title: KPC-2-producing Klebsiella pneumoniae isolated from a Czech patient previously hospitalized in Greece and in vivo selection of colistin resistance.
abstract: Carbapenemase-producing Gram-negative bacteria peak clinical interest due to their ability to hydrolyze most β-lactams, including carbapenems; moreover, their genes spread through bacterial populations by horizontal transfer. Bacteria with acquired carbapenemase have sporadically been reported in the Czech Republic, so far only in Enterobacteriaceae and Pseudomonas aeruginosa. In this study, we described the first finding of a KPC-2-producing strain of Klebsiella pneumoniae, which was isolated from a surgical wound swab, decubitus ulcer, and urine of a patient previously hospitalized in Greece. The patient underwent various antibiotic therapies including a colistin treatment. However, after approximately 20 days of the colistin therapy, the strain developed a high-level resistance to this drug. All the isolates were indistinguishable by pulsed field gel electrophoretic analysis and belonged to the international clone ST258, which is typical of KPC-producing K. pneumoniae isolates. The bla (KPC-2) gene was located on a Tn4401a transposon variant. The OmpK35 and OmpK36 genes analysis performed due to the high resistance level of the strains to β-lactams exhibited no changes in their sequence or in their expression when compared with carbapenem-susceptible isolates.
authors.affiliation: Department of Microbiology, Faculty of Medicine in Plzeň, Charles University in Prague and University Hospital in Plzeň, Alej Svobody 80, Plzeň, Czech Republic. Jaroslav.Hrabak@lfp.cuni.cz
authors.forename: Jaroslav
authors.initials: J
authors.lastname: Hrabák
authors.forename: Jana
authors.initials: J
authors.lastname: Niemczyková
authors.forename: Eva
authors.initials: E
authors.lastname: Chudáčková
authors.forename: Marta
authors.initials: M
authors.lastname: Fridrichová
authors.forename: Vendula
authors.initials: V
authors.lastname: Studentová
authors.forename: Dana
authors.initials: D
authors.lastname: Cervená
authors.forename: Pavla
authors.initials: P
authors.lastname: Urbášková
authors.forename: Helena
authors.initials: H
authors.lastname: Zemličková
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D003091:Colistin / Q000494:pharmacology*; D018153:Czech Republic; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000235:genetics; D015964:Gene Expression Regulation, Bacterial; D006115:Greece; D006760:Hospitalization; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D018272:Porins / Q000235:genetics; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics
chemical_list: D000900:Anti-Bacterial Agents; D018272:Porins; D001618:beta-Lactamases; C547585:beta-lactamase KPC-2, Klebsiella pneumoniae; D003091:Colistin