title: Arrival of Klebsiella pneumoniae producing KPC carbapenemase in the United Kingdom.
abstract: BACKGROUND
  KPC-type carbapenemases are increasingly prevalent in parts of the USA and Israel and are an emerging concern in South America, Europe and China. We investigated the UK's first two KPC-producing Klebsiella pneumoniae isolates.
  
  
  METHODS
  The isolates were referred to the UK's national reference laboratory for confirmation of carbapenem resistance. Susceptibilities were determined by agar dilution, and bla(KPC) and Tn4401-like elements were sought by PCR and sequencing. Isolates were compared by PFGE of XbaI- and SpeI-digested genomic DNA.
  
  
  RESULTS
  The isolates were from patients in different UK hospitals, with no epidemiological connection. Both were resistant to carbapenems (MICs > 16 mg/L), with imipenem MICs unchanged by EDTA, and also to all other beta-lactams (including inhibitor combinations), tobramycin, amikacin and ciprofloxacin. They were susceptible to gentamicin (MICs </= 1 mg/L) and colistin (MICs </= 0.5 mg/L), with intermediate susceptibility to tigecycline (MICs 1-2 mg/L). The isolates belonged to the same PFGE-defined strain, highly related to a disseminated KPC-producing strain characterized previously in Tel Aviv, Israel. Like this Israeli strain, the UK isolates produced KPC-3 carbapenemase, with the bla(KPC-3) gene located within a Tn4401-like element.
  
  
  CONCLUSIONS
  The first KPC-3-producing K. pneumoniae isolates detected in the UK were highly genetically related to a KPC-3-producing Israeli K. pneumoniae strain. This relatedness was consistent with the history of one UK patient, who had been hospitalized previously in Israel. However, this strain may be circulating more widely since the second UK patient had no identifiable links with Israel or other overseas countries.
authors.affiliation: Centre for Infections, Health Protection Agency, 61 Colindale Avenue, London NW9 5EQ, UK. neil.woodford@hpa.org.uk
authors.forename: Neil
authors.initials: N
authors.lastname: Woodford
authors.forename: Jiancheng
authors.initials: J
authors.lastname: Zhang
authors.forename: Marina
authors.initials: M
authors.lastname: Warner
authors.forename: Mary E
authors.initials: ME
authors.lastname: Kaufmann
authors.forename: Jorge
authors.initials: J
authors.lastname: Matos
authors.forename: Alan
authors.initials: A
authors.lastname: Macdonald
authors.forename: Daniel
authors.initials: D
authors.lastname: Brudney
authors.forename: David
authors.initials: D
authors.lastname: Sompolinsky
authors.forename: Shiri
authors.initials: S
authors.lastname: Navon-Venezia
authors.forename: David M
authors.initials: DM
authors.lastname: Livermore
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis*; D015373:Bacterial Typing Techniques; D016000:Cluster Analysis; D016172:DNA Fingerprinting; D016521:Electrophoresis, Gel, Pulsed-Field; D005260:Female; D005798:Genes, Bacterial; D005838:Genotype; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000201:enzymology* / Q000302:isolation & purification*; D008297:Male; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D006113:United Kingdom / Q000453:epidemiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000096:biosynthesis*; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D047090:beta-Lactams; D001618:beta-Lactamases; C063912:carbapenemase