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JAC Advance Access originally published online on August 4, 2009
Journal of Antimicrobial Chemotherapy 2009 64(4):718-722; doi:10.1093/jac/dkp272
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Detection of aac(6')-Ib-cr in KPC-producing Klebsiella pneumoniae isolates from Tel Aviv, Israel

Inna Chmelnitsky1,*, Orit Hermesh1, Shiri Navon-Venezia1, Jacob Strahilevitz2 and Yehuda Carmeli1

1 Division of Epidemiology, Tel Aviv Medical Center, Tel Aviv, Israel 2 Department of Clinical Microbiology and Infectious Diseases, Hadassah-Hebrew University, Jerusalem, Israel

Received 2 March 2009; returned 15 April 2009; revised 28 June 2009; accepted 5 July 2009

* Corresponding author. Tel: +972-3-6974892; Fax: +972-3-6974332; E-mail: innach{at}tasmc.health.gov.il

Objectives: We aimed to evaluate the occurrence and characteristics of plasmid-mediated quinolone resistance (PMQR) genes in KPC-producing (KPC-P) Klebsiella pneumoniae (Kpn) isolates in Tel Aviv Medical Center, Israel.

Methods: Forty-seven KPC-P Kpn isolates were studied. Antibiotic susceptibilities were determined by Vitek 2, Etest or agar dilution. β-Lactamases and PMQR determinants were detected by PCR. For plasmid characterization, transformation, transconjugation, restriction mapping and Southern blot analysis were performed.

Results: Six out of 47 (13%) KPC-P isolates carried aac(6')-Ib-cr. Acquisition of aac(6')-Ib-cr-encoding plasmids increased the MIC of ciprofloxacin by 2-fold. In five of six KPC-P isolates, aac(6')-Ib-cr and blaKPC-2 were encoded on the same plasmid.

Conclusions: The most prevalent PMQR gene in the studied KPC-P K. pneumoniae isolates is aac(6')-Ib-cr. The co-existence of PMQR genes with KPC on the same plasmid poses a serious epidemiological, clinical and public-health threat.

Keywords: β-lactamases , carbapenem resistance , quinolone resistance , plasmids


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