title: An update of the evolving epidemic of blaKPC-2-carrying Klebsiella pneumoniae in Greece (2009-10).
abstract: OBJECTIVE
  To follow the epidemic of KPC-2-producing Klebsiella pneumoniae in Greece.
  
  
  METHODS
  KPC-2-producing isolates (n = 378) were collected during January 2009-April 2010 in 40 Greek hospitals. bla(KPC) and bla(VIM) were detected by PCR. Carbapenemase production was confirmed by spectrophotometry. Sequences flanking bla(KPC-2) and their plasmid carriers were studied. Isolates were typed by PFGE and multilocus sequence typing (MLST).
  
  
  RESULTS
  All 378 isolates were bla(KPC-2) positive; 18 also carried bla(VIM-1/VIM-4). Higher isolation frequencies were observed in Athens and Crete. Isolates were classified into 13 PFGE types and 11 sequence types (STs). ST258 was predominant (n = 322), followed by ST147 (n = 20), ST383 (n = 9), ST133 (n = 6), ST274 (n = 4) and ST323 (n = 3). Of the remaining isolates, seven were distributed into five STs (11, 17, 340 and the novel 494 and 495) and seven were not typed. bla(KPC-2) could not be transferred from ST258 isolates, in contrast to isolates of ST17, ST133, ST147, ST274, ST494 and ST495. All bla(KPC-2)-encoding plasmids were of similar size (∼100 kb) and showed indistinguishable restriction fragment length polymorphism (RFLP) patterns except those from the ST340 isolates. Sequences flanking bla(KPC-2) revealed that the Tn4401a isoform was present in plasmids from all STs except ST340 containing Tn4401b. Co-production of VIM enzymes was observed in isolates of ST147, ST323 and ST383.
  
  
  CONCLUSIONS
  Apart from the epidemic of KPC-2-producing K. pneumoniae belonging to ST258 in Greece, diffusion of bla(KPC-2) to at least 10 additional STs has taken place. Notably, strains from three of the latter STs (147, 323 and 383) were found to carry both bla(KPC-2) and bla(VIM).
authors.affiliation: Department of Microbiology, National School of Public Health, Athens, Greece.
authors.forename: Panagiota
authors.initials: P
authors.lastname: Giakkoupi
authors.forename: Costas C
authors.initials: CC
authors.lastname: Papagiannitsis
authors.forename: Vivi
authors.initials: V
authors.lastname: Miriagou
authors.forename: Olga
authors.initials: O
authors.lastname: Pappa
authors.forename: Michalis
authors.initials: M
authors.lastname: Polemis
authors.forename: Kyriaki
authors.initials: K
authors.lastname: Tryfinopoulou
authors.forename: Leonidas S
authors.initials: LS
authors.lastname: Tzouvelekis
authors.forename: Alkiviadis C
authors.initials: AC
authors.lastname: Vatopoulos
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D022761:Gene Transfer, Horizontal; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D017720:Molecular Epidemiology; D058889:Molecular Typing; D010957:Plasmids; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D004269:DNA, Bacterial; D001618:beta-Lactamases; C547585:beta-lactamase KPC-2, Klebsiella pneumoniae