Bloodstream infections caused by multidrug-resistant Klebsiella pneumoniae producing the carbapenem-hydrolysing VIM-1 metallo-beta-lactamase: first Italian outbreak.
OBJECTIVE
To investigate the first Italian outbreak of bloodstream infections caused by multidrug-resistant (MDR) Klebsiella pneumoniae producing metallo-beta-lactamase (MBL), which occurred in three wards of one large tertiary-care hospital in Genoa, Italy, from September 2004 to March 2005.


METHODS
MBL production was screened by an imipenem-EDTA disc synergy test and confirmed by a conventional hydrolysis test. Antibiotic susceptibility was determined by broth microdilution or disc diffusion. PFGE was used to study the genetic relatedness of isolates. PCR and sequencing were carried out to identify the beta-lactamase genes and to analyse the genetic context of the MBL gene. Outer membrane protein (OMP) profiles were analysed by SDS-PAGE.


RESULTS
Nine cases of bloodstream infections caused by an MDR strain of K. pneumoniae producing the VIM-1 MBL and the SHV-5 extended-spectrum beta-lactamase (ESBL) were identified. The isolates exhibited various carbapenem resistance levels (imipenem MICs ranged from 4 to 64 mg/L) and were resistant to other beta-lactams, fluoroquinolones, trimethoprim/sulfamethoxazole and chloramphenicol. The isolate with the highest imipenem MIC also lacked the k36 OMP. The bla(VIM-1) gene cassette was part of the variable region of a class 1 integron that also included an aac(6')-IIc cassette. The ESBL and MBL genes were transferable by conjugation.


CONCLUSIONS
This is the first report on the emergence of an MDR strain of K. pneumoniae producing the VIM-1 MBL, causing an outbreak of bloodstream infections in an Italian hospital. The strain evolved through OMP alterations generating a mutant with increased carbapenem resistance.
Cagnacci
Simone
S
Di.S.C.A.T., Microbiology Unit, University of Genoa, Genoa, Italy.
Gualco
Laura
L
Roveta
Simona
S
Mannelli
Stefania
S
Borgianni
Luisa
L
Docquier
Jean-Denis
JD
Dodi
Ferdinando
F
Centanaro
Monica
M
Debbia
Eugenio
E
Marchese
Anna
A
Rossolini
Gian Maria
GM
D016470:Bacteremia / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D015780:Carbapenems / Q000494:pharmacology / Q000627:therapeutic use; D004196:Disease Outbreaks; D024901:Drug Resistance, Multiple, Bacterial / Q000502:physiology*; D006785:Hospitals, University; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000302:isolation & purification*; D001618:beta-Lactamases / Q000096:biosynthesis
D015780:Carbapenems; C417264:VIM-1 metallo-beta-lactamase; D001618:beta-Lactamases