JAC Advance Access originally published online on September 23, 2008
Journal of Antimicrobial Chemotherapy 2008 62(6):1261-1264; doi:10.1093/jac/dkn396
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Original research |
Arrival of Klebsiella pneumoniae producing KPC carbapenemase in the United Kingdom
1 Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK 2 Department of Microbiology, Crosshouse Hospital, Kilmarnock, UK 3 Department of Microbiology, Royal Free Hospital, London, UK 4 Institute for Microbiology, Ma’ayanei Hayeshua Medical Center, Bnei Brak, Israel 5 Faculty of Biology, Bar Ilan University, Ramat Gan, Israel 6 Division of Epidemiology and the Laboratory for Molecular Epidemiology and Antibiotic Research, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
Received 7 July 2008; returned 13 August 2008; revised 21 August 2008; accepted 26 August 2008
* Corresponding author. Tel: +44-20-8327-7255; Fax: +44-20-8327-6264; E-mail: neil.woodford{at}hpa.org.uk
Background: KPC-type carbapenemases are increasingly prevalent in parts of the USA and Israel and are an emerging concern in South America, Europe and China. We investigated the UK’s first two KPC-producing Klebsiella pneumoniae isolates.
Methods: The isolates were referred to the UK’s national reference laboratory for confirmation of carbapenem resistance. Susceptibilities were determined by agar dilution, and blaKPC and Tn4401-like elements were sought by PCR and sequencing. Isolates were compared by PFGE of XbaI- and SpeI-digested genomic DNA.
Results: The isolates were from patients in different UK hospitals, with no epidemiological connection. Both were resistant to carbapenems (MICs > 16 mg/L), with imipenem MICs unchanged by EDTA, and also to all other β-lactams (including inhibitor combinations), tobramycin, amikacin and ciprofloxacin. They were susceptible to gentamicin (MICs 
1 mg/L) and colistin (MICs 0.5 mg/L), with intermediate susceptibility to tigecycline (MICs 1–2 mg/L). The isolates belonged to the same PFGE-defined strain, highly related to a disseminated KPC-producing strain characterized previously in Tel Aviv, Israel. Like this Israeli strain, the UK isolates produced KPC-3 carbapenemase, with the blaKPC-3 gene located within a Tn4401-like element.
Conclusions: The first KPC-3-producing K. pneumoniae isolates detected in the UK were highly genetically related to a KPC-3-producing Israeli K. pneumoniae strain. This relatedness was consistent with the history of one UK patient, who had been hospitalized previously in Israel. However, this strain may be circulating more widely since the second UK patient had no identifiable links with Israel or other overseas countries.
Keywords: Enterobacteriaceae , class A β-lactamase , non-metallo-carbapenemase , international clone , mobile genetic element
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