Molecular epidemiology of OXA-48-producing Klebsiella pneumoniae in France

Liapis, E.; Pantel, Alix; Robert, Jérôme; Nicolas–Chanoine, Marie–Hélène; Cavalié, Laurent; Mee-Marquet, Nathalie van der; Champs, Christophe de; Aissa, Nejla; Eloy, C.; Blanc, Véronique; Guyeux, Christophe; Hocquet, Didier; Lavigne, Jean‐Philippe; Bertrand, Xavier; ONERBA, On behalf of

doi:10.1111/1469-0691.12727

Cited by 45 publications

(31 citation statements)

References 12 publications

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“…These results suggest that K. pneumoniae isolates belonging to ST11 and ST405 strongly contribute to the dissemination of OXA-48-producing Enterobacteriaceae in Spain. ST11 has been identified as an international high-risk clone associated with ESBL and carbapenemase production (28,29), but ST405 has recently been associated with OXA-48 production in Spain, Belgium, and France (5,6,18,19 (30). The acquisition of carbapenemases by the globally distributed E. coli ST131 detected in this and other studies (31,32) is a finding of serious concern.…”

Section: Bacterial Isolates and Carbapenemase Typesmentioning

confidence: 61%

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Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals High In Vitro Susceptibility to Colistin and Meropenem

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Bartolomé

et al. 2015

Antimicrob Agents Chemother

130

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hospitals (about 40,000 hospital beds) prospectively collected nonduplicate Enterobacteriaceae using the screening cutoff recommended by EUCAST. Carbapenemase characterization was performed by phenotypic methods and confirmed by PCR and sequencing. Multilocus sequencing types (MLST) were determined for Klebsiella pneumoniae and Escherichia coli. A total of 702 Enterobacteriaceae isolates met the inclusion criteria; 379 (54%) were CPE. OXA-48 (71.5%) and VIM-1 (25.3%) were the most frequent carbapenemases, and K. pneumoniae (74.4%), Enterobacter cloacae (10.3%), and E. coli (8.4%) were the species most affected. Susceptibility to colistin, amikacin, and meropenem was 95.5%, 81.3%, and 74.7%, respectively. The most prevalent sequence types (STs) were ST11 and ST405 for K. pneumoniae and ST131 for E. coli. Forty-five (54.1%) of the hospitals had at least one CPE case. For K. pneumoniae, ST11/OXA-48, ST15/OXA-48, ST405/ OXA-48, and ST11/VIM-1 were detected in two or more Spanish provinces. ST11 isolates carried four carbapenemases (VIM-1, OXA-48, KPC-2, and OXA-245), but ST405 isolates carried OXA-48 only. A wide interregional spread of CPE in Spain was observed, mainly due to a few successful clones of OXA-48-producing K. pneumoniae (e.g., ST11 and ST405). The dissemination of OXA-48-producing E. coli is a new finding of public health concern. According to the susceptibilities determined in vitro, most of the CPE (94.5%) had three or more options for antibiotic treatment. C arbapenemase-producing Enterobacteriaceae (CPE), mainly Klebsiella pneumoniae, are an emerging threat to public and individual health worldwide. These microorganisms are often resistant to almost all available antibiotics (1, 2), so there are few alternative treatment options. The most common carbapenemases are KPC (class A); VIM, IMP, and NDM (class B); and the OXA-48 types (class D). However, the extent to which health care systems have been affected and the carbapenemase types that are predominant differ substantially from country to country (3).A multicenter study performed in Spain in 2009 revealed 43 (0.04%) cases of CPE, which were mostly VIM-1 and IMP-22 (4). After that, we reported a rapid increase in the number of cases of CPE, mainly OXA-48-producing K. pneumoniae, in this country from 2010 to 2012 (5-7).Because previous studies (5, 6) were based on voluntary reports without taking into account key important issues, in this paper, we present data on the impact of CPE as obtained from a prospective, multicenter, and population-based study. We show that carbapenemase production in this country is widely and irregularly distributed; however, the rates of susceptibility to meropenem and colistin were still high.(The preliminary results of this study were presented in part at the 24th European Congress of Clinical Microbiology and Infectious Diseases Annual Meeting, 10 to 13 May 2014 in Barcelona, Spain,).

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Section: Bacterial Isolates and Carbapenemase Typesmentioning

confidence: 61%

“…OXA-48 prevalence is also increasing in other European countries, such as France, Germany, Belgium, and the United Kingdom, where increasing numbers of outbreaks have been described (1,(17)(18)(19)(20)(21). However, OXA-48 is rarely identified in North America (22).…”

Section: Bacterial Isolates and Carbapenemase Typesmentioning

confidence: 99%

Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals High In Vitro Susceptibility to Colistin and Meropenem

