Emergence of a colistin-resistant KPC-2-producing Klebsiella pneumoniae ST258 clone in Hungary

Abstract

Nine Klebsiella pneumoniae isolates showing non-susceptibility to carbapenems were collected from three centres in the north-eastern region of Hungary. The minimum inhibitory concentrations (MICs) of antibiotics were determined by Etest. The putative production of a carbapenemase was tested by the modified Hodge test. The presence of bla (KPC) genes was verified by polymerase chain reaction (PCR) and sequencing. Furthermore, molecular typing was performed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). All isolates showed extensively drug-resistant (XDR) phenotype, and of these, eight isolates were highly resistant to colistin. The isolates carried bla (KPC-2), bla (SHV-12), bla (TEM-1) and bla (SHV-11). PFGE analysis of the nine KPC-2-producing Hungarian ST258 K. pneumoniae isolates, two KPC-2-producing Norwegian ST258 isolates and 33 CTX-M-15-producing ST11 isolates revealed the existence of one genetic cluster at an 88% similarity level. The overall results of the PFGE clustering, MLST and the presence of SHV-11 in both ST11 and ST258 suggest that this is the first hyperepidemic clonal complex of multidrug-resistant K. pneumoniae, probably CC258/CC340, possibly undergoing worldwide spread.

What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline

“…Carbapenem-resistant isolates from individual cases and outbreaks may be different from those examined here. For example, most ST258 K. pneumoniae with KPC carbapenemases are susceptible to gentamicin, tigecycline and colistin but, as already noted, some variants are resistant even to colistin [13,14], whereas non-ST258 K. pneumoniae isolates presently circulating in north-west England, and not included in the present study, often are susceptible to multiple aminoglycosides and fluoroquinolones (Health Protection Agency, data on file). Second, the present results M a n u s c r i p t suggest formulary-based interventions, e.g.…”

“…Moreover, in some cases, colistin resistance is selected during therapy, and this may apply for the resistant E. cloacae with NDM-1 enzyme in the present study, which was from a child who had already received colistin for Acinetobacter and Pseudomonas infections [12]. Furthermore, colistin-resistant variants of the international KPC + ST258 K. pneumoniae strain are circulating in Greece and Hungary [13,14], with a few cases also seen in the UK. In the case of tigecycline, there are positive case reports of its use in infections due to K. pneumoniae with VIM and KPC carbapenemases in Greece [15], but also of resistance emerging during therapy, albeit in an off-label setting (nosocomial pneumonia) [16].…”

Colistin-Resistant Klebsiella pneumoniae: Report of a Cluster of 24 Cases from a New Oncology Center in Eastern India

“…Colistin resistance in Klebsiella species can either arise de novo because of colistin-induced antibiotic pressure or be horizontally transmitted because of breakdown of infection control measures. [4][5][6] The clonality of these isolates is yet to be established (laboratory-based molecular typing has been planed). Typing of CRK isolates can be done by both phenotypic and genotypic methods.…”

Diseminación de Klebsiella pneumoniae productoras de KPC-3 en hospitales de Bogotá durante un periodo de tres años

“…Sin embargo, actualmente ya hay reportes de aislamientos portadores de KPC resistentes a estos antibióticos en Estados Unidos (22), Europa (23,24) Asia (25) y, más recientemente, en Suramérica (26).…”