JAC Advance Access originally published online on February 13, 2009
Journal of Antimicrobial Chemotherapy 2009 63(4):654-658; doi:10.1093/jac/dkp018
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Original research |
Emergence of clonally related Klebsiella pneumoniae isolates of sequence type 258 producing plasmid-mediated KPC carbapenemase in Norway and Sweden
1 Reference Centre for Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway 2 Department of Microbiology, Sørlandet Hospital, Kristiansand, Norway 3 Department of Microbiology and Immunology, The Gade Institute, Haukeland University Hospital, Bergen, Norway 4 Department of Microbiology, Central Laboratory, Hospital of Asker and Bærum, Oslo, Norway 5 Department of Microbiology, Førde Central Hospital, Førde, Norway 6 Department of Microbiology and Virology, University of Tromsø, Tromsø, Norway 7 Karolinska Institutet-MTC, Clinical Microbiology, Karolinska University Hospital, Solna, Stockholm, Sweden
Received 20 November 2008; returned 15 December 2008; revised 9 January 2009; accepted 12 January 2009
* Corresponding author. Tel: +47-77627043; Fax: +47-77627015; E-mail: orjan.samuelsen{at}unn.no
Background: The class A carbapenemase KPC has disseminated rapidly worldwide, challenging the treatment of Gram-negative infections. This report describes the first KPC-producing Klebsiella pneumoniae isolates identified in Norway (n=6) and the second isolate from Sweden.
Methods: Antimicrobial susceptibility profiles were determined using Etest. PCR and sequencing were used to determine the blaKPC variant, the surrounding genetic structure and the presence of AmpC and extended-spectrum β-lactamase genes. PFGE and multilocus sequence typing (MLST) were used for epidemiological comparisons. Localization of blaKPC was investigated by S1 nuclease digestion, followed by PFGE and Southern blot hybridization.
Results: All isolates expressed a multidrug-resistant phenotype with some variability in the carbapenem susceptibility profile. The Norwegian isolates carried blaKPC-2, while the Swedish isolate carried blaKPC-3. All isolates carried TEM-1, but were negative for blaCTX-M and blaAmpC genes. SHV-11 and SHV-12 were detected in the Norwegian isolates, while the Swedish isolate carried only SHV-11. Isolates from four patients were associated with import from Greece (n=3) and Israel. The other isolates were probably associated with local transmissions. PFGE and MLST showed that the isolates were clonally related, with three isolates displaying ST258, a single locus variant of ST11 previously associated with the clonal spread of CTX-M-15-producing K. pneumoniae in Hungary. In all isolates, blaKPC was located on plasmids as part of isoform a of Tn4401.
Conclusions: The emergence of KPC-producing isolates of K. pneumoniae in Norway and Sweden is associated with multiple import events and probable local transmission of a successful multiresistant ST258 clone, closely related to the CTX-M-15-producing ST11 clone previously described in Hungary.
Keywords: Enterobacteriaceae , MLST , PFGE , class A β-lactamase , international clone , import , Scandinavia , Tn4401
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