Carbapenemase-Producing Enterobacteriaceae in Spain in 2012

Abstract

We report the epidemiological impact of carbapenemase-producing Enterobacteriaceae (CPE) in Spain in 2012. Of the 237 carbapenemases detected, 163 were from the OXA-48 group, 60 were from VIM-1, 8 were from KPC-2, 5 were from IMP, and 1 was from NDM-1. Interhospital spread of carbapenemase-producing Klebsiella pneumoniae was due to a limited number of multilocus sequence types (MLST) and carbapenemase types, including ST15-VIM-1, ST11-OXA-48, ST405-OXA-48, ST101-KPC-2, and ST11-VIM-1. The number of CPE cases in Spain has increased sharply in recent years, due mainly to the emergence of OXA-48.

Identification and characterization of CTX-M-15 producing Klebsiella pneumoniae clone ST101 in a Hungarian university teaching hospital

“…This sequence type was associated with various β-lactam resistance mechanisms in different parts of the world: CTX-M-15 production in France, Greece and Italy; SHV-12 production in the Czech Republic; OXA-48 production in Spain, Libya, France, Tunisia, Morocco, Switzerland and South Africa; KPC-2 production in Italy and Spain [32,[35][36][37][38][39][40][41][42]. In our institution the presence of CTX-M-15 producing ST101 seemed to be restricted both timely and spatially, as the majority of the isolates originated from a single department with a decreasing incidence ( Tables II and III).…”

Emergence of VIM-1-producing Salmonella enterica serovar Typhimurium in a paediatric patient

“…VIM metallo-b-lactamase has been found in our hospital in several K. pneumoniae and E. coli isolates obtained between 2005and 2008(Cendejas et al, 2010, and since then has been found in several hospital sections with a low but slowly increasing prevalence, paralleling the steady increase of VIM producers in Spain (Oteo et al, 2013). This, together with the fact that no other cases were detected, suggests that the carbapenem-resistant S. enterica isolate might have acquired the bla VIM-1 gene from another enterobacterial species in this patient or from a close contact.…”

Cluster of Escherichia coli Isolates Producing a Plasmid-Mediated OXA-48 β-Lactamase in a Spanish Hospital in 2012

“…Here, we report the characterization of three E. coli OXA-48-producing isolates, each obtained from a different patient at a Spanish hospital (Hospital Universitario Central de Asturias [HUCA]) over a 3-month period (Table 1). These are the first OXA-48-producing E. coli isolates detected in our region, and only one was previously reported in Spain (8). The three patients underwent surgery, were hospitalized for long periods, were coinfected with other bacteria, and received prolonged treatment with numerous antimicrobials.…”

“…2). Note that the cluster of E. coli isolates carrying the bla OXA-48 gene was detected in our hospital during the national outbreak of K. pneumoniae producing the OXA-48 carbapenemase (4,8). As the re- sponsible gene appeared to be carried by the same conjugative IncL/M plasmid in the two species, it may have been transferred from K. pneumoniae into E. coli isolates which had been circulating at the time in the same hospital.…”

“…The presence of bla in Ec-HUCA 1 (ST131) is particularly worrisome, considering the ability of the pandemic ST131 clone to acquire genes encoding extended-spectrum ␤-lactamases, especially bla CTX-M (15). In Spain, the only reported OXA-48-producing E. coli isolate was also ST131 (8). Note that the detection of carbapenem resistance was difficult, because the three E. coli isolates showed intermediate resistance to imipenem, and that treatment of the patients was complicated by additional resistances accompanying OXA-48 production in two out of the three isolates and by coinfection of the patients with other bacteria.…”