Multiclonal emergence of carbapenem-resistant Klebsiella pneumoniae in Tuscany, Italy

Mammina, Caterina; Aléo, Aurora; Bonura, Celestino; Calà, Cinzia; Degl’Innocenti, Roberto; Conti, Antonella; Pecile, Patrizia; Pesavento, Giovanna; Nastasi, A

doi:10.1016/j.ijantimicag.2010.08.004

Cited by 9 publications

(6 citation statements)

References 6 publications

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“…Three other important data that emerge from our results and complete the description of the CR-Kp epidemiological scene in Palermo are: firstly, the circulation of strains belonging to ST101. This clone was previously recognized worldwide as a high risk carbapenem-producing clone [30] and has already been identified in Palermo and in the North of Italy [46–48]. Our ST101 strain (9R) carried the bla KPC-3, bla SHV-28, bla TEM-1 and bla OXA-9 genes and the Klebsiella ferrous uptake system, which is typically found in K. pneumoniae hypervirulent strains [49, 50]; secondly, the characteristic of the strain belonging to ST405, which carried the bla KPC-3, bla CTX-15, bla SHV-76, bla TEM-1 and bla OXA-1/9 genes, the aac6-Ib-cr and qnrB and was resistant to colistin.…”

Section: Discussionmentioning

confidence: 99%

Co-existence of virulence factors and antibiotic resistance in new Klebsiella pneumoniae clones emerging in south of Italy

Fasciana

Gentile²,

Aquilina

et al. 2019

BMC Infect Dis

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BackgroundEndemic presence of Klebsiella pneumoniae resistant to carbapenem in Italy has been due principally to the clonal expansion of CC258 isolates; however, recent studies suggest an ongoing epidemiological change in this geographical area.Methods50 K. pneumoniae strains, 25 carbapenem-resistant (CR-Kp) and 25 susceptible (CS-Kp), collected from march 2014 to march 2016 at the Laboratory of Bacteriology of the Paolo Giaccone Polyclinic University hospital of Palermo, Italy, were characterized for antibiotic susceptibility and fully sequenced by next generation sequencing (NGS) for the in silico analysis of resistome, virulome, multi-locus sequence typing (MLST) and core single nucleotide polymorphism (SNP) genotypesResultsMLST in silico analysis of CR-Kp showed that 52% of isolates belonged to CC258, followed by ST395 (12%), ST307 (12%), ST392 (8%), ST348 (8%), ST405 (4%) and ST101 (4%). In the CS-Kp group, the most represented isolate was ST405 (20%), followed by ST392 and ST15 (12%), ST395, ST307 and ST1727 (8%). The in silico β-lactamase analysis of the CR-Kp group showed that the most detected gene was blaSHV (100%), followed by blaTEM (92%), blaKPC (88%), blaOXA (88%) and blaCTX-M (32%). The virulome analysis detected mrk operon in all studied isolates, and wzi-2 was found in three CR-Kp isolates (12%). Furthermore, the distribution of virulence genes encoding for the yersiniabactin system, its receptor fyuA and the aerobactin system did not show significant distribution differences between CR-Kp and CS-Kp, whereas the Klebsiella ferrous iron uptake system (kfuA, kfuB and kfuC genes), the two-component system kvgAS and the microcin E495 were significantly (p < 0.05) prevalent in the CS-Kp group compared to the CR-Kp group.Core SNP genotyping, correlating with the MLST data, allowed greater strain tracking and discrimination than MLST analysis.ConclusionsOur data support the idea that an epidemiological change is ongoing in the Palermo area (Sicily, Italy). In addition, our analysis revealed the co-existence of antibiotic resistance and virulence factors in CR-Kp isolates; this characteristic should be considered for future genomic surveillance studies.

