title: Outbreak of carbapenem-resistant Klebsiella pneumoniae producing KPC-3 in a tertiary medical centre in Israel.
abstract: This report describes an outbreak of carbapenem-resistant KPC-3-producing Klebsiella pneumoniae outside the USA. Ninety patients from different departments of a tertiary medical centre were diagnosed with carbapenem-resistant, extended-spectrum beta-lactamase (ESBL)-negative Klebsiella pneumoniae infection by standard methods over a 10-month period in 2006. Fifteen randomly selected outbreak isolates were subjected to randomly amplified polymorphic DNA (RAPD) polymerase chain reaction (PCR) as well as PCR amplification and sequencing of the KPC genes, and the findings were compared with two carbapenem-susceptible K. pneumoniae isolates (one ESBL-positive and one ESBL-negative). All the outbreak isolates were resistant to all fluoroquinolones and beta-lactam antibiotics tested, including carbapenems, and were sensitive only to colistin, gentamicin and most of them also to tigecycline. On RAPD-PCR, all 15 outbreak isolates were identical to each other and clearly distinguishable from control strains, indicating clonality. The KPC-3 enzyme was identified by nucleotide sequencing analysis in all outbreak isolates but not in the control strains. These findings should alert government and medical authorities to institute stringent control measures and to initiate research into therapeutic and preventive strategies.
authors.affiliation: Laboratory of Clinical Microbiology, Rabin Medical Center, Beilinson Hospital, Petah Tiqwa 49100, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
authors.forename: Zmira
authors.initials: Z
authors.lastname: Samra
authors.forename: Orit
authors.initials: O
authors.lastname: Ofir
authors.forename: Yinon
authors.initials: Y
authors.lastname: Lishtzinsky
authors.forename: Liora
authors.initials: L
authors.lastname: Madar-Shapiro
authors.forename: Jihad
authors.initials: J
authors.lastname: Bishara
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis* / Q000235:genetics; D015780:Carbapenems / Q000494:pharmacology*; D004196:Disease Outbreaks; D006785:Hospitals, University; D006801:Humans; D007557:Israel / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D019105:Random Amplified Polymorphic DNA Technique; D017422:Sequence Analysis, DNA; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D047090:beta-Lactams; D001618:beta-Lactamases; C495220:beta-lactamase KPC-3, Klebsiella pneumoniae