Emergence of Klebsiella pneumoniae co-producing NDM-1, OXA-48, CTX-M-15, CMY-16, QnrA and ArmA in Switzerland

Salome N Seiffert; Jonas Marschall; Vincent Perreten; Alessandra Carattoli; Hansjakob Furrer; Andrea Endimiani

doi:10.1016/j.ijantimicag.2014.05.008

Emergence of Klebsiella pneumoniae co-producing NDM-1, OXA-48, CTX-M-15, CMY-16, QnrA and ArmA in Switzerland

Int J Antimicrob Agents. 2014 Sep;44(3):260-2. doi: 10.1016/j.ijantimicag.2014.05.008. Epub 2014 Jun 23.

Authors

Salome N Seiffert¹, Jonas Marschall², Vincent Perreten³, Alessandra Carattoli⁴, Hansjakob Furrer², Andrea Endimiani⁵

Affiliations

¹ Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, Postfach 61, CH-3010 Bern, Switzerland; Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
² Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
³ Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
⁴ Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, Postfach 61, CH-3010 Bern, Switzerland; Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland; Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
⁵ Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, Postfach 61, CH-3010 Bern, Switzerland. Electronic address: [email protected].

PMID: 25123809
DOI: 10.1016/j.ijantimicag.2014.05.008

Abstract

Extensively drug-resistant (XDR) Klebsiella pneumoniae isolates usually carry a single carbapenemase (e.g. KPC, NDM, OXA-48-like). Here we describe an XDR K. pneumoniae of sequence type 101 that was detected in the screening rectal swab of a patient transferred from the intensive care unit of a hospital located in Belgrade (Serbia) to Bern University Hospital (Switzerland). The isolate was resistant to all antibiotics with the exception of colistin [minimum inhibitory concentration] (MIC ≤ 0.125 μg/mL), tigecycline (MIC = 0.5 μg/mL) and fosfomycin (MIC = 2 μg/mL). The isolate co-possessed class B (NDM-1) and class D (OXA-48) carbapenemases, class A extended-spectrum β-lactamase (CTX-M-15), class C cephalosporinase (CMY-16), ArmA 16S rRNA methyltransferase, substitutions in GyrA and ParC, loss of OmpK35 porin, as well as other genes conferring resistance to quinolones (qnrA), tetracyclines [tet(A)], sulfonamides (sul1, sul2), trimethoprim (dfrA12, dfrA14), rifampicin (arr-1), chloramphenicol (cmlA1, floR) and streptomycin (aadA1). The patient was placed under contact isolation precautions preventing the spread of this nearly untreatable pathogen.

Keywords: 16S rRNA; AmpC; Carbapenemase; ESBL; MBL.

Publication types

Case Reports
Research Support, Non-U.S. Gov't

MeSH terms

Anti-Bacterial Agents / pharmacology
Bacterial Proteins / biosynthesis
Bacterial Proteins / genetics*
Carrier State / microbiology*
Cluster Analysis
DNA, Bacterial / chemistry
DNA, Bacterial / genetics
Drug Resistance, Multiple, Bacterial
Escherichia coli Proteins / biosynthesis
Escherichia coli Proteins / genetics*
Feces / microbiology
Humans
Intensive Care Units
Klebsiella Infections / microbiology*
Klebsiella pneumoniae / drug effects*
Klebsiella pneumoniae / genetics*
Klebsiella pneumoniae / isolation & purification
Male
Methyltransferases / biosynthesis
Methyltransferases / genetics*
Microbial Sensitivity Tests
Middle Aged
Switzerland
beta-Lactamases / biosynthesis
beta-Lactamases / genetics*

Substances

Anti-Bacterial Agents
Bacterial Proteins
DNA, Bacterial
Escherichia coli Proteins
Qnr protein, Klebsiella pneumoniae
ArmA protein, E coli
Methyltransferases
beta-Lactamases