Outbreak of Klebsiella pneumoniae Producing a New Carbapenem-Hydrolyzing Class A β-Lactamase, KPC-3, in a New York Medical Center

Abstract

, 24 patients in intensive care units at Tisch Hospital, New York, N.Y., were infected or colonized by carbapenem-resistant Klebsiella pneumoniae. Pulsed-field gel electrophoresis identified a predominant outbreak strain, but other resistant strains were also recovered. Three representatives of the outbreak strain from separate patients were studied in detail. All were resistant or had reduced susceptibility to imipenem, meropenem, ceftazidime, piperacillin-tazobactam, and gentamicin but remained fully susceptible to tetracycline. PCR amplified a bla KPC allele encoding a novel variant, KPC-3, with a His(272)3Tyr substitution not found in KPC-2; other carbapenemase genes were absent. In the outbreak strain, KPC-3 was encoded by a 75-kb plasmid, which was transferred in vitro by electroporation and conjugation. The isolates lacked the OmpK35 porin but expressed OmpK36, implying reduced permeability as a cofactor in resistance. This is the third KPC carbapenem-hydrolyzing ␤-lactamase variant to have been reported in members of the Enterobacteriaceae, with others reported from the East Coast of the United States. Although producers of these enzymes remain rare, the progress of this enzyme group merits monitoring.

β-Lactams and β-Lactamase Inhibitors: An Overview

“…8 and 10 mg/mL, respectively (Jacoby and Sutton 1989;Fass et al 1990), but does not retain activity against isolates with multiple resistance mechanisms (Dong et al 2014). None of these inhibitors is effective in inhibiting the hydrolytic activity of MBLs (Bush 2015), and their modest activity against serine carbapenemases does not translate into clinical susceptibility (Yigit et al 2003;Woodford et al 2004) owing, at least in part, to the presence of multiple b-lactamases in the producing organisms (Moland et al 2007). Even the potent inhibitory Following a hiatus of approximately two decades, a unique class of non-b-lactam b-lactamase inhibitors emerged, based on a novel bridged diazabicyclooctane (DBO) structure (Table 6) (Coleman 2011).…”

Emergence of NDM – 1 in the Clinical Isolates of Pseudomonas aeruginosa in India

“…Multiplex PCR for the bla OXA-23 and the bla OXA-24 genes and simple PCR for bla KPC were carried out on the isolates by using the Gene Amp 9700 PCR System (Applied Biosystems, Singapore). The primers and the cycling conditions for the PCR were as has been described earlier [7][8][9]. PCR for the detection of bla NDM-1 was carried out by using primers, as has been reported previously [10].…”

SCT in patients with carbapenem resistant Klebsiella pneumoniae: a single center experience with oral gentamicin for the eradication of carrier state

“…2 Several reports on hospital outbreaks of this highly resistant strain have been published. [3][4][5][6][7][8][9][10][11][12] The New York area in the USA, as well as Israel and Greece, are considered as endemic regions for this infection. 13 Carbapenem resistant Klebsiella pneumoniae (CRKP) carrier state may be associated with the development of clinical disease in substantial number of patients with a mortality rate approaching 50%.…”