Surveillance and molecular epidemiology of Klebsiella pneumoniae isolates that produce carbapenemases: first report of OXA-48-like enzymes in North America

Antimicrob Agents Chemother. 2013 Jan;57(1):130-6. doi: 10.1128/AAC.01686-12. Epub 2012 Oct 15.

Abstract

A study was designed to characterize nonrepeat isolates of carbapenemase-producing K. pneumoniae obtained from the SMART worldwide surveillance program during 2008 and 2009. Characterization was done by PCR and sequencing for bla(VIM), bla(IMP), bla(NDM), bla(OXA), bla(KPC), and plasmid-mediated quinolone resistance and virulence factors (VFs). Genetic relatedness was determined with pulsed-field gel electrophoresis (PFGE) using XbaI and multilocus sequence typing. A total of 110 isolates were included; 47 possess genes that encode K. pneumoniae carbapenemases (KPCs), 26 NDMs, 19 VIMs, 13 OXA-48-like, and 5 imipenems (IMPs). We identified 3 different major sequence types (STs) among 65% of the isolates (i.e., ST11 [n = 11], ST147 [n = 23], and ST258 [n = 38]). ST11 and ST147, producing OXA-48-like and NDMs, were found in Argentina, Turkey, Greece, Italy, and India; ST258, producing KPCs, was present in the United States, Israel, Greece, and Puerto Rico. The major STs consisted of up to 4 different pulsotypes, and each pulsotype had a specific geographical distribution. A new ST, named ST903, with bla(IMP-26), was identified in the Philippines, while two bla(OXA-48)-positive isolates were detected in the United States. There were no significant differences in the distribution of the VFs between the isolates; all were positive for fimH, mrkD, wabG, and ureA. This is the first report of OXA-48-like enzymes in North America. Our study highlights the importance of surveillance programs using molecular techniques as powerful tools to identify the importance of international sequence types.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Drug Resistance, Multiple, Bacterial
  • Electrophoresis, Gel, Pulsed-Field
  • Epidemiological Monitoring*
  • Humans
  • Klebsiella Infections / drug therapy
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / microbiology
  • Klebsiella pneumoniae / classification
  • Klebsiella pneumoniae / drug effects
  • Klebsiella pneumoniae / genetics*
  • Klebsiella pneumoniae / isolation & purification
  • Multilocus Sequence Typing
  • North America / epidemiology
  • Phylogeny
  • Phylogeography
  • Plasmids*
  • Polymerase Chain Reaction
  • Sequence Analysis, DNA
  • Virulence Factors / genetics
  • beta-Lactamases / genetics*

Substances

  • Anti-Bacterial Agents
  • Virulence Factors
  • beta-Lactamases
  • oxacillinase