as AmpC enzyme CMY-4 were found. The FIIAs-replicon-type was found in all KPC-2 producers while the A/C-replicons dominated in NDM-1 producing isolates. The single NDM-1 producing E. coli was determined as MLST-Type ST10 (Warwick scheme).

CONCLUSION:

The interregional clonal expansion of NDM-1 producing ST11 K. pneumoniae and the dissemination of blaKPC-2 carrying plasmids were responsible for the spread of carbapenemase-producing K. pneumoniae in Bulgaria. Our findings highlight the urgency to prevent dissemination of these highly transmissible and dangerous lineages.

KEYWORDS:

Bulgaria; Carbapenemases; E. coli; K. pneumoniae; KPC; NDM

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