title: Emergence of Klebsiella pneumoniae co-producing NDM-1, OXA-48, CTX-M-15, CMY-16, QnrA and ArmA in Switzerland.
abstract: Extensively drug-resistant (XDR) Klebsiella pneumoniae isolates usually carry a single carbapenemase (e.g. KPC, NDM, OXA-48-like). Here we describe an XDR K. pneumoniae of sequence type 101 that was detected in the screening rectal swab of a patient transferred from the intensive care unit of a hospital located in Belgrade (Serbia) to Bern University Hospital (Switzerland). The isolate was resistant to all antibiotics with the exception of colistin [minimum inhibitory concentration] (MIC ≤ 0.125 μg/mL), tigecycline (MIC = 0.5 μg/mL) and fosfomycin (MIC = 2 μg/mL). The isolate co-possessed class B (NDM-1) and class D (OXA-48) carbapenemases, class A extended-spectrum β-lactamase (CTX-M-15), class C cephalosporinase (CMY-16), ArmA 16S rRNA methyltransferase, substitutions in GyrA and ParC, loss of OmpK35 porin, as well as other genes conferring resistance to quinolones (qnrA), tetracyclines [tet(A)], sulfonamides (sul1, sul2), trimethoprim (dfrA12, dfrA14), rifampicin (arr-1), chloramphenicol (cmlA1, floR) and streptomycin (aadA1). The patient was placed under contact isolation precautions preventing the spread of this nearly untreatable pathogen.
authors.affiliation: Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, Postfach 61, CH-3010 Bern, Switzerland; Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences, University of Bern, Bern, Switzerland.
authors.forename: Salome N
authors.initials: SN
authors.lastname: Seiffert
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Jonas
authors.initials: J
authors.lastname: Marschall
authors.affiliation: Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
authors.forename: Vincent
authors.initials: V
authors.lastname: Perreten
authors.affiliation: Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, Postfach 61, CH-3010 Bern, Switzerland; Institute of Veterinary Bacteriology, Vetsuisse Faculty, University of Bern, Bern, Switzerland; Department of Infectious, Parasitic and Immune-Mediated Diseases, Istituto Superiore di Sanità, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Carattoli
authors.affiliation: Department of Infectious Diseases, Bern University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Hansjakob
authors.initials: H
authors.lastname: Furrer
authors.affiliation: Institute for Infectious Diseases, University of Bern, Friedbühlstrasse 51, Postfach 61, CH-3010 Bern, Switzerland. Electronic address: aendimiani@gmail.com.
authors.forename: Andrea
authors.initials: A
authors.lastname: Endimiani
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000096:biosynthesis / Q000235:genetics*; D002353:Carrier State / Q000382:microbiology*; D016000:Cluster Analysis; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial; D029968:Escherichia coli Proteins / Q000096:biosynthesis / Q000235:genetics*; D005243:Feces / Q000382:microbiology; D006801:Humans; D007362:Intensive Care Units; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D008297:Male; D008780:Methyltransferases / Q000096:biosynthesis / Q000235:genetics*; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013557:Switzerland; D001618:beta-Lactamases / Q000096:biosynthesis / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D004269:DNA, Bacterial; D029968:Escherichia coli Proteins; C485385:Qnr protein, Klebsiella pneumoniae; C506767:ArmA protein, E coli; D008780:Methyltransferases; D001618:beta-Lactamases
keywords: 16S rRNA; AmpC; Carbapenemase; ESBL; MBL