Outbreak of KPC-2-producing Klebsiella pneumoniae endowed with ceftazidime-avibactam resistance mediated through a VEB-1-mutant (VEB-25), Greece, September to October 2019

Euro Surveill. 2020 Jan;25(3):2000028. doi: 10.2807/1560-7917.ES.2020.25.3.2000028.

Abstract

From September to October 2019, seven patients colonised or infected with a ceftazidime-avibactam (CZA)-resistant Klebsiella pneumoniae carbapenemase (KPC)-2-producing K. pneumoniae were detected in two intensive care units of a Greek general hospital. The outbreak strain was sequence type (ST)147 and co-produced KPC-2 and the novel plasmid-borne Vietnamese extended-spectrum β-lactamase (VEB)-25 harbouring a K234R substitution associated with CZA resistance. Epidemiological investigations revealed that the resistance was probably acquired by horizontal transmission independently from previous CZA exposure.

Keywords: K.pneumoniae; K234R; KPC-2; VEB-14; VEB-25; ceftazidime-avibactam.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology*
  • Azabicyclo Compounds
  • Ceftazidime
  • Disease Outbreaks
  • Drug Combinations
  • Drug Resistance, Bacterial
  • Female
  • Genome, Bacterial
  • Greece
  • Humans
  • Intensive Care Units
  • Klebsiella Infections / microbiology*
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / enzymology
  • Klebsiella pneumoniae / genetics*
  • Klebsiella pneumoniae / isolation & purification
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Mutation / genetics
  • Whole Genome Sequencing
  • beta-Lactamases / genetics*
  • beta-Lactamases / metabolism*

Substances

  • Anti-Bacterial Agents
  • Azabicyclo Compounds
  • Drug Combinations
  • avibactam, ceftazidime drug combination
  • Ceftazidime
  • beta-Lactamases