First Description of KPC-2-ProducingKlebsiella oxytocaIsolated from a Pediatric Patient with Nosocomial Pneumonia in Venezuela

Abstract

During the last decade, carbapenem resistance has emerged among clinical isolates of the Enterobacteriaceae family. This has been increasingly attributed to the production of β-lactamases capable of hydrolyzing carbapenems. Among these enzymes, Klebsiella pneumoniae carbapenemases (KPCs) are the most frequently and clinically significant class-A carbapenemases. In this report, we describe the first nosocomial KPC-2-producing K. oxytoca isolated from a pediatric patient with pneumonia admitted to the intensive care unit at The Andes University Hospital, Mérida, Venezuela. This strain was resistant to several antibiotics including imipenem, ertapenem, and meropenem but remained susceptible to ciprofloxacin, colistin, and tigecycline. Conjugation assays demonstrated the transferability of all resistance determinants, except aminoglycosides. The isolate LMM-SA26 carried a ~21 kb conjugative plasmid that harbored the bla KPC-2, bla CTX-M-8, and bla TEM-15 genes. Although carbapenem resistance in the Enterobacteriaceae is still unusual in Venezuela, KPCs have a great potential to spread due to their localization on mobile genetic elements. Therefore, rapid detection of KPC-carrying bacteria with phenotypic and confirmatory molecular tests is essential to establish therapeutic options and effective control measures.

pKBuS13, a KPC-2-Encoding Plasmid from Klebsiella pneumoniae Sequence Type 833, Carrying Tn 4401b Inserted into an Xer Site-Specific Recombination Locus

“…Unfortunately, no data are available about STs circulating in Venezuela, as none of the hospitals were part of the study in 2010, although the circulation of the bla KPC determinant in Venezuelan hospitals is documented (24,25).…”

Identification of Klebsiella pneumoniae Carbapenemase-producing Klebsiella oxytoca in Clinical Isolates in Tehran Hospitals, Iran by Chromogenic Medium and Molecular Methods

“…In July 2012, Nobari et al [17] identified a strain of K. pneumoniae bla KPC gene that was isolated from the urine of a female patient hospitalized in an Intensive Care Unit ward; they reported it as the first case of K. pneumoniae bla KPC gene in Iran. Some cases of K. oxytoca have also been identified and reported in Brazil [20] and Venezuela [21]. A study in Austria reported the identification of 31 strains of KPC-producing K. oxytoca isolated from five patients hospitalized in Intensive Care Unit wards [1].…”

“…K. oxytoca is an opportunistic pathogen and is now identified and introduced as an important clinical pathogen that is associated with nosocomial infections in hospitalized patients, including children, newborns, and individuals with immune deficiency [19]. A few studies have reported the identification of the KPC gene in K. oxytoca strains in some countries such as Austria [18], Brazil [20], and Venezuela [21]. Identification of this gene plays an important role in the study of K. oxytoca antibiotic resistance.…”

Estudio clínico y microbiológico de la infección urinaria asociada a catéter en los servicios de medicina interna de un hospital universitario venezolano

“…Sin embargo, en este estudio la presencia de estas enzimas fue confirmada mediante la aplicación de los métodos de sinergismo con inhibidores específicos (EDTA-SMA y ácido borónico). El registro de cepas productoras de KPC es escaso en HULA (25) y la presencia de metaloenzimas en enterobacterias no había sido descrita hasta el momento.…”