title: Emergence of blaKPC carbapenemase genes in Australia.
abstract: blaKPC genes encoding resistance to carbapenems are increasingly widely reported and are now endemic in parts of several countries, but only one Klebsiella pneumoniae isolate carrying blaKPC-2 had previously been reported in Australia, in 2010. Here we characterised this isolate, six additional K. pneumoniae and one Escherichia coli carrying blaKPC and another K. pneumoniae lacking blaKPC, all isolated in Australia in 2012. Seven K. pneumoniae belonged to clonal complex (CC) 292, associated with blaKPC in several countries. Five with blaKPC-2 plus the isolate lacking a blaKPC gene were sequence type 258 (ST258) and the seventh was the closely related ST512 with blaKPC-3. The eighth K. pneumoniae isolate, novel ST1048, and the E. coli (ST131) also carried blaKPC-2. blaKPC genes were associated with the most common Tn4401a variant, which gives the highest levels of expression, in all isolates. The ST258 isolates appeared to share a similar set of plasmids, with IncFIIK, IncX3 and