title: Emergence of a VIM-1 MBL and CTX-M-15 ESbL-producing Klebsiella pneumoniae clone from acute and rehabilitation hospitals in Italy.
abstract: We report the emergence of VIM-1 MBL and CTX-M-15-producing K. pneumoniae isolates collected from patients at two acute care hospitals (I.R.C.C.S. "S. Matteo" and "Casa Sollievo della Sofferenza" Hospital) and a long-term rehabilitation facility in Northern Italy (I.R.C.C.S. "S. Maugeri"). Between February 2007 and October 2008, 30 K. pneumoniae strains showing decreased susceptibility to carbapenems were collected. PCR and sequencing experiments revealed the presence of blaVIM-1 gene in 14/30 isolates. All the above isolates carried the blaSHV-5 determinant as well; interestingly, 8/14 VIM positive isolates were also CTX-M-1- like producers. VIM-1 positive strains were present in all hospitals. PFGE genomic profiles of the 14/30 isolates showed that 2 different clones, A and B, were responsible for outbreaks. The coexistence in the same bacterial cell of compatible plasmids carrying epidemiologically important emerging resistance genes, such as MBLs and CTX-Ms, is worrisome since it could predict the generation and spread of pan-resistant bacteria and the consequent treatment option limitations that can lead to significant morbidity and mortality. Control measures should be applied to detect MBL-producing strains and to contrast the vertical and plasmidic diffusion of carbapenem-resistant K. pneumoniae in acute care and rehabilitation facilities.
authors.affiliation: Department of Clinical-Surgical, Diagnostic and Paediatric Sciences, Unit of Microbiology, University of Pavia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Nucleo
authors.forename: Melissa
authors.initials: M
authors.lastname: Spalla
authors.forename: Aurora
authors.initials: A
authors.lastname: Piazza
authors.forename: Maria Sofia
authors.initials: MS
authors.lastname: Caltagirone
authors.forename: Sara
authors.initials: S
authors.lastname: Asticcioli
authors.forename: Maurizia
authors.initials: M
authors.lastname: Debiaggi
authors.forename: Carolina
authors.initials: C
authors.lastname: Matti
authors.forename: Rossana
authors.initials: R
authors.lastname: Daturi
authors.forename: Antonella
authors.initials: A
authors.lastname: Navarra
authors.forename: Maria
authors.initials: M
authors.lastname: Labonia
authors.forename: Roberta
authors.initials: R
authors.lastname: Migliavacca
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology*; D015780:Carbapenems / Q000494:pharmacology*; D003428:Cross Infection; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D006761:Hospitals; D006801:Humans; D007558:Italy / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification*; D008826:Microbial Sensitivity Tests; D010957:Plasmids / Q000235:genetics; D016133:Polymerase Chain Reaction; D012047:Rehabilitation Centers; D001618:beta-Lactamases / Q000235:genetics* / Q000378:metabolism
chemical_list: D000890:Anti-Infective Agents; D015780:Carbapenems; D004269:DNA, Bacterial; C417264:VIM-1 metallo-beta-lactamase; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases