First Description of Colistin and Tigecycline-Resistant Acinetobacter baumannii Producing KPC-3 Carbapenemase in Portugal

Abstract

Herein, we describe a case report of carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae isolates that were identified from the same patient at a Tertiary University Hospital Centre in Portugal. Antimicrobial susceptibility and the molecular characterization of resistance and virulence determinants were performed. PCR screening identified the presence of the resistance genes blaKPC-3, blaTEM-1 and blaSHV-1 in both isolates. The KPC-3 K. pneumoniae isolate belonged to the ST-14 high risk clone and accumulated an uncommon resistance and virulence profile additional to a horizontal dissemination capacity. In conclusion, the molecular screening led to the first identification of the A. baumannii KPC-3 producer in Portugal with a full antimicrobial resistance profile including tigecycline and colistin.

Multidrug-resistant Klebsiella pneumoniae: genetic diversity, mechanisms of resistance to polymyxins and clinical outcomes in a tertiary teaching hospital in Brazil

“…Liu et al 25 reported a plasmidial mcr- 1 gene in E. coli identified in raw meat, animals and humans conferring elevated MICs (8 µg/ml) to colistin. Plasmid-mediated resistance has epidemiological implications due to a facilitated way of spread, including K. pneumoniae, as seen previously with ESBL and KPC 26 .…”

The Current Burden of Carbapenemases: Review of Significant Properties and Dissemination among Gram-Negative Bacteria

“…KPC-3 was detected in A. baumannii from an infected wound culture of a patient admitted to a university hospital in Portugal. The isolate accumulated carbapenem, tigecycline, and colistin resistance [60]. No other reports of KPC-producing A. baumannii exist in other countries.…”

“…This is a 10-kb Tn3-based transposon, delimited by two 39-bp imperfect inverted repeat sequences, that harbors, in addition to the KPC-2 gene, a transposase gene, a resolvase gene, and two novel insertion sequences known as ISKpn6 and ISKpn7 [56]. Besides Enterobacteriaceae, KPC has been described in P. aeruginosa from Brazil [57] and China [58], as well as in A. baumannii from Puerto Rico [59] and Portugal [60]. KPC-producing K. pneumoniae isolates may be deficient in OmpK35 and OmpK36, which are porins for carbapenem entry.…”

Insights into Acinetobacter baumannii: A Review of Microbiological, Virulence, and Resistance Traits in a Threatening Nosocomial Pathogen

“…In 2010, Robledo et al reported, for the first time, Ambler class A Klebsiella pneumoniae carbapenemase (KPC)-5 in MDR A. baumannii from Puerto Rico [137]. Additional reports described KPC-3 in A. baumannii a Portugese University hospital [138], and both KPC-2 and KPC-3 in isolates from Brazil [139]. In a recent meta-analysis about A. baumannii in burn injury patients, the prevalence of KPC was over 16% [140].…”