Emergence of Carbapenem-Resistant Klebsiella Species Possessing the Class A Carbapenem-Hydrolyzing KPC-2 and Inhibitor-Resistant TEM-30  -Lactamases in New York City

Bradford, Patricia A.; Bratu, Simona; Urban, Carl; Visalli, M; Mariano, Noriel; Landman, David; Rahal, James J.; Brooks, Steven E.; Cebular, Sanda; Quale, John

doi:10.1086/421495

Cited by 463 publications

(318 citation statements)

References 26 publications

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“…Total DNA was extracted by boiling. Potential antimicrobial resistance determinants, which included carbapenemase genes, ESBL genes, plasmidborne ampC genes and plasmid-borne quinolone resistance determinants, were investigated by PCR and nucleotide sequencing, using previously published primers (Bradford et al, 2004;Robicsek et al, 2006;Yu et al, 2007). The DNA sequences of the ompK35 and ompK36 genes were determined by PCR and DNA sequencing with primers ompK35-F (59-ATGATGAAGCGCAATATTCTGGCAGTGG-39), ompK35-R (59-TCGGCTTTGTCGCCATTGCCGTCA-39), ompK36-F (59-ATGAAAGTTAAAGTACTGTCCCTC-39) and ompK36-R (59-GTCGTCGGTAGAGATACCGGC-39).…”

Section: Methodsmentioning

confidence: 99%

Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla IMP-4 and bla DHA-1 in a neonatal intensive care unit in China

Ying

Chen

et al. 2012

Journal of Medical Microbiology

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Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla and bla DHA-1 in a neonatal intensive care unit in China Outbreaks caused by Klebsiella pneumoniae producing carbapenemases and other blactamases have been reported. Four neonates admitted to a neonatal intensive care unit (NICU) in a Chinese hospital developed respiratory infection while receiving intensive care. In all four cases, multidrug-resistant K. pneumoniae was isolated from multiple respiratory specimens, leading to additional characterization of these organisms and investigation of the local environment in the NICU. Multiple b-lactamase genes, including bla TEM-1 , bla IMP-4 , bla DHA-1 and bla CTX-M-14 , as well as the quinolone resistance gene qnrB4, were harboured by transferable plasmids from all four clinical isolates. Furthermore, PFGE confirmed that three of the four clinical isolates from the patients and three K. pneumoniae isolates collected from the hands of healthcare workers and an incubator in the NICU belonged to the same PFGE cluster, indicating that an outbreak due to multidrug-resistant K. pneumoniae carrying bla IMP-4 and bla DHA-1 occurred in this NICU. As far as is known, this is the first report of the co-existence of bla IMP-4 and bla DHA-1 in the same K. pneumoniae isolate. These data suggest that additional precautions are needed to prevent outbreaks of infection caused by multidrug-resistant K. pneumoniae resulting from environmental exposure in NICUs. INTRODUCTIONKlebsiella pneumoniae frequently exhibits resistance to extended-spectrum cephalosporins due to the production of extended-spectrum b-lactamases (ESBLs) (Falagas & Karageorgopoulos, 2009

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Section: Methodsmentioning

confidence: 99%

Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla IMP-4 and bla DHA-1 in a neonatal intensive care unit in China

Ying

Chen

et al. 2012

Journal of Medical Microbiology

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“…Polymerase chain reaction (PCR) was used to screen the strains for the blaKPC gene, as described by Bradford et al [21]. The presence of MBL genes (IMP-1, -2, -4, -7, -12; VIM-1, -2, -7; SIM-1; GIM-1; and SPM-1) was investigated by multiplex PCR, as described by Ellington et al [22].…”

Section: Molecular Analysismentioning

confidence: 99%

Molecular characterization of carbapenem-resistant Klebsiella pneumoniae isolates from a university hospital in Brazil

