Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece

• DOI: 10.1093/jac/dkp207
• Publication Date: 2009-06-14T00:26:43Z
• Authors: Spyros Pournaras; Efthimia Protonot...; Evangelia Voulgari; Ioulia Kristo; Evangelia Dimitro...; Danai Vitti; Maria Tsalidou; Antonios N. Maniatis; Athanassios Tsakris; Danai Sofianou
• Keywords: Ertapenem; Etest; Colistin; Tigecycline; Agar dilution; Carbapenem

KPC-possessing Klebsiella pneumoniae have been found to be widespread in several regions but are still rarely detected Europe. We describe the characteristics of an outbreak caused by KPC producers a tertiary care Greek hospital.During 12 month period (October 2007-September 2008), 47 patients Hippokration University Hospital yielded K. isolates that exhibited reduced susceptibility carbapenems and were phenotypically positive for carbapenemase production negative metallo-beta-lactamase (MBL) production. Single patient tested Vitek 2, Etest, agar dilution MICs, phenotypic assays PFGE. Carbapenemase other beta-lactamase genes identified PCR sequencing. Patient records retrospectively reviewed access co-morbidities, antibiotic exposure prior infection outcome.The various susceptibilities imipenem meropenem; all non-susceptible ertapenem antibiotics most susceptible gentamicin, colistin tigecycline. PFGE classified into two clonal types, with predominant type, which was closely related hyperepidemic strains from USA Israel, comprising three subtypes. All carried bla(KPC-2) gene; 45 also bla(SHV-12) 29 bla(TEM-1). Patients hospitalized nine different units. The median length hospital stay isolation 21 days; 38 (80.9%) had evidence clinical due producer 16 (34%) bacteraemia. crude mortality rate 27.7%. A beta-lactam/beta-lactamase inhibitor combination frequently administered antimicrobial (20 patients; 42.5%), whereas only (19.1%) carbapenem use.This study presents first time wide intrahospital spread KPC-producing clones European hospital. rapidly disseminated units, indicating difficulty restraining such multidrug-resistant when they established environment.