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Section: Discussionmentioning

confidence: 99%

Co-existence of virulence factors and antibiotic resistance in new Klebsiella pneumoniae clones emerging in south of Italy

Fasciana

Gentile²,

Aquilina

et al. 2019

BMC Infect Dis

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“…A further issue of concern is the involvement in such a polyclonal epidemic not only of STs which have been previously recognized worldwide as carbapenemase producing international high risk clones, such as ST15 or ST101 [ 19 , 20 ], or have been identified also in Italy in bla KPC carrying Kp strains, such as ST101 or ST147 [ 21 ], but also of less “reputed” STs, such as the more prevalent ST307 and ST273. Indeed, ST307 has been so far reported in a KPC-2 carrying strain clonally spreading in Texas [ 22 ] and as a major CTX-M producing clone in Pakistan [ 23 ].…”

Section: Discussionmentioning

confidence: 99%

An Update of the Evolving Epidemic of blaKPC Carrying Klebsiella pneumoniae in Sicily, Italy, 2014: Emergence of Multiple Non-ST258 Clones

et al. 2015

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BackgroundIn Italy, Klebsiella pneumoniae carbapenemase producing K. pneumoniae (KPC-Kp) strains are highly endemic and KPC producing CC258 is reported as the widely predominating clone. In Palermo, Italy, previous reports have confirmed this pattern. However, recent preliminary findings suggest that an epidemiological change is likely ongoing towards a polyclonal KPC-Kp spread. Here we present the results of molecular typing of 94 carbapenem non susceptible K. pneumoniae isolates detected during 2014 in the three different hospitals in Palermo, Italy.Methods and ResultsNinety-four consecutive, non replicate carbapenem non susceptible isolates were identified in the three largest acute general hospitals in Palermo, Italy, in the six-month period March-August 2014. They were characterized by PCR for β-lactam, aminoglycoside and plasmid mediated fluoroquinolone resistance genetic determinants. The mgrB gene of the colistin resistant isolates was amplified and sequenced. Clonality was assessed by pulsed field gel electrophoresis and multilocus sequence typing. Eight non-CC258 sequence types (STs) were identified accounting for 60% of isolates. In particular, ST307 and ST273 accounted for 29% and 18% of isolates. CC258 isolates were more frequently susceptible to gentamicin and non-CC258 isolates to amikacin. Colistin non susceptibility was found in 42% of isolates. Modifications of mgrB were found in 32 isolates.ConclusionsConcurrent clonal expansion of some STs and lateral transmission of genetic resistance determinants are likely producing a thorough change of the KPC-Kp epidemiology in Palermo, Italy. In our setting mgrB inactivation proved to substantially contribute to colistin resistance. Our findings suggest the need to continuously monitor the KPC-Kp epidemiology and to assess by a nationwide survey the possible shifting towards a polyclonal epidemic.

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“…Italian K. pneumoniae were all ST512 belonging to the clonal complex 258 the most prevalent in Italy [16,26]. Recently, K. pneumoniae ST 101 strains were isolated in Italy [27,28] and other European Countries [29]. Based on MLST analysis the possibility that the Syrian migrant was infected upon its arrival in Italy, should not have been excluded, because K. pneumonaie ST101 strains circulation has been reported also in Italy.…”

Section: Methodsmentioning

confidence: 99%

Whole-genome sequencing of Klebsiella pneumoniae MDR strain isolated in a Syrian refugee

Angeletti

Cella

Lai

et al. 2017

Pathogens and Global Health

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Multiclonal emergence of carbapenem-resistant Klebsiella pneumoniae in Tuscany, Italy

Cited by 9 publications

References 6 publications

Co-existence of virulence factors and antibiotic resistance in new Klebsiella pneumoniae clones emerging in south of Italy

Co-existence of virulence factors and antibiotic resistance in new Klebsiella pneumoniae clones emerging in south of Italy

An Update of the Evolving Epidemic of blaKPC Carrying Klebsiella pneumoniae in Sicily, Italy, 2014: Emergence of Multiple Non-ST258 Clones

Whole-genome sequencing of Klebsiella pneumoniae MDR strain isolated in a Syrian refugee

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