Carbapenem Heteroresistance in VIM-1-Producing
            <i>Klebsiella pneumoniae</i>
            Isolates Belonging to the Same Clone: Consequences for Routine Susceptibility Testing

Tato, Marta; Morosini, María Isabel; Garcia, Laura; Albertí, Sebastián; Coque, Marie; Cantón, Rafael

doi:10.1128/jcm.01130-10

Cited by 61 publications

(47 citation statements)

References 27 publications

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“…Using the EUCAST epidemiological cutoff (ECOFF) values, a number of isolates displayed MICs higher than the corresponding ECOFF values for imipenem (5 isolates), meropenem (13 isolates), doripenem (13 isolates) and ertapenem (14 isolates). As previously observed, differences in susceptibility levels to carbapenems among isolates belonging to the same PFGE clone were found (32). Although aztreonam is not hydrolyzed by MBLs, two K. pneumoniae isolates and two E. cloacae isolates recovered in 2006 were resistant to this antibiotic due to the expression of SHV-12 or AmpC hyperproduction, respectively.…”

Section: Fecal Carriage Of Cpe In Hospitalized Andsupporting

confidence: 73%

“…Dissemination of bla VIM-1 class-1 integrons within highly transferable plasmids in a polyclonal population has potentially contributed to the maintenance and spread of CPE. With the exception of OXA-48, these enzymes confer high-level resistance to most ␤-lactam compounds, such as penicillins and cephalosporins, but variably affect susceptibility to carbapenems (20,32). Unlike in other South European countries such as Greece and Italy, the prevalence of CPE in Spain remains low and is mainly related to VIM-producing isolates (13,28,31,35).…”

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Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

et al. 2012

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bFecal carriage of carbapenemase-producing Enterobacteriaceae (CPE) has not been extensively investigated, except in the cases of selected patients at risk, mostly during outbreaks. A total of 1,100 fecal samples randomly collected in our institution in two different periods in 2006 (n ‫؍‬ 600) and 2009 -2010 (n ‫؍‬ 500) from hospitalized (26.8%) and nonhospitalized (73.2%) patients were screened for CPE. The first period coincided with an outbreak of VIM-1-producing Enterobacteriaceae, and the second one coincided with the emergence of KPC enzymes in our hospital. Diluted samples in saline were cultured in Luria-Bertani broth with 1 g/ml imipenem and subcultured in MacConkey agar plates with 4 g/ml ceftazidime. Growing colonies were screened for CPE (modified Hodge test and EDTA and boronic acid synergy tests). Carbapenemase genes, plasmids in which they are located, and clonal relatedness were determined. Individuals who exhibited fecal carriage of CPE (11/1,043, 1.1%; 95% confidence interval [CI], 0.53 to 1.88) included 8 hospitalized (carriage rate, 2.9%; 95% CI, 1.24 to 5.55) and 3 nonhospitalized patients (carriage rate, 0.4%; 95% CI, 0.08 to 1.14), the latter being identified in 2009. Eighty-two percent of colonized patients were not infected with CPE. Isolates harboring bla VIM-1 with or without bla SHV-12 were identified as Klebsiella pneumoniae (n ‫؍‬ 8; ST39, ST688, ST253, and ST163), Enterobacter cloacae (n ‫؍‬ 3; two pulsed-field gel electrophoresis [PFGE] types), Escherichia coli (n ‫؍‬ 2; ST155 and ST2441), and Citrobacter freundii (n ‫؍‬ 1). Some of these lineages had previously been detected in our institution. The bla VIM-1 gene was a member of the class 1 integrons In110 (bla VIM-1 -aacA4-aadA1) and In113 (bla VIM-1 -aacA4-dhfrII) located on plasmids IncN (n ‫؍‬ 11; 30 to 50 kb) and IncHI2 (n ‫؍‬ 3; 300 kb), respectively. Dissemination of bla VIM-1 class-1 integrons within highly transferable plasmids in a polyclonal population has potentially contributed to the maintenance and spread of CPE. With the exception of OXA-48, these enzymes confer high-level resistance to most ␤-lactam compounds, such as penicillins and cephalosporins, but variably affect susceptibility to carbapenems (20,32). Unlike in other South European countries such as Greece and Italy, the prevalence of CPE in Spain remains low and is mainly related to VIM-producing isolates (13,28,31,35). Nevertheless, KPC-2-, KPC-3-, NDM-1-, and OXA-48-producing Enterobacteriaceae were recently detected in our country (6,10,24,30).Fecal carriage of CPE isolates has been investigated rarely compared with carriage of isolates producing extended-spectrum ␤-lactamases (ESBLs) (17,18,35,36), particularly among patients not selected for their relation to outbreak cases. In addition, few surveillance culture recommendations are available for detecting CPE (1,26,36).The objectives of the present study were to evaluate the prevalence of intestinal colonization with CPE in nonselected hospitalized and nonhospitalized patients from the same geographi...

