Fifteen Klebsiella pneumoniae clinical isolates showing non-susceptibility to carbapenems and resistant to colistin were collected in an Italian hospital. All isolates resulted negative to AmpC, MBL and ESBL production but positive to modified Hodge test, therefore were evaluated as KPC producers. The presence of blaKPC genes was verified by polymerase chain reaction (PCR) and sequencing. Furthermore, molecular typing was performed by multilocus sequence typing (MLST). PCR analysis and nucleotide sequencing revealed that all 15 isolates carried the blaKPC-3 gene. MLST analysis attributed the isolates from all patients to belong to the sequence type ST512. All isolates showed extensively drug-resistant (XDR) phenotype. The emergence of colistin-resistant K. pneumoniae underscores the implementation of strict control measures to prevent the dissemination of these organisms in hospitals.
ChenLFAndersonDJPatersonDL. Overview of the epidemiology and the threat of Klebsiella pneumoniae carbapenemases (KPC) resistance. Infect Drug Resist2012; 5:133–41.
2.
NordmannP.GniadkowskiM.GiskeC. G.PoirelL.WoodfordN.V.. Miriagou and the European Network on Carbapenemases Identification and screening of carbapenemase-producing Enterobacteriaceae. Clin Microbiol Infect2012; 18:432–38.
3.
HirschEBTamVH. Detection and treatment options for Klebsiella pneumonia carbapenemases (KPCs): an emerging cause of multidrug-resistant infection. J Antimicrob Chemother2010; 65:1119–25.
4.
RyanSAThomKRSharmaSPhillipsMJohnsonJKMorganDJ. Emergence of Klebsiella pneumoniae Carbapenemase (KPC)-Producing Bacteria. South Med J2011; 104:40–5.
5.
LeavittAChmelnitskyIOfekCarmeliYNavon-VeneziaS. Plasmid pKpQIL encoding KPC-3 and TEM-1 confers carbapenem resistance in an extremely drug-resistant epidemic Klebsiella pneumoniae strain. J Antimicrob Chemother2010; 65:243–8.
6.
WarburgGHidalgo-GrassCPartridgeSRTolmaskyMETemperVMosesAEBlockCStrahilevitzJ. A carbapenem-resistant Klebsiella pneumoniae epidemic clone in Jerusalem: sequence type 512 carrying a plasmid encoding aac(6′)-Ib. J Antimicrob Chemother2012; 67:898–901.
7.
BenensonSWarburgGHidalgo-GrassCTemperVMosesAEBlockCStrahilevitzJ. Comparison of two carbapenem-resistant Klebsiella pneumoniae clones: from a contained outbreak in a paediatric population and from a national epidemic. J Antimicrob Chemother2012; 67:1651–54.
8.
Munoz-PriceLSQuinnJP. The spread of Klebsiella pneumoniae carbapenemases: a tale of strains, plasmids, and transposons. Clin Infect Dis2009; 49:1739–41.
9.
LivermoreDMWarnerMMushtaqSDoumithMZhangJWoodfordN. What remains against carbapenem-resistant Enterobacteriaceae? Evaluation of chloramphenicol, ciprofloxacin, colistin, fosfomycin, minocycline, nitrofurantoin, temocillin and tigecycline. Int J Antimicrob Agents2011; 37:415–9.
10.
GiamarellouHPoulakouG. Multidrug-resistant Gram-negative infections: what are the treatment options?Drugs2009; 69:1879–901.
11.
NordmannPCuzonGNaasT. The real threat of Klebsiella pneumoniae carbapenemase producing bacteria. Lancet Infect Dis2009; 9:228–36.
12.
ZarkotouOPournarasSVoulgariEChrysosGPrekatesAVoutsinasDThemeli-DigalakiKTsakrisA. Risk factors and outcomes associated with acquisition of colistin-resistant KPC-producing Klebsiella pneumoniae: a matched case-control study. Clin Microbiol2010; 48:2271–74.
13.
KontopoulouKProtonotariouEVasilakosKKritiMKoteliAAntoniadouESofianouD. Hospital outbreak caused by Klebsiella pneumoniae producing KPC-2 b-lactamase resistant to colistin. J Hosp Infect2010; 76:70–73.
14.
SamraZOfirOLishtzinskyYMadar-ShapiroLBisharaJ. Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel. Int J Antimicrob Agents2007; 30:525–29.
15.
SuhJYSonJSChungDRPeckKRKoKSSongJH. Non clonal emergence of colistin-resistant Klebsiella pneumoniae isolates from blood samples in South Korea. Antimicrob Agents Chemother2010; 54:560–2.
16.
MarchaimDChopraTPogueJM. Outbreak of Colistin-Resistant, Carbapenem-Resistant Klebsiella pneumoniae in Metropolitan Detroit, Michigan. Antimicrob Agents Chemother2011; 55:593–9.
17.
CantónRAkóvaMCarmeliY. Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect2012; 18:413–21.
18.
BogdanovichTAdams-HaduchJMTianGBNguyenMHKwakEJMutoCADoiY. Colistin-resistant, Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae belonging to the international epidemic clone ST258. Clin Infect Dis2011; 53:373–6.
19.
MezzatestaMLGonaFCaioCPetrolitoVSciortinoDSciaccaASantangeloCStefaniS. Outbreak of KPC-3-producing, and colistin-resistant, Klebsiella pneumoniae infections in two Sicilian hospitals. Clin Microbiol Infect2011; 17:1444–47.
SantinoIBonoSBorrusoLBoveMCialdiEMartinelliDAlariA. Kodamaea ohmeri isolate from two immunocompromised patients: first report in Italy. 2013; 56(2): 179–81. Epub 2012 Aug 12.
23.
SouliMGalaniIGiamarellouH. Emergence of extensively drug-resistant and pandrug-resistant Gram-negative bacilli in Europe. Euro Surveill2008; 13:19045.
24.
RichterSNFrassonIBergoFranchin ELavezzoEBarzonLCavallaroAPalùG. KPC-mediate resistance in Klebsiella pneumoniae in two hospitals in Padua, Italy, June 2009-December 2012: massive spreading of a KPC-3-encoding plasmid and involvement of non-intensive care units. Gut Pathog2012; 4:7.
25.
CaponeAGiannellaMFortiniD. High rate of colistin resistance among patients with carbapenem-resistant Klebsiella pneumoniae infection accounts for an excess of mortality. Clin Microbiol Infect2013; 19:23–30.
