title: Emergence of OXA-48-producing Klebsiella pneumoniae and the novel carbapenemases OXA-244 and OXA-245 in Spain.
abstract: OBJECTIVE
  To describe the molecular and population-level characterization of a selected group of OXA-48-like-producing Klebsiella pneumoniae isolates collected in Spain between January 2011 and May 2012.
  
  
  METHODS
  During the study period, 151 OXA-48-like-producing K. pneumoniae isolates were collected from 10 hospitals in six different Spanish regions. From these, a representative sample of 21 isolates that caused hospital outbreaks and single infections was selected for further in-depth analysis. Molecular epidemiology was investigated using PFGE and multilocus sequence typing (MLST). Resistance genes were characterized by PCR and sequencing. Plasmids carrying bla(OXA-48-like) were studied by PFGE with S1 nuclease digestion.
  
  
  RESULTS
  All 21 isolates had ertapenem MICs ≥ 1 mg/L, but 47.6% remained susceptible to imipenem and meropenem; bla(OXA-48) was identified in 19 isolates (90.5%) and the novel bla(OXA-244) and bla(OXA-245) genes were detected in 1 isolate each. With one exception, all isolates that contained bla(OXA-48-like) also contained bla(CTX-M-15). PFGE typing revealed six clusters comprising isolates that belonged to MLST types ST11, ST16, ST392, ST405, ST437 and ST663, respectively. Two main clusters were identified: PFGE cluster 1 (12 isolates, belonging either to ST405 or ST663, from seven hospitals), and PFGE cluster 2 (4 ST16 isolates from two hospitals). Six of seven donor isolates conjugated successfully; bla(OXA-48-like) (but not bla(CTX-M-15)) was carried on ≈ 60 kb Inc L/M plasmids.
  
  
  CONCLUSIONS
  Multidrug-resistant K. pneumoniae producing OXA-48-like carbapenemase are emerging as important pathogens in Spain due to intra- and inter-hospital, clonal and non-clonal dissemination.
authors.affiliation: Laboratorio de Antibióticos, Servicio de Bacteriología, CNM, Majadahonda, Madrid,  Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Oteo
authors.forename: Juan Manuel
authors.initials: JM
authors.lastname: Hernández
authors.forename: Mateu
authors.initials: M
authors.lastname: Espasa
authors.forename: Ana
authors.initials: A
authors.lastname: Fleites
authors.forename: David
authors.initials: D
authors.lastname: Sáez
authors.forename: Verónica
authors.initials: V
authors.lastname: Bautista
authors.forename: María
authors.initials: M
authors.lastname: Pérez-Vázquez
authors.forename: Ma Dolores
authors.initials: MD
authors.lastname: Fernández-García
authors.forename: Alberto
authors.initials: A
authors.lastname: Delgado-Iribarren
authors.forename: Isabel
authors.initials: I
authors.lastname: Sánchez-Romero
authors.forename: Luisa
authors.initials: L
authors.lastname: García-Picazo
authors.forename: Ma Dolores
authors.initials: MD
authors.lastname: Miguel
authors.forename: Sonia
authors.initials: S
authors.lastname: Solís
authors.forename: Esteban
authors.initials: E
authors.lastname: Aznar
authors.forename: Gloria
authors.initials: G
authors.lastname: Trujillo
authors.forename: Concepción
authors.initials: C
authors.lastname: Mediavilla
authors.forename: Dionisia
authors.initials: D
authors.lastname: Fontanals
authors.forename: Susana
authors.initials: S
authors.lastname: Rojo
authors.forename: Ana
authors.initials: A
authors.lastname: Vindel
authors.forename: José
authors.initials: J
authors.lastname: Campos
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics* / Q000378:metabolism; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D017720:Molecular Epidemiology; D008969:Molecular Sequence Data; D058885:Multilocus Sequence Typing; D010957:Plasmids; D016133:Polymerase Chain Reaction; D013030:Spain / Q000453:epidemiology; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D001618:beta-Lactamases; C063912:carbapenemase