Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization

Abstract

We describe the first outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP), the infection control measures adopted and the shift in resistance patterns of isolates during antibiotic treatment. The ST258 KPC-KP strain exhibited a multiresistant antibiotic phenotype including co-resistance to gentamycin, colistin and tigecycline intermediate susceptibility. Isolates before and after treatment had different behaviour concerning their antibiotic susceptibility and the population analysis profile study. A progressive increase in the aminoglycosides (acquiring amicacin resistance) and β-lactam MICs, and a decreased susceptibility to fosfomycin was observed throughout the administration of combined antimicrobial regimens including meropenem. A high meropenem resistance KPC-KP homogeneous population (MIC 256 Jg/mL), could arise from the meropenem heterogeneous low-level resistance KPC-KP population (MIC 8 Jg/mL), by the selective pressure of the prolonged meropenem therapy. The kpc gene was inserted in a Tn4401 isoform a, and no transconjugants were detected. The core measures adopted were successful to prevent evolution towards resistance dissemination.

Genetic Diversity of KPC-ProducingEscherichia coli, Klebsiella oxytoca, Serratia marcescens, andCitrobacter freundiiIsolates from Argentina

“…1, C, No. [8][9][10][11][12][13][14]. This arrangement was found in 17 isolates (19%) and we observed 7 different variable regions defined between ISKpn8 and bla KPC-2 .…”

“…3 KPC in Latin America (LA) was first reported in 2006, with the isolation of genetically unrelated K. pneumoniae isolates in Medellin, Colombia. 4 Since then, the expansion of bla KPC harbored by K. pneumoniae ST258 in LA hospitals has been increasingly reported in Brazil, 5,6 Argentina, 7,8 Uruguay, 9 Puerto Rico, 10,11 and Cuba. 12 KPC enzymes have been detected in other ETB, including Salmonella spp., Enterobacter spp., Klebsiella oxytoca, Serratia marcescens, Citrobacter freundii, Escherichia coli, and Proteus mirabilis.…”

Sepsis caused by New Delhi metallo-β-lactamase (blaNDM-1) and qnrD-producing Morganella morganii, treated successfully with fosfomycin and meropenem: case report and literature review

“…We recently reported the detection and control of the first outbreak in our country caused by KPC-producing K. pneumoniae ST258. 61 In this paper we reported the successful management of an immunocompromised patient with urosepsis produced by XDR M. morganii only susceptible to fosfomycin. The patient was treated with meropenem and fosfomycin and showed a clinical improvement and reduction of acute-phase markers such as procalcitonin and CRP.…”

Silver nanoparticles/silver chloride (Ag/AgCl) synthesized from Fusarium oxysporum acting against Klebsiella pneumouniae carbapenemase (KPC) and extended spectrum beta-lactamase (ESBL)

“…Since 2006, KPC-KP has arisen in South America, particularly in countries bordering Uruguay, Argentina and Brazil [2].…”