First Isolation of bla _VIM-2 in Klebsiella oxytoca Clinical Isolates from Portugal

Abstract

VIM-type carbapenemases were originally detected in Europe (2, 4, 7) and have been essentially found in Pseudomonas aeruginosa, as well as in Enterobacteriaceae (2,6,8). The bla VIM genes are often carried by mobile gene cassettes inserted into class 1 integrons (7,11). The Klebsiella genus is responsible for the most frequent human nosocomial infections of the respiratory and urinary tracts. Four Klebsiella oxytoca clinical isolates were recovered by blood culture from neonatal patients at a pediatric hospital. The clinical isolates showed resistance to amoxicillin and ticarcillin, which was restored by clavulanate, aminoglycosides, and fluoroquinolones, and intermediate susceptibility to imipenem (MIC, 4 g/ml) and broad-spectrum cephalosporins and aztreonam (MICs, 8 and 16 g/ml) and were susceptible to meropenem (MIC, 0.075 g/ml). A deformation of ellipses between the two gradient sections with Etest MBL (metallo-␤-lactamase) strips was indicative of MBL production (10).Plasmid DNA was prepared by the alkaline lysis method (9), and the same 50-kb plasmid was detected in all of the isolates. Conjugation experiments were attempted with rifampin-resistant strain Escherichia coli C600 in liquid and solid media. E. coli DH10B was used as the bacterial host in electroporation experiments. No resistance phenotype transfer was observed in conjugation or transformation experiments.M13 PCR fingerprinting, used as a typing method, was performed by using the core region of bacteriophage M13 as the primer (3). The four isolates have the same M13 profile.Since several ␤-lactamase genes are part of gene cassettes included in class 1 integrons, PCR was performed for class 1 integrons with 5Ј-CS and 3Ј-CS primers (5) on plasmid DNA from K. oxytoca 17FFUL purified by a QIAGEN Plasmid Midi Kit, yielding an amplicon with a size of 3,500 bp. Consecutive PCR amplifications with specific primers for MBL and aminoglycoside acetyltransferase genes were performed. Analysis of sequence data revealed the presence of four gene cassettes in the class 1 integron. The first cassette contained the bla VIM-2 gene, coding for an MBL. The second and the third cassettes contained genes coding for 6Ј-N-aminoglycoside acetyltransferase (aacA4) and an aminoglycoside adenylyltransferase (aadA1), respectively. The last gene cassette contains a bla OXA-2 gene coding for an oxacillinase.As in P. aeruginosa COL-1 (7), the bla VIM-2 gene was found to be carried on a plasmid-borne integron. However, the VIM-2-encoding plasmids and the structure of the bla VIM-2 gene cassette were different in the two bacteria. Key signatures of class 1 integrons were identified, such as a 5Ј-CS attI1 recombination site, a core site (GTTATGC), and an inverse core site (GCATAAC). The 59-base element was 72 bp long as the 59-base element of the bla VIM-2 gene cassette in COL-1 but differed by three nucleotides, showing 95.8% homology.A chromosomal bla VIM-2 gene in a P. aeruginosa clinical isolate was already detected in Portugal (1), and the detection of a plasmid-borne bla ...

Predominance of KPC-3 in a Survey for Carbapenemase-Producing Enterobacteriaceae in Portugal

“…Notable is the fact that two isolates (Kp17060 and Kp17061, Table 1) were collected on the same day from patients admitted in the same hospital room, suggesting that organisms were transferred through direct contact. Also, we confirmed the location of the bla VIM-2 gene in a class 1 integron, as previously described (4).…”

Extended-Spectrum β-Lactamases: a Clinical Update

“…A recent report from Taiwan has described a Klebsiella pneumoniae isolate with a novel IMP-type carbapenemase (IMP-7), which was encoded on a plasmid also harboring genes encoding TEM-1 and the ESBL SHV-12 (430). Several other examples of IMP and VIM metalloenzyme producing klebsiellae have been reported (89,137,139,216,224,250).…”

Prospective Observational Study of the Impact of VIM-1 Metallo-β-Lactamase on the Outcome of Patients with Klebsiella pneumoniae Bloodstream Infections

“…Although there have been several reports on the emergence and spread of MBL-producing organisms (3,4,8,13,16), our understanding of what MBL-production entails in terms of clinical impact and antimicrobial chemotherapy for infections caused by K. pneumoniae is limited. Given the clinical importance of VPKP, a prospective observational study was conducted to investigate: (i) the microbiologic characteristics of VPKP causing bloodstream infections (BSIs) and (ii) the effect of VIM-production on the outcome of such infections.…”

“…In Greece, VPKP isolates are endemic in various hospitals and cause life-threatening infections (5,8,29). Based on previous reports (30) and on the National Surveillance System for Antibiotic Resistance Database (www.mednet.gr/whonet/top .htm), the dissemination of such isolates appears to have occurred in a relatively short period of time in this region, probably between 2002 and 2003.Although there have been several reports on the emergence and spread of MBL-producing organisms (3,4,8,13,16), our understanding of what MBL-production entails in terms of clinical impact and antimicrobial chemotherapy for infections caused by K. pneumoniae is limited. Given the clinical importance of VPKP, a prospective observational study was conducted to investigate: (i) the microbiologic characteristics of VPKP causing bloodstream infections (BSIs) and (ii) the effect of VIM-production on the outcome of such infections.…”