An Outbreak of Infection due to β-Lactamase Klebsiella pneumoniae Carbapenemase 2-Producing K-pneumoniae in a Greek University Hospital: Molecular Characterization, Epidemiology, and Outcomes
An Outbreak of Infection due to β-Lactamase Klebsiella pneumoniae Carbapenemase 2-Producing K-pneumoniae in a Greek University Hospital: Molecular Characterization, Epidemiology, and Outcomes
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DOI：
10.1086/649865
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发表时间：
2010-02-01
影响因子：
11.8
通讯作者：
Giamarellou, Helen
中科院分区：
文献类型：
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作者：
Souli, Maria;Galani, Irene;Giamarellou, Helen
背景我们描述了产碳青霉烯酶2（KPC-2）肺炎克雷伯菌的出现和传播。肺炎在希腊大学医院。将碳青霉烯最小抑制浓度> 1 μ g/mL且EDTA-亚胺培南纸片协同试验结果为阴性的分离株进行硼酸纸片试验和聚合酶链反应（PCR），以进行KPC基因和测序。来自KPC-2产生菌K.肺炎分离的回顾性审查。采用脉冲场凝胶电泳对临床分离菌株进行分子分型，并采用等电聚焦和PCR技术对β-内酰胺酶含量进行研究。从2007年1月至2008年12月，50例患者（34例在重症监护病房[ICU]）被产KPC-2的K.肺炎。KPC-2生产K的流行率不断增加。肺炎的发生与我们ICU中产金属β内酰胺酶分离株的患病率下降一致。多药耐药性的特点是研究的菌株，与粘菌素，庆大霉素，磷霉素是最活跃的代理商。除KPC-2外，临床分离株编码TEM-1样、SHV-11、SHV-12、CTX-M-15和LEN-19酶。检测到四种不同的克隆类型;主要的一种包括41个单个患者分离株（82%）。产KPC-2的克雷伯氏菌的零星多克隆病例。2007年9月至2008年5月期间发现肺炎感染。暴发菌株于2008年2月引入，并通过交叉传播迅速传播; 2008年8月后确定了38名患者（76%）。确定了14例菌血症、2例手术部位感染、2例下呼吸道感染（1例菌血症）和1例尿路感染。大多数患者接受了含粘菌素的联合治疗。ICU患者和非ICU患者的粗死亡率分别为58.8%和37.5%，但归因死亡率分别为22.2%和33.3%。产生KPC-2的K.希腊医院的肺炎给临床医生和医院流行病学家带来了重要挑战，因为它增加了本已很高的抗菌药物耐药性负担。
Background. We describe the emergence and spread of Klebsiella pneumoniae carbapenemase 2 (KPC-2)-producing K. pneumoniae at a Greek University hospital.Methods. Isolates with a carbapenem minimum inhibitory concentration > 1 mu g/mL and a negative EDTA-imipenem disk synergy test result were submitted to boronic acid disk test and to polymerase chain reaction (PCR) for KPC gene and sequencing. Records from patients who had KPC-2-producing K. pneumoniae isolated were retrospectively reviewed. Clinical isolates were submitted to molecular typing using pulsed-field gel electrophoresis, and the beta-lactamase content was studied using isoelectric focusing and PCR.Results. From January 2007 through December 2008, 50 patients (34 in the intensive care unit [ICU]) were colonized (n = 32) or infected (n = 18) by KPC-2-producing K. pneumoniae. Increasing prevalence of KPC-2 producing K. pneumoniae coincided with decreasing prevalence of metallo-beta lactamase-producing isolates in our ICU. Multidrug resistance characterized the studied isolates, with colistin, gentamicin, and fosfomycin being the most active agents. Besides KPC-2, clinical isolates encoded TEM-1-like, SHV-11, SHV-12, CTX-M-15, and LEN-19 enzymes. Four different clonal types were detected; the predominant one comprised 41 single patient isolates (82%). Sporadic multiclonal cases of KPC-2-producing K. pneumoniae infection were identified from September 2007 through May 2008. The outbreak strain was introduced in February 2008 and disseminated rapidly by cross-transmission; 38 patients (76%) were identified after August 2008. Fourteen cases of bacteremia, 2 surgical site infections, 2 lower respiratory tract infections (1 bacteremic), and 1 urinary tract infection were identified. Most patients received a colistin-containing combination treatment. Crude mortality was 58.8% among ICU patients and 37.5% among non-ICU patients, but attributable mortality was 22.2% and 33.3%, respectively.Conclusions. The emergence of KPC-2-producing K. pneumoniae in Greek hospitals creates an important challenge for clinicians and hospital epidemiologists, because it is added to the already high burden of antimicrobial resistance.