Vivan¹,

Rosa²,

Rizek³

et al. 2017

J Infect Dev Ctries

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Introduction: The emergence of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kpn) isolates is attracting significant attention in nosocomial infection settings. K. pneumoniae is the main pathogen that harbours blaKPC genes. Methodology: This study evaluated 54 K. pneumoniae carbapenem-resistant isolates from patients hospitalized at the University Hospital of Londrina, between July 2009 and July 2010. The isolates were phenotypically screened for carbapenemase production and submitted for genotypic confirmation by polymerase chain reaction (PCR) for KPC, metallo-β-lactamases, OXA-48, and extended-spectrum beta-lactamase genes. The absence of outer membrane proteins (OMP) was investigated by SDS-PAGE. The susceptibility profile was determined by broth microdilution, according to Clinical and Laboratory Standards Institute protocol. Results: All isolates were phenotypically positive for class A carbapenemase production, but negative for metallo-β-lactamase activity. PCR analysis demonstrated that all isolates carried blaKPC genes and sequencing showed that all strains belonged to KPC-2 subtype. Four strains did not show porin expression, and all isolates were resistant to ertapenem, meropenem, and imipenem. Susceptibility rates reached 35.2% for gentamicin, 85.2% for polymixyn B, 87% for colistin, and 98.1% for both tigecycline and fosfomycin. Pulsed-field gel electrophoresis showed six clones, and three of them predominated among the isolates. Conclusions: KPC-2-producing K. pneumoniae is becoming predominant among carbapenem-resistant K. pneumoniae isolates at the hospital. The association of the enzyme KPC with other resistance determinants, such as loss of porins, may increase the severity of the situation of nosocomial infections. There is an urgent need to develop strategies for infection control and prevention.

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“…2 Several reports on hospital outbreaks of this highly resistant strain have been published. [3][4][5][6][7][8][9][10][11][12] The New York area in the USA, as well as Israel and Greece, are considered as endemic regions for this infection. 13 Carbapenem resistant Klebsiella pneumoniae (CRKP) carrier state may be associated with the development of clinical disease in substantial number of patients with a mortality rate approaching 50%.…”

Section: Introductionmentioning

confidence: 99%

SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state

Zuckerman

Benyamini

Sprecher

et al. 2010

Bone Marrow Transplant

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Following an outbreak of carbapenem resistant Klebsiella pneumoniae (CRKP) bacteremia among inpatients in the Hemato-oncology and BMT unit, we studied the course of this infection in patients undergoing intensive chemotherapy and SCT. In addition, we conducted a pilot study aimed to eradicate CRKP colonization in the gastrointestinal tract, using oral gentamicin. Adult patients admitted to the BMT unit, identified as CRKP carriers on surveillance rectal cultures, were included in the study. Oral gentamicin at a dose of 80 mg q.i.d. was administered to all identified carriers until eradication. Among 15 colonized patients included in the study, the eradication rate achieved was 66% (10/15); discontinuation of persistent bacteremia occurred in 62.5% (5/8) and nosocomial spread of CRKP carrier state ceased. Administration of intensive chemotherapy and SCT is feasible, although associated with increased risk. Hematological patients in need of intensive chemotherapy/SCT should not be denied the required treatment on the basis of being CRKP carriers. Oral gentamicin treatment for eradication of CRKP from the gastrointestinal reservoir could serve as additional tool in the combat against the nosocomial spread and severe infections caused by this difficult-to-treat organism.

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Emergence of Carbapenem-Resistant Klebsiella Species Possessing the Class A Carbapenem-Hydrolyzing KPC-2 and Inhibitor-Resistant TEM-30 -Lactamases in New York City

Cited by 463 publications

References 26 publications

Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla IMP-4 and bla DHA-1 in a neonatal intensive care unit in China

Outbreak of pulmonary infection caused by Klebsiella pneumoniae isolates harbouring bla IMP-4 and bla DHA-1 in a neonatal intensive care unit in China

Molecular characterization of carbapenem-resistant Klebsiella pneumoniae isolates from a university hospital in Brazil

SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state

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