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Section: Fecal Carriage Of Cpe In Hospitalized Andsupporting

confidence: 73%

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confidence: 99%

Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

et al. 2012

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“…They include enzymes belonging to the Ambler classes A (KPC types), B (VIM, IMP, and more recently NDM enzymes), and D . With the exception of OXA-48, these enzymes confer high-level resistance to most β-lactam compounds, such as penicillins and cephalosporins, but variably affect susceptibility to carbapenems (Tato et al 2010). To date, three main classes of carbapenemases have been identified (Queenan and Bush 2007a).…”

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Detection of carbapenemase-producing Enterobacteriaceae in rectal surveillance cultures in non-hospitalized patients

et al. 2017

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Background: Carbapenem-resistant Enterobacteriaceae have been increasingly reported worldwide since their first identification more than 20 years ago. The early identification of carriers and implementing of cohorting strategies is the only means to prevent nosocomial outbreaks caused by carbapenemase.The aim of this work is to evaluate the prevalence of intestinal colonization with carbapenemase-producing Enterobacteriaceae (CPE) in non-hospitalized patients and assesses a microbiological protocol for screening these isolates in fecal material. Methods: This study was conducted on patients seen at Kasr Alaini hospital and investigated at microbiology laboratory in Cairo University Hospitals, from May 2013 to October 2013. The study was conducted on 600 patients; 450 of them were non hospitalized patients (group I) and came for regular checkup, and 150 were inpatients as control group (group II) from different hospital departments. Results: Based on questionnaire feedback, history and clinical findings, certain patients were suspected to have CPE. Group I includes 337 (56.2%) males and 113 (18.8%) females and group II includes 83 (13.8%) males and 67 (11.2%) females. Age of group I ranged from 18 to 82 years with a mean of 44 years, while the age of group II ranged from 10 to 77 years with a mean of 37 years. Out of 600 fecal samples (450 from group I and 150 from group II) 12 (carriage rate 2%) were positive by disk diffusion methods, Chrom agar-KPC and or Modified Hodge Test (MHT) and PCR. Two of them were non hospitalized patients (group I) (carriage rate 0.33%) and 10 were hospitalized patients (control group) (carriage rate 1. 7%) from different hospital departments. Conclusions: We describe a fecal carriage of carbapenam producing Enterobactericae ,all of them are NAD producers orOXA-48 producers in patients non infected by these organisms.

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“…In Spain, several outbreaks caused by members of the Enterobacteriaceae producing carbapenemases have been recently reported, mostly due to VIM-1 (Tato et al, 2010;Oteo et al, 2010;Sánchez-Romero et al, 2012), OXA-48 and KPC (Curiao et al, 2010).…”

Section: Resultsmentioning

confidence: 99%

Abdominal abscess due to NDM-1-producing Klebsiella pneumoniae in Spain

Oteo

Domingo-García

Fernández-Romero

et al. 2012

Journal of Medical Microbiology

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We describe a clinical case of an abdominal abscess due to NDM-1-producing Klebsiella pneumoniae in a 35-year-old Spanish patient after hospitalization in India for perforated appendicitis and peritonitis. The strain belonged to the MLST type 231 and had multiple additional antibiotic resistance genes such as bla CTX-M-15 , armA methylase, aac(69)-Ib-cr, dfrA12, sul1 and qnrB and lack of porin genes ompK35 and ompK36. The patient was cured after abscess drainage. IntroductionAcquired carbapenemases are increasingly reported in Gram-negative pathogens (Miriagou et al., 2010). Metallob-lactamases belong to the class B carbapenemases and confer resistance to all b-lactams, including carbapenems, except aztreonam. Spread of metallo-b-lactamases among members of the Enterobacteriaceae represents a public health threat. Although VIM and KPC types are the most common carbapenemases in Europe, the class D OXA-48 carbapenemase is also spreading, and the New Delhi metallo-blactamase 1 (NDM-1) has been described in Sweden (Yong et al., 2009) We describe a clinical case of NDM-1-producing Klebsiella pneumoniae in Spain causing an abdominal abscess after surgery for perforated appendicitis. To the best of our knowledge, this is the first case of NDM-1-producing K. pneumoniae in our country. Case reportA 35-year-old white male was admitted to a third level teaching hospital in Madrid (Spain) in August of 2010 due to acute abdominal pain in the right iliac fossa. In the previous 9 days, the patient had been hospitalized in India because of acute perforating appendicitis followed by peritonitis. The patient underwent a laparoscopic appendectomy and peritoneal cavity washing. Pseudomonas aeruginosa and Escherichia coli were cultured from the peritoneal fluid, both susceptible to levofloxacin and meropenem, and treatment with one unidentified antibiotic was prescribed for 5 days.The patient returned to Spain, and 2 days after completing antibiotic treatment started to have pain in the right iliac fossa and had a temperature of 38.8 u C. A haemogram revealed leukocytosis and an abdominal echography showed a pus collection in the right iliac fossa. Blood cultures were obtained, and antimicrobial therapy with amoxicillin/ clavulanic acid (1 g t.i.d.) was prescribed. Three days later, leukocytosis continued, treatment was changed to meropenem (1 g t.i.d.) and the abscess was then drained. The purulent exudate was cultured onto conventional media for aerobic and anaerobic bacteria following standard methodologies. Growth was positive for Enterococcus faecium and carbapenem-resistant K. pneumoniae but anaerobic cultures were negative. Blood cultures were also negative.Although the patient was not specifically treated with antibiotics active against carbapenem-resistant K. pneumoniae, his health condition improved over the next 2 weeks, probably due to the pus drainage. A control echography did not reveal any pus collection and the patient was discharged 16 days after pus drainage. No secondary clinical cases were observed. MethodsAn...

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Carbapenem Heteroresistance in VIM-1-Producing Klebsiella pneumoniae Isolates Belonging to the Same Clone: Consequences for Routine Susceptibility Testing

Cited by 61 publications

References 27 publications

Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

Fecal Carriage of Carbapenemase-Producing Enterobacteriaceae: a Hidden Reservoir in Hospitalized and Nonhospitalized Patients

Detection of carbapenemase-producing Enterobacteriaceae in rectal surveillance cultures in non-hospitalized patients

Abdominal abscess due to NDM-1-producing Klebsiella pneumoniae in Spain

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