Klebsiella pneumoniae Isolate from a New York City Hospital Belonging to Sequence Type 258 and Carrying bla _KPC-2 and bla _VIM-4

Abstract

Among 69 of 139 (49.6%) carbapenem-nonsusceptible Enterobacteriaceae carrying bla KPC , 1 Klebsiella pneumoniae was also positive for bla VIM . The isolate belonged to sequence type 258 (ST258) and carried bla KPC-2 on a copy of Tn4401a and bla VIM-4 on a class 1 integron. Genes were located on distinct plasmids belonging to Inc types A/C and FII. Elevated expression of the efflux pump AcrAB-TolC (acrA, 15.3 times) and reduced expression of outer membrane protein genes ompK35 and ompK37 (0.16 and 0.081 times, respectively) associated with various amino acid alterations on OmpK37 were observed. The presence of two carbapenemases in ST258 K. pneumoniae is of great concern due to the ability of this organism to widely disseminate.T he first reported Klebsiella pneumoniae carbapenemase (KPC)-producing isolate was a Klebsiella pneumoniae collected in 1996 from a patient hospitalized in North Carolina (1). Over the past decade, KPC variants became the most clinically significant ␤-lactamases among class A derivatives, and KPC-producing Enterobacteriaceae have been reported worldwide. Within the United States, there are differences in the prevalence of KPC-producing isolates, which have been reported in all states except Alaska, Maine, and Idaho; however, these strains seem to be endemic in the New York City area (2).(This study was presented at the 114th General Meeting of the American Society for Microbiology, Boston, MA, 2014.) Overall, the dissemination of bla KPC genes has been associated with clonally related strains, and the majority of bla KPC -carrying K. pneumoniae belong to multilocus sequence type (MLST) 258 and double-locus variants, which may have contributed to the worldwide dissemination of KPC-producing strains (3). Moreover, there is mounting evidence that bla KPC genes are consistently associated with a specific genetic element (i.e., transposon Tn4401) (3). Tn4401 is a Tn3-like transposon that has been identified in distinct plasmids carried by KPC-producing Enterobacteriaceae and Pseudomonas aeruginosa isolates from various geographic areas (4).During 2013, a total of 139 Enterobacteriaceae isolates with elevated imipenem or meropenem MIC values (Ն2 g/ml) were collected from U.S. medical centers as part of the SENTRY Antimicrobial Surveillance Program. Susceptibilities were performed on the isolates using the reference broth microdilution method described by the Clinical and Laboratory Standards Institute (CLSI) (5). Categorical interpretations from CLSI M100-S25 were used for all antimicrobials (6), and quality control (QC) was performed using Escherichia coli ATCC 25922 and Pseudomonas aeruginosa ATCC 27853. All QC results were within ranges specified by CLSI (6).Carbapenem-nonsusceptible isolates were screened for the presence of bla KPC , bla NDM , bla VIM , bla IMP , bla SME , bla IMI , bla NMC-A , and bla OXA-48 in a multiplex PCR. Amplicons generated were sequenced on both strands; nucleotide and deduced amino acid sequences were analyzed using the Lasergene software package (DNAStar, Madi...

Diversity of resistance mechanisms in carbapenem-resistant Enterobacteriaceae at a health care system in Northern California, from 2013 to 2016

“…The CP-CRE rate of 38.7% (24/62) among all CRE at our institution is comparable to 47.9% (90/188) reported for metropolitan areas in 7 US states, including Oregon and Colorado, but much lower than 81.7% (94/115) reported by an academic health system in Los Angeles (Guh et al, 2015). Unlike all other North American institutions where KPC predominates as the most common carbapenemase among CP-CRE isolates (Castanheira et al, 2016;Guh et al, 2015;Mataseje et al, 2016;Pollett et al, 2014;Tamma et al, 2017), at our institution, CP-CRE were evenly caused by KPC (20.8%, 5/24), OXA-48 like (25.0%, 6/24), NDM (20.8%, 5/24), and SME (20.8%, 5/24), and less commonly by IMP (8.3%, 2/24) and VIM (4.2%, 1/24). The reason for nonpredominance of KPC at our health system may be in part due to the geographic location of our institution in the Silicon Valley where high-tech industry draws people from major cities around the globe where different plasmid-encoded carbapenemases are endemic.…”

The rapid spread of carbapenem-resistant Enterobacteriaceae

“…A K. pneumoniae isolate obtained in the United States in 2013 from the high risk ST258 clade expressed plasmid borne bla KPC-2 and bla VIM-4 [Castanheira 2016]. An E. cloacae ST231 from China in 2012 was found to harbor bla NDM-1 on IncA/C2 mosaic plasmid and bla KPC-3 on a novel IncX6 plasmid [Du 2016].…”

Rapid Identification of Five Classes of Carbapenem Resistance Genes Directly from Rectal Swabs by Use of the Xpert Carba-R Assay

“…One paper by Barbarini and colleagues described the changing epidemiology of CPOs in an Italian hospital over a 3-year period, in which 44 bla VIM -positive K. pneumoniae isolates were reported (14). Another study reported a single isolate of sequence type 258 (ST258) bla KPC K. pneumoniae that was also found to coexpress bla VIM in addition to other resistance determinants (15). In spite of these limited reports, however, the bla VIM ␤-lactamase has been reported to a lesser extent than other carbapenemases in species of Enterobacteriaceae.…”