Dissemination of clonally related multidrug-resistantKlebsiella pneumoniaein Ireland

Abstract

In October 2012, an outbreak of gentamicin-resistant, ciprofloxacin non-susceptible extended-spectrum β-lactamase (ESBL)-producing Klebsiella pneumoniae occurred in a neonatal intensive care unit in Ireland. In order to determine whether the outbreak strain was more widely dispersed in the country, 137 isolates of K. pneumoniae with this resistance phenotype collected from 17 hospitals throughout Ireland between January 2011 and July 2013 were examined. ESBL production was confirmed phenotypically and all isolates were screened for susceptibility to 19 antimicrobial agents and for the presence of genes encoding bla TEM, bla SHV, bla OXA, and bla CTX-M; 22 isolates were also screened for bla KPC, bla NDM, bla VIM, bla IMP and bla OXA-48 genes. All isolates harboured bla SHV and bla CTX-M and were resistant to ciprofloxacin, gentamicin, nalidixic acid, amoxicillin-clavulanate, and cefpodoxime; 15 were resistant to ertapenem, seven to meropenem and five isolates were confirmed as carbapenemase producers. Pulsed-field gel electrophoresis of all isolates identified 16 major clusters, with two clusters comprising 61% of the entire collection. Multilocus sequence typing of a subset of these isolates identified a novel type, ST1236, a single locus variant of ST48. Data suggest that two major clonal groups, ST1236/ST48 (CG43) and ST15/ST14 (CG15) have been circulating in Ireland since at least January 2011.

The Global Ascendency of OXA-48-Type Carbapenemases

“…3). Health care-associated outbreaks have also been described in various other countries, including Greece (70,71), Australia (72), Israel (73,74), the United Kingdom (75,76), the Netherlands (77,78), Ireland (79,80), Spain (81)(82)(83)(84)(85), France (86)(87)(88), Germany (89,90), Mexico (91), China (92), Belgium (93), Norway (94), Poland (95), Taiwan (96), South Africa (97), Croatia (98), and Slovenia (99).…”

OXA-48-like carbapenemases producing Enterobacteriaceae in different niches

“…4). It has been described in Algeria [65,[110][111][112][113][114], Argentina [98], Belgium [83,85,[115][116][117], Bulgaria [118], China [119], Columbia [120], Croatia [121], the Czech Republic [44], Denmark [69,122,123], Egypt [87,96], Finland [120], France [56,84,[124][125][126][127][128][129], Germany [130,131], Greece [104,132], Hungary [133], India [88,134], Iran [92,[135][136][137], Ireland [138,139], Israel [140,141], Italy [42, 142,143], Jordan [144], Kuwait [63], Leb...…”

“…It has been implicated in different outbreaks in Morocco, Spain, and Tunisia [177,189]. This clone has now spread widely and has been recovered from many countries including European countries (the Czech Republic, Denmark, France, Germany, Ireland, Italy, Romania, Sweden, the UK), Africa (Egypt, Algeria), South East Asia (Malaysia), and the Middle East (Israel, Kuwait) [42,52,95,96,113,115,123,130,138,158,171,190,191]. ST395 and ST405 have been widely described in European outbreaks (e.g., Belgium, France, and Spain) involving strains from North Africa [66,117,157,188,192].…”

Clonal Dissemination of Plasmid-Mediated Carbapenem and Colistin Resistance in Refugees Living in Overcrowded Camps in North Lebanon

“…In addition, the remaining three isolates (KP-6, KP-7, and KP-8) harbouring both the NDM-1 and the OXA-48 genes, also had the same ST (ST14), and were collected from the Talhayat shelter from closely related tents. NDM-1 and/or OXA-48 producing K. pneumoniae ST14 have been reported worldwide [ 55 , 56 , 57 , 58 ], highlighting the rapid spread of this clone. In Lebanon, several studies have described NDM-1 and/or OXA-48 producing K. pneumoniae isolates [ 49 , 52 , 53 ]; however, this is the first description of the co-occurrence of NDM-1 and OXA-48 genes in the same isolate, which highlights the dissemination of plasmids carrying these resistance genes between isolates.…”