Emergence of OXA-162 Carbapenemase- and DHA-1 AmpC Cephalosporinase-Producing Sequence Type 11 Klebsiella pneumoniae Causing Community-Onset Infection in Greece

Abstract

b OXA-48-like carbapenemases have only recently emerged in Europe. OXA-162 is a rare OXA-48 variant usually coexpressed with extended-spectrum ␤-lactamases. Here, we report the identification of the first OXA-162 carbapenemase-producing Klebsiella pneumoniae isolates, which coexpressed an AmpC cephalosporinase (DHA-1), retrieved from a patient in Greece. They belonged to a single sequence type (ST11) and caused the first documented community-onset urinary tract infections attributable to an OXA-48-like-producing Enterobacteriaceae strain.

Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016

“…Since then, sporadic cases have been observed in hospitals in Athens (Attica), Patras (Peloponnese, western Greece) and Larissa (Thessaly, central Greece), all belonging to multilocus sequence type (ST) 11 type [4][5][6]. The first OXA-48-like carbapenemase outbreak was detected in 2012 [7] and apart from single cases [8,9], no major epidemics have been recorded in Greece.…”

The rapid spread of carbapenem-resistant Enterobacteriaceae

“…Conjugatable bla OXA-48 (9/11) was the most prevalent carbapenemase detected in CPE from a hospital in Morocco collected in June to August 2011 [Barguigua 2015]. The first documented instance of a community acquired UTI due to an bla OXA-48-like producing Enterobacteriaceae was in Greece in January 2010 when a recovered K. pneumoniae ST11 isolate was found with carbapenem resistance due to bla OXA-162 [Voulgari 2015]. Multiple studies identified bla OXA-48 as the most prevalent carbapenemase in Spain, and this is associated with successful spread of K. pneumoniae , particularly ST11 [Branas 2015, Oteo 2015].…”

Emergence of Klebsiella pneumoniae co-producing OXA-48, CTX-M-15, and ArmA in Greece

“…6, 7.6, 7.4 and 5.4. PCR with specific primers and conditions [2,3] and sequencing of PCR products, confirmed the presence of bla CTX-M-15 , bla SHV-11 , bla OXA-48 and bla-TEM-1 , respectively. Multiplex PCR for 16S rRNA methylase genes revealed the carriage of armA gene in the K. pneumoniae isolate [3].…”

“…web.pasteur.fr/klebsiella/klebsiella.html) assigning the isolate to Sequence type ST147. In Greece, OXA-48 and its variant OXA-162 carbapenemases were first detected in 2010 and were acquired by an ST11 K. pneumoniae clone [2].…”

“…The isolate harboured at least three different plasmids, as shown by the S1 nuclease-digested genomic DNA analysis, that were successfully transferred to the RC85 E. coli recipient. The first plasmid (62 kb in size) belonging to IncL/M incompatibility group as shown by replicon typing [2] and carrying bla OXA-48 , was transferred to RC85 E. coli conferring resistance to ampicillin, temocillin, amoxicillin/clavulanate, ticarcillin/clavulanate and reduced susceptibility to piperacilin/tazobactam and carbapenems. The other two plasmids (approximately 120 kb and 220 kb in size) belonging to IncA/C incompatibility group were co-transferred to RC85 E. coli recipient conferring resistance to all aminoglycosides (due to armA), resistance or reduced susceptibility to cephalosporins (due to bla CTX-M-15 ) and resistance to tetracycline and chloramphenicol.…”