title: [Dissemination of the KPC carbapenemase producing Klebsiella pneumoniae in a hospital in Warsaw, Poland].
abstract: Within the last decade, human infections caused by enterobacteria which produce the Klebsiella pneumoniae carbapenemase (KPC) became a serious therapeutic and epidemiological problem worldwide. The KPC producing strains of K. pneumoniae broadly disseminated in the USA then spread to Europe. Recently, the KPC-2 was found in Poland. In the presented study we tested 11 ertapenem resistant isolates of K. pneumoniae. The isolates were obtained from 10 patients of a regular hospital (RH) and from one patient of a palliative care hospital (PH) in Warsaw, Poland. Expression of the KPC was confirmed in all the tested isolates by the positive result of phenotypic test with boronic acid. All the isolates were also shown to harbour the bla(KPC) gene by PCR with primers targeting the core 372 bp fragment of the gene, and all but two were resistant to imipenem and meropenem as determined by the disc-diffusion method. The DNA sequence analysis of the complete bla(KPC) gene from representative isolate DM0269 revealed variant 2 of KPC (KPC-2). Tested isolates were subjected to genotyping by the PFGE with XbaI. Dendrogram based on the PFGE profiles was composed of two main branches with 82,3% of similarity. Branch A encompassed 9 isolates (93,2%), including the one from the PH-patient, while the two remaining isolates (86,5%) were located in branch B. Five isolates of the branch A were indistinguishable by the PFGE. The high genetic similarity of the branch A isolates strongly suggests the intra-hospital dissemination of epidemic K. pneumoniae KPC+ sensu stricto strain. Most probably, the strain was also transferred to the palliative care hospital. In contrast, the branch B isolates appear to belong to the distinct sensu stricto strain, that has acquired the bla(KPC) gene via horizontal transfer. This is the first report on the intra-hospital dissemination of the KPC producing K. pneumoniae in Poland. It is noteworthy, all the tested strains were also resistant to cefotaxime, ceftazidime, aztreonam, ciprofloxacin and sulphonamides, but sensitive to colistin.
authors.affiliation: Zakład Bakteriologii, Narodowego Instytutu Zdrowia Publicznego-Państwowego Zakładu Higieny.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Piekarska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Zacharczuk
authors.forename: Jolanta
authors.initials: J
authors.lastname: Szych
authors.forename: Elwira
authors.initials: E
authors.lastname: Zawidzka
authors.forename: Elzbieta
authors.initials: E
authors.lastname: Wilk
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wardak
authors.forename: Marek
authors.initials: M
authors.lastname: Jagielski
authors.forename: Rafał
authors.initials: R
authors.lastname: Gierczyński
mesh_terms: D000328:Adult; D000368:Aged; D001398:Aztreonam / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis; D002439:Cefotaxime / Q000494:pharmacology; D002442:Ceftazidime / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D003091:Colistin / Q000494:pharmacology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification* / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008875:Middle Aged; D011044:Poland / Q000453:epidemiology; D013045:Species Specificity; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D001426:Bacterial Proteins; D002939:Ciprofloxacin; D002442:Ceftazidime; D001618:beta-Lactamases; C531581:carbapenemase-2, Klebsiella pneumoniae; D001398:Aztreonam; D002439:Cefotaxime; D003091:Colistin