Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece
Clonal spread of KPC-2 carbapenemase-producing Klebsiella pneumoniae strains in Greece
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DOI：
10.1093/jac/dkp207
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发表时间：
2009-08-01
影响因子：
5.2
通讯作者：
Sofianou, Danai
中科院分区：
文献类型：
--
作者：
Pournaras, Spyros;Protonotariou, Efthimia;Sofianou, Danai
已发现具有KPC的肺炎克雷伯菌在几个地区广泛分布，但在欧洲仍然很少检测到。我们描述了KPC生产者在希腊一家三级医院引起的暴发的特征。在12个月的时间里（2007年10月至2008年9月），希波克拉申大学医院的47名患者产生了K。肺炎分离株表现出对碳青霉烯类的敏感性降低，并且对碳青霉烯酶产生呈表型阳性，但对金属-β-内酰胺酶（MBL）产生呈阴性。通过Vitek 2、Etest、琼脂稀释MIC、表型测定和PFGE检测单个患者分离株。通过PCR和测序鉴定碳青霉烯酶和其他β-内酰胺酶基因。回顾性分析患者病历，以了解合并症、感染前抗生素暴露和结局。肺炎分离株对亚胺培南和美罗培南表现出不同的敏感性;所有分离株对厄他培南和几种其它抗生素都不敏感，但大多数对庆大霉素、粘菌素和替加环素敏感。PFGE将分离株分为两个克隆型，其中优势型与美国和以色列的高脂血症株关系密切，包括3个亚型。所有分离株均携带bla（KPC-2）基因; 45株还携带bla（SHV-12）和29株bla（TEM-1）。患者在9个不同的单位住院。KPC隔离前的平均住院时间为21天; 38例患者（80.9%）有KPC生产者导致临床感染的证据，16例（34%）有菌血症。粗死亡率为27.7%。β-内酰胺/β-内酰胺酶抑制剂组合是KPC分离前最常使用的抗菌药物（20例患者; 42.5%），而只有9例患者（19.1%）既往使用过碳青霉烯。在欧洲的一家医院里发现了肺炎克隆。KPC生产者在几个单位迅速传播，这表明当他们在医院环境中建立时，很难抑制这种多重耐药克隆。
KPC-possessing Klebsiella pneumoniae have been found to be widespread in several regions but are still rarely detected in Europe. We describe the characteristics of an outbreak caused by KPC producers in a tertiary care Greek hospital.During a 12 month period (October 2007-September 2008), 47 patients in Hippokration University Hospital yielded K. pneumoniae isolates that exhibited reduced susceptibility to carbapenems and were phenotypically positive for carbapenemase production but negative for metallo-beta-lactamase (MBL) production. Single patient isolates were tested by Vitek 2, Etest, agar dilution MICs, phenotypic assays and PFGE. Carbapenemase and other beta-lactamase genes were identified by PCR and sequencing. Patient records were retrospectively reviewed to access co-morbidities, antibiotic exposure prior to infection and outcome.The 47 K. pneumoniae isolates exhibited various susceptibilities to imipenem and meropenem; all were non-susceptible to ertapenem and several other antibiotics but most were susceptible to gentamicin, colistin and tigecycline. PFGE classified the isolates into two clonal types, with the predominant type, which was closely related to that of hyperepidemic strains from the USA and Israel, comprising three subtypes. All isolates carried the bla(KPC-2) gene; 45 also carried bla(SHV-12) and 29 bla(TEM-1). Patients were hospitalized in nine different units. The median length of hospital stay prior to KPC isolation was 21 days; 38 patients (80.9%) had evidence of clinical infection due to a KPC producer and 16 (34%) had bacteraemia. The crude mortality rate was 27.7%. A beta-lactam/beta-lactamase inhibitor combination was the most frequently administered antimicrobial prior to KPC isolation (20 patients; 42.5%), whereas only nine patients (19.1%) had prior carbapenem use.This study presents for the first time a wide intrahospital spread of KPC-producing K. pneumoniae clones in a European hospital. The KPC producers were rapidly disseminated in several units, indicating the difficulty in restraining such multidrug-resistant clones when they have been established in a hospital environment.