Tracking KPC-3-producing ST-258 Klebsiella pneumoniae outbreak in a third-level hospital in Granada (Andalusia, Spain) by risk factors and molecular characteristics

Soria‐Segarra, Carmen; González‐Bustos, Pablo; López-Cerero, Lorena; Fernández-Cuenca, Felipe; Rojo-Martín, María Dolores; Fernández-Sierra, María Amelia; Gutiérrez‐Fernández, José

doi:10.1007/s11033-019-05203-w

Cited by 7 publications

(15 citation statements)

References 27 publications

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“…Although detected in small numbers, the identification of 4 ST307 isolates producing KPC-3 among medical and surgical units is of great concern because of its higher resistance profile and the recognized virulence potential (high resistance to complement-mediated killing) of this high-risk clone reported worldwide [ 16 , 17 ]. Our data confirms the absence of ST258 K. pneumoniae in our country, a clone that is well-established in other neighboring European countries [ 18 , 19 ]. Furthermore, the detection of ST131 E. coli producing KPC-3 especially as rectal colonizers poses a major threat to public health, since it has the potential to cause widespread resistance to carbapenems in the community setting.…”

Section: Discussionsupporting

confidence: 91%

Multiplicity of Carbapenemase-Producers Three Years after a KPC-3-Producing K. pneumoniae ST147-K64 Hospital Outbreak

et al. 2020

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Carbapenem resistance rates increased exponentially between 2014 and 2017 in Portugal (~80%), especially in Klebsiella pneumoniae. We characterized the population of carbapanemase-producing Enterobacterales (CPE) infecting or colonizing hospitalized patients (2017–2018) in a central hospital from northern Portugal, where KPC-3-producing K. pneumoniae capsular type K64 has caused an initial outbreak. We gathered phenotypic (susceptibility data), molecular (population structure, carbapenemase, capsular type) and biochemical (FT-IR) data, together with patients’ clinical and epidemiological information. A high diversity of Enterobacterales species, clones (including E. coli ST131) and carbapenemases (mainly KPC-3 but also OXA-48 and VIM) was identified three years after the onset of carbapenemases spread in the hospital studied. ST147-K64 K. pneumoniae, the initial outbreak clone, is still predominant though other high-risk clones have emerged (e.g., ST307, ST392, ST22), some of them with pandrug resistance profiles. Rectal carriage, previous hospitalization or antibiotherapy were presumptively identified as risk factors for subsequent infection. In addition, our previously described Fourier Transform infrared (FT-IR) spectroscopy method typed 94% of K. pneumoniae isolates with high accuracy (98%), and allowed to identify previously circulating clones. This work highlights an increasing diversity of CPE infecting or colonizing patients in Portugal, despite the infection control measures applied, and the need to improve the accuracy and speed of bacterial strain typing, a goal that can be met by simple and cost-effective FT-IR based typing.

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Section: Discussionsupporting

confidence: 91%

Multiplicity of Carbapenemase-Producers Three Years after a KPC-3-Producing K. pneumoniae ST147-K64 Hospital Outbreak

et al. 2020

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“…Our statistical analysis revealed that halo diameters were significantly larger for VIM-1- versus OXA-48-carrier bacteria on ERT disks, which may indicate a lower activity for this type of enzyme than for OXA-48 carbapenemases. Although the difference was not significant, the diameter range generated by bacteria expressing the KPC-3 enzyme was also lower, as in the case of the OXA-48 enzyme, although the isolated activity of KPC-3 was not sufficient to generate resistance to all β-lactams [ 36 , 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics

et al. 2020

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The increasing resistance to antibiotics is compromising the empirical treatment of infections caused by resistant bacteria. Rapid, efficient, and clinically applicable phenotypic methods are needed for their detection. This study examines the phenotypic behavior of β-lactam-resistant Gram-negative bacteria grown on ChromID ESBL medium with ertapenem, cefoxitin, and cefepime disks, reports on the coloration of colonies, and establishes a halo diameter breakpoint for the detection of carbapenemase-producing bacteria. We studied 186 β-lactam-resistant Gram-negative microorganisms (77 with extended spectrum beta lactamase (ESBL), 97 with carbapenemases, and 12 with AmpC β-lactamases (AmpC)). Susceptibility profiles of Gram-negative bacteria that produced ESBL, AmpC, and carbapenemases were similar to the expected profiles, with some differences in the response to cefepime of ESBL-producing microorganisms. Coloration values did not differ from those described by the manufacturer of ChromID ESBL medium. In the screening of carbapenemase production, inhibition halo diameter breakpoints for antibiotic resistance were 18 mm for Enterobacterales and ertapenem, 18 mm for Pseudomonas and cefepime, and 16 mm for Acinetobacter baumannii and cefepime. This innovative phenotypic approach is highly relevant to clinical laboratories, combining susceptibility profiles with detection by coloration of high-priority resistant microorganisms such as carbapenemase-producing A. baumannii, carbapenemase-producing Pseudomonas spp., and ESBL and/or carbapenemase-producing Enterobacterales.

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“…Soon thereafter, epidemiologic surveillance from different countries showed global spread of ST258 among K. pneumoniae isolates with KPC in numerous countries such as Mexico [205], Canada [206], Brazil [207], and Ecuador [208]. Outside the Americas, ST258 was detected in Spain [209], Greece [210], Germany [211], Italy [212], Norway [213], China [214], and Korea [215], which suggests that it possesses characteristics of an international high-risk clone. Apart from such a clinical phenomenon, a recent paper from Croatia [216] described the first evidence of KPC-2-producing K. pneumoniae of ST258 in river water, where it persisted for 50 days.…”

Section: Enterobacteriaceaementioning

confidence: 99%

The Current Burden of Carbapenemases: Review of Significant Properties and Dissemination among Gram-Negative Bacteria

2020

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Carbapenemases are β-lactamases belonging to different Ambler classes (A, B, D) and can be encoded by both chromosomal and plasmid-mediated genes. These enzymes represent the most potent β-lactamases, which hydrolyze a broad variety of β-lactams, including carbapenems, cephalosporins, penicillin, and aztreonam. The major issues associated with carbapenemase production are clinical due to compromising the activity of the last resort antibiotics used for treating serious infections, and epidemiological due to their dissemination into various bacteria across almost all geographic regions. Carbapenemase-producing Enterobacteriaceae have received more attention upon their first report in the early 1990s. Currently, there is increased awareness of the impact of nonfermenting bacteria, such as Acinetobacter baumannii and Pseudomonas aeruginosa, as well as other Gram-negative bacteria that are carbapenemase-producers. Outside the scope of clinical importance, carbapenemases are also detected in bacteria from environmental and zoonotic niches, which raises greater concerns over their prevalence, and the need for public health measures to control consequences of their propagation. The aims of the current review are to define and categorize the different families of carbapenemases, and to overview the main lines of their spread across different bacterial groups.

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Tracking KPC-3-producing ST-258 Klebsiella pneumoniae outbreak in a third-level hospital in Granada (Andalusia, Spain) by risk factors and molecular characteristics

Cited by 7 publications

References 27 publications

Multiplicity of Carbapenemase-Producers Three Years after a KPC-3-Producing K. pneumoniae ST147-K64 Hospital Outbreak

Multiplicity of Carbapenemase-Producers Three Years after a KPC-3-Producing K. pneumoniae ST147-K64 Hospital Outbreak

Clinical Relevance of Antibiotic Susceptibility Profiles for Screening Gram-negative Microorganisms Resistant to Beta-Lactam Antibiotics

The Current Burden of Carbapenemases: Review of Significant Properties and Dissemination among Gram-Negative Bacteria

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