Oteo

Ortega

Bartolomé

et al. 2015

Antimicrob Agents Chemother

130

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“…8 In a recent survey, ST147 was also among the five major international clones of K. pneumoniae disseminating OXA-48. 12 Of note, K. pneumoniae 204, reported to produce OXA-204, was identified as a ST383 strain. 20 This indicates that at least two different K. pneumoniae genetic backgrounds were responsible for the spread of OXA-204 in the same country in 2012/2013, which is the period of isolation of both strains.…”

Section: Discussionmentioning

confidence: 99%

Emergence of ST147Klebsiella pneumoniaeProducing OXA-204 Carbapenemase in a University Hospital, Tunisia

GramiRaoudha

Mansour²,

KhalifaAnis³

et al. 2016

Microbial Drug Resistance

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Molecular features of the first carbapenem-resistant Klebsiella pneumoniae isolates (KP1 and KP2) from the University Hospital Tahar Sfar, Tunisia, were investigated. Antimicrobial susceptibility testing, multilocus sequence typing, S1 nuclease pulsed-field gel electrophoresis, Southern blot, and polymerase chain reaction (PCR)-based replicon typing were performed. Extended-spectrum β-lactamases and carbapenemase genes were detected by PCR and sequencing. Both isolates were multidrug resistant. KP1 was of sequence type (ST) ST101 and exhibited blaCTX-M-15 and blaTEM-1 on an untypeable plasmid and blaOXA-48 on an IncL/M plasmid. KP2 was genetically unrelated to KP1 (ST147) and harbored an IncA/C plasmid carrying blaCMY-4 and the blaOXA-48 derivative gene: blaOXA-204. This study reports the second case worldwide of an OXA-204-producing K. pneumoniae isolate from the same country, however, in a different genetic background.

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“…The remaining isolates belonged to distinct STs. STs 11,15,45,101,395, and 461 have previously been associated with OXA-48-like-producing isolates from several geographical areas (17)(18)(19). All three E. coli isolates were of different STs, including the pandemic ST38 (19)(20)(21).…”

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confidence: 92%

“…In conclusion, the present study investigated the first cases and outbreaks of OXA-48-like-producing Enterobacteriaceae isolates from the Czech Republic. Five of the patients had recently traveled abroad, with one of them being (17)(18)(19)(20)(21).…”

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confidence: 99%

Molecular Characterization of OXA-48-Like-Producing Enterobacteriaceae in the Czech Republic and Evidence for Horizontal Transfer of pOXA-48-Like Plasmids

Skálová

Chudějová

Rotova

et al. 2017

Antimicrob Agents Chemother

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The aim of this study was to characterize the first cases and outbreaks of OXA-48-like-producing Enterobacteriaceae recovered from hospital settings in the Czech Republic. From 2013 to 2015, 22 Klebsiella pneumoniae isolates, 3 Escherichia coli isolates, and 1 Enterobacter cloacae isolate producing OXA-48-like carbapenemases were isolated from 20 patients. Four of the patients were colonized or infected by two or three different OXA-48-like producers. The K. pneumoniae isolates were classified into nine sequence types (STs), with ST101 being predominant (n ϭ 8). The E. coli isolates were of different STs, while the E. cloacae isolate belonged to ST109. Twenty-four isolates carried bla OXA-48 , while two isolates carried bla OXA-181 or bla . Almost all isolates (n ϭ 22) carried bla OXA-48 -positive plasmids of a similar size (ϳ60 kb), except the two isolates producing OXA-181 or OXA-232. In an ST45 K. pneumoniae isolate and an ST38 E. coli isolate, S1 nuclease profiling plus hybridization indicated a chromosomal location of bla . Sequencing showed that the majority of bla OXA-48 -carrying plasmids exhibited high degrees of identity with the pOXA-48-like plasmid pE71T. Additionally, two novel pE71T derivatives, pOXA-48_30715 and pOXA-48_30891, were observed. The bla OXA-181 -carrying plasmid was identical to the IncX3 plasmid pOXA181_EC14828, while the bla OXA-232 -carrying plasmid was a ColE2-type plasmid, being a novel derivative of pOXA-232. Finally, sequencing data showed that the ST45 K. pneumoniae and ST38 E. coli isolates harbored the IS1R-based composite transposon Tn6237 containing bla OXA-48 integrated into their chromosomes. These findings underlined that the horizontal transfer of pOXA-48-like plasmids has played a major role in the dissemination of bla in the Czech Republic. In combination with the difficulties with their detection, OXA-48 producers constitute an important public threat.

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Molecular epidemiology of OXA-48-producing Klebsiella pneumoniae in France

Cited by 45 publications

References 12 publications

Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals High In Vitro Susceptibility to Colistin and Meropenem

Prospective Multicenter Study of Carbapenemase-Producing Enterobacteriaceae from 83 Hospitals in Spain Reveals High In Vitro Susceptibility to Colistin and Meropenem

Emergence of ST147Klebsiella pneumoniaeProducing OXA-204 Carbapenemase in a University Hospital, Tunisia

Molecular Characterization of OXA-48-Like-Producing Enterobacteriaceae in the Czech Republic and Evidence for Horizontal Transfer of pOXA-48-Like Plasmids

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