title: KPC-2-producing Klebsiella pneumoniae infections in Greek hospitals are mainly due to a hyperepidemic clone.
abstract: To verify the presence of Klebsiella pneumoniae carbapenemase-producing (KPC-producing) Klebsiella pneumoniae in Greece, we asked 40 Greek hospitals participating in the Greek System for the Surveillance of Antimicrobial Resistance (GSSAR) to apply a combination of the modified Hodge test plus EDTA synergy test on all K. pneumoniae clinical isolates obtained from February 2008 which displayed reduced susceptibility to carbapenems (MIC of imipenem > or = 1 mg/L). The presence of the blaKPC gene was confirmed by PCR and sequencing. This procedure revealed the presence of KPC-2 in isolates from 173 patients in 18 hospitals during a period of 11 months. Of these, 166 isolates belonged to a single pulsotype a fact consistent with possible epidemic spread, whereas the remaining seven isolates were further classified into four different pulsotypes. BlaKPC-2 gene was found to be transferable by conjugation in the four pulsotypes other than the prevailing one. The emergence of a new carbapenemase gene in Greece, where high resistance rates to carbapenems in K. pneumoniae due to the spread of the VIM type metalloenzyme have been observed, emphasises the urgent need for the implementation of public health measures in the field of infection control and antibiotic consumption. It also underlines the need to supplement surveillance systems based on susceptibility data with the surveillance of resistance mechanisms.
authors.affiliation: Department of Microbiology, National School of Public Health Athens, Greece.
authors.forename: P
authors.initials: P
authors.lastname: Giakoupi
authors.forename: H
authors.initials: H
authors.lastname: Maltezou
authors.forename: M
authors.initials: M
authors.lastname: Polemis
authors.forename: O
authors.initials: O
authors.lastname: Pappa
authors.forename: G
authors.initials: G
authors.lastname: Saroglou
authors.forename: A
authors.initials: A
authors.lastname: Vatopoulos
mesh_terms: D000581:Amidohydrolases; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000235:genetics; D015780:Carbapenems / Q000627:therapeutic use; D003428:Cross Infection / Q000209:etiology*; D004269:DNA, Bacterial / Q000235:genetics*; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D011159:Population Surveillance; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D004269:DNA, Bacterial; D000581:Amidohydrolases; C114020:beta-lactam synthetase; D001618:beta-Lactamases; C531581:carbapenemase-2, Klebsiella pneumoniae