title: Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization.
abstract: We describe the first outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP), the infection control measures adopted and the shift in resistance patterns of isolates during antibiotic treatment. The ST258 KPC-KP strain exhibited a multiresistant antibiotic phenotype including co-resistance to gentamycin, colistin and tigecycline intermediate susceptibility. Isolates before and after treatment had different behaviour concerning their antibiotic susceptibility and the population analysis profile study. A progressive increase in the aminoglycosides (acquiring amicacin resistance) and β-lactam MICs, and a decreased susceptibility to fosfomycin was observed throughout the administration of combined antimicrobial regimens including meropenem. A high meropenem resistance KPC-KP homogeneous population (MIC 256 Jg/mL), could arise from the meropenem heterogeneous low-level resistance KPC-KP population (MIC 8 Jg/mL), by the selective pressure of the prolonged meropenem therapy. The kpc gene was inserted in a Tn4401 isoform a, and no transconjugants were detected. The core measures adopted were successful to prevent evolution towards resistance dissemination.
authors.affiliation: Cátedra de Microbiología, Instituto de Química Biológica, Facultad de Ciencias y de Química-UdelaR, Universidad de la República Montevideo, Uruguay.
authors.forename: C
authors.initials: C
authors.lastname: Marquez
authors.affiliation: Facultad de Química-UdelaR, Cátedra de Microbiología, UdelaR Montevideo, Uruguay.
authors.forename: A
authors.initials: A
authors.lastname: Ingold
authors.affiliation: Facultad de Química-UdelaR, Cátedra de Microbiología, UdelaR Montevideo, Uruguay.
authors.forename: N
authors.initials: N
authors.lastname: Echeverría
authors.affiliation: Facultad de Química-UdelaR, Cátedra de Microbiología, UdelaR Montevideo, Uruguay.
authors.forename: A
authors.initials: A
authors.lastname: Acevedo
authors.affiliation: Dpto Bacteriología y Virología, Instituto de Higiene/Facultad de Medicina-UdelaR Montevideo, Uruguay.
authors.forename: R
authors.initials: R
authors.lastname: Vignoli
authors.affiliation: Dpto Bacteriología y Virología, Instituto de Higiene/Facultad de Medicina-UdelaR Montevideo, Uruguay.
authors.forename: V
authors.initials: V
authors.lastname: García-Fulgueiras
authors.affiliation: Laboratorio Gram/Microbiología, Sanatorio SemmMautone Maldonado, Uruguay.
authors.forename: J
authors.initials: J
authors.lastname: Viroga
authors.affiliation: Laboratorio Gram/Microbiología, Sanatorio SemmMautone Maldonado, Uruguay.
authors.forename: O
authors.initials: O
authors.lastname: Gonzalez
authors.affiliation: Comité de Infecciones, Sanatorio SemmMautone Maldonado, Uruguay.
authors.forename: V
authors.initials: V
authors.lastname: Odizzio
authors.affiliation: Comité de Infecciones, Sanatorio SemmMautone Maldonado, Uruguay.
authors.forename: K
authors.initials: K
authors.lastname: Etulain
authors.affiliation: Unidad de Cuidados Intensivos, Sanatorio SemmMautone Maldonado, Uruguay.
authors.forename: E
authors.initials: E
authors.lastname: Nuñez
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Maciel Montevideo, Uruguay.
authors.forename: H
authors.initials: H
authors.lastname: Albornoz
authors.affiliation: Facultad de Química-UdelaR, Bioquímica Clínica Montevideo, Uruguay.
authors.forename: G
authors.initials: G
authors.lastname: Borthagaray
authors.affiliation: Dpto Microbiología, Hospital Maciel, UDYCI Montevideo, Uruguay.
authors.forename: A
authors.initials: A
authors.lastname: Galiana
keywords: Antibiotic resistance; KPC; infection control