Hospital outbreak due to a Klebsiella pneumoniae ST147 clonal strain co-producing KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital in Northern Greece

Efthymia Protonotariou; Aggeliki Poulou; Lida Politi; Ioannis Sgouropoulos; Simeon Metallidis; Melania Kachrimanidou; Spyros Pournaras; Athanasios Tsakris; Lemonia Skoura

doi:10.1016/j.ijantimicag.2018.04.004

Hospital outbreak due to a Klebsiella pneumoniae ST147 clonal strain co-producing KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital in Northern Greece

Int J Antimicrob Agents. 2018 Sep;52(3):331-337. doi: 10.1016/j.ijantimicag.2018.04.004. Epub 2018 Apr 11.

Authors

Efthymia Protonotariou¹, Aggeliki Poulou², Lida Politi³, Ioannis Sgouropoulos², Simeon Metallidis⁴, Melania Kachrimanidou⁵, Spyros Pournaras³, Athanasios Tsakris³, Lemonia Skoura²

Affiliations

¹ Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece. Electronic address: protonotariou@auth.gr.
² Department of Microbiology, AHEPA University Hospital, Aristotle University of Thessaloniki, S. Kiriakidi 1, 546 36 Thessaloniki, Greece.
³ Department of Microbiology, Medical School, University of Athens, Athens, Greece.
⁴ First Department of Internal Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
⁵ First Department of Microbiology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.

PMID: 29654892
DOI: 10.1016/j.ijantimicag.2018.04.004

Abstract

Here we present the characteristics of a large outbreak caused by a clonal Klebsiella pneumoniae strain producing both KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital. Between January 2013 and January 2015, 45 carbapenem-resistant K. pneumoniae isolates that gave a positive modified Hodge test and were phenotypically suspected of metallo-β-lactamase (MBL) and K. pneumoniae carbapenemase (KPC) co-production were recovered from 25 patients hospitalised in AHEPA University Hospital (Thessaloniki, Greece). All of the patients were hospitalised in the three intensive care units of the hospital and 17 (68%) of them developed bloodstream infections; the overall mortality of the patients involved in the outbreak was 48% (12/25). Molecular testing verified that all 45 K. pneumoniae isolates co-harboured bla_KPC-2 and bla_VIM-1 genes and were associated with OmpK35 deficiency and OmpK36 porin loss. The bla_TEM-1 gene was also present in 18 isolates. Pulsed-field gel electrophoresis (PFGE) clustered all of the isolates into a single clonal type, and multilocus sequence typing (MLST) assigned them to the emerging high-risk ST147 clonal lineage. Following recognition of the outbreak, infection control measures were implemented in the affected areas. The outbreak continued for ca. 2 years and since then only sporadic cases of K. pneumoniae harbouring both carbapenemases have been detected.

Keywords: Carbapenemases; Hospital outbreak; KPC; Klebsiella pneumoniae; VIM.

MeSH terms

Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents / therapeutic use*
Bacteremia / epidemiology
Bacteremia / microbiology
Bacterial Proteins / genetics*
Bacterial Proteins / metabolism
Disease Outbreaks
Drug Resistance, Multiple, Bacterial / genetics
Female
Greece / epidemiology
Hospitals, Teaching
Humans
Intensive Care Units
Klebsiella Infections / drug therapy
Klebsiella Infections / epidemiology*
Klebsiella Infections / microbiology
Klebsiella pneumoniae / drug effects*
Klebsiella pneumoniae / isolation & purification*
Klebsiella pneumoniae / metabolism
Male
Microbial Sensitivity Tests
Middle Aged
Multilocus Sequence Typing
Porins / genetics
Tertiary Care Centers
beta-Lactamases / genetics*
beta-Lactamases / metabolism*

Substances

Anti-Bacterial Agents
Bacterial Proteins
OmpK35 porin, Klebsiella pneumoniae
OmpK36 protein, Klebsiella pneumoniae
Porins
VIM-1 metallo-beta-lactamase
beta-Lactamases
beta-lactamase KPC-2, Klebsiella pneumoniae
carbapenemase