title: Microbiological and molecular characteristics of carbapenemase-producing Klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010.
abstract: We report 570 carbapenemase-producing Klebsiella pneumoniae (CPKP) clinical isolates in a 1,040-bed Greek tertiary hospital during 2004 to 2010. The first CPKP (VIM-producing) was isolated in September 2004. Despite initial containment, VIM producers have become endemic since 2006. KPC-producing K. pneumoniae was first isolated in August 2007 from a patient who came from Israel, spread rapidly, and outcompeted VIM. Overall, 267 (47%) VIM-producing and 301 (53%) KPC-producing strains were isolated, including 141 (24.7%) from patients with bacteraemia. Two isolates carrying both VIM and KPC were isolated in two consecutive months in 2009, but not since. The prevalence of CPKP increased from 0% in 2003 to 38.3% in 2010 (p<0.0001). All genotyped KPC producers harboured blaKPC-2 and belonged to two clones, among which the hyperepidemic Greek clone, related to those from the United States and Israel, predominated. Most metallo-beta-lactamase (MBL) producers carried the blaVIM-1 gene and belonged to several clones, whereas all but one isolate with blaVIM-12 were clustered within a five-month period, arising from one clone. Resistance to non-beta-lactam antibiotics was also increased among CPKP. They were almost invariably resistant to ciprofloxacin and trimethoprim-sulfamethoxazole. Resistance to colistin increased from 3.5% (4/115) in 2008 to 20.8% (25/120) in 2010, and resistance to tigecycline also increased. Following reinforcement of infection control measures, prevalence of CPKP (mainly KPC) has been reduced since mid-2009 (from 46% in 2009 to 38.3% in 2010). In view of the exhaustion of available therapies, investment in infection control resources and optimal antibiotic use is urgently required.
authors.affiliation: Department of Clinical Microbiology, Hippokration General Hospital, and Infectious Diseases Unit, Third Department of Paediatrics, Aristotle University, Thessaloniki, Greece.
authors.forename: A
authors.initials: A
authors.lastname: Zagorianou
authors.forename: E
authors.initials: E
authors.lastname: Sianou
authors.forename: E
authors.initials: E
authors.lastname: Iosifidis
authors.forename: V
authors.initials: V
authors.lastname: Dimou
authors.forename: E
authors.initials: E
authors.lastname: Protonotariou
authors.forename: S
authors.initials: S
authors.lastname: Miyakis
authors.forename: E
authors.initials: E
authors.lastname: Roilides
authors.forename: D
authors.initials: D
authors.lastname: Sofianou
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001426:Bacterial Proteins / Q000096:biosynthesis* / Q000235:genetics; D015373:Bacterial Typing Techniques; D024901:Drug Resistance, Multiple, Bacterial; D019353:Endemic Diseases; D005260:Female; D005784:Gene Amplification; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics* / Q000302:isolation & purification*; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D010641:Phenotype; D016133:Polymerase Chain Reaction; D015995:Prevalence; D017422:Sequence Analysis, DNA; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics; D047090:beta-Lactams / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D047090:beta-Lactams; D001618:beta-Lactamases; C063912:carbapenemase