In vivo multiclonal transfer of blaKPC-3 from Klebsiella pneumoniae to Escherichia coli in surgery patients

Abstract

During active surveillance at the Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT, Palermo, Italy) with the CARBA screening medium, five pairs of Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae and Escherichia coli strains were isolated in each of five colonized patients. In each patient, lateral gene transfer was demonstrated by comparing K. pneumoniae and E. coli strains, both possessing KPC-3, Tn4401a and pKpQIL-IT elements. The isolates were found to be multiclonal by multilocus sequence typing (sequence type (ST) 512 related to ST258, and ST307 belonging to a clonal complex different from the habitual sequence clone ST258 isolated in Italy) and pulsed-field gel electrophoresis. The results of our study highlight the easy transfer of KPC among Enterobacteriaceae colonizing the human intestine, and the active and careful surveillance required to identify and prevent the spread of these multidrug-resistant microorganisms.

Population Genomic Analysis of 1,777 Extended-Spectrum Beta-Lactamase-Producing Klebsiella pneumoniae Isolates, Houston, Texas: Unexpected Abundance of Clonal Group 307

“…Among all of our strains with a bla KPC carbapenemase gene (581 strains), bla KPC-2 was the dominant allele (572 strains, 98.4%), including 293 CG258 strains (96.4%) and 197 CG307 strains (93.4%). Our results differ from those of other studies reporting that both bla KPC-2 and bla KPC-3 are found in CG258 K. pneumoniae (10, 13, 17, 20, 45, 53) and that CG307 was strongly associated with bla KPC-3 (39). CG307 strains expressing bla KPC-2 have been recently reported in Korea and Colombia (34–36).…”

A Two-Year Surveillance in Five Colombian Tertiary Care Hospitals Reveals High Frequency of Non-CG258 Clones of Carbapenem-Resistant Klebsiella pneumoniae with Distinct Clinical Characteristics

“…It is possible that a carbapenem-susceptible strain acquired a KPC plasmid from another strain (e.g., CG258) or that an ST307 strain was imported from somewhere else. Interestingly, this clone has been reported to harbor KPC-2 and KPC-3 in the United States (56) and in Italy (57), where it seems to be replacing ST258 (58,59). In addition, it has been reported to carry OXA-48 and CTX-M-15 in Morocco (60), which coincides with our results showing that 94.1% of ST307 isolates carried this ESBL.…”

Is the monoclonal spread of the ST258, KPC-3-producing clone being replaced in southern Italy by the dissemination of multiple clones of carbapenem-nonsusceptible, KPC-3-producing Klebsiella pneumoniae?

“…This finding, along with the report by Gona et al [3] of a multiclonal cluster of cases of colonization and infection by KPC-producing K. pneumoniae (KPC-Kp) at the Mediterranean Institute for Transplantation and Advanced Specialized Therapies (ISMETT) in Palermo, Italy, prompted us to look for a possible spread of KPC-Kp isolates other than ST258 in the healthcare facilities of this city.…”