title: High clonal diversity in a non-outbreak situation of clinical ESBL-producing Klebsiella pneumoniae isolates in the first national surveillance program in Cuba.
abstract: This work summarized the results obtained in an institutional Klebsiella pneumoniae surveillance program recently implemented in Cuba. Eighteen hospitals from five regions provided a total of 228 K. pneumoniae isolates (164 from admitted patients, four from hospital environmental sources, and 60 isolates from community patients). The genetic relationship was assessed by pulsed-field gel electrophoresis and multilocus sequence typing. Antimicrobial susceptibility was determined by the agar dilution method, and bla(ESBL) genes were sequenced. Fifty four K. pneumoniae isolates were extended-spectrum β-lactamases (ESBL)-producers (23.6%), mostly due to the CTX-M-15 enzyme (79.6%). ESBL isolates were grouped in 27 different sequence types (STs), being the most prevalent ST15 (15%), ST152 (13%), and both ST48 and ST147 (11%, respectively). Community-acquired criteria could be demonstrated in 60 patients (26%) corresponding to urological (33%), wound (27%), respiratory (27%), and otic (13%) infections. Population structure analysis showed that our isolates corresponded to a highly polyclonal population with 10 nonpreviously described STs, demonstrating the importance of local epidemiological studies. We report the first data of the population structure of ESBL-producing K. pneumoniae isolates obtained in a national multicenter surveillance Cuban program. Results showed that a highly polyclonal ESBL-producer K. pneumoniae population was mainly due to CTX-M-15 carriage, whereas carbapenemases production was not present.
authors.affiliation: 1 Servicio de Bacteriología-Micología, Instituto de Medicina Tropical Pedro Kourí , La Habana, Cuba .
authors.forename: Dianelys
authors.initials: D
authors.lastname: Quiñones
authors.forename: Aránzazu
authors.initials: A
authors.lastname: Valverde
authors.forename: Mercedes
authors.initials: M
authors.lastname: Rodríguez-Baños
authors.forename: Nobumichi
authors.initials: N
authors.lastname: Kobayashi
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Zayaz
authors.forename: Miriam
authors.initials: M
authors.lastname: Abreu
authors.forename: Rafael
authors.initials: R
authors.lastname: Cantón
authors.forename: Rosa
authors.initials: R
authors.lastname: del Campo
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002999:Clone Cells; D003462:Cuba / Q000453:epidemiology; D016521:Electrophoresis, Gel, Pulsed-Field; D062665:Epidemiological Monitoring; D015870:Gene Expression; D014644:Genetic Variation; D006801:Humans; D007710:Klebsiella Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing; D010802:Phylogeny; D010957:Plasmids; D017422:Sequence Analysis, DNA; D018440:beta-Lactam Resistance / Q000187:drug effects / Q000235:genetics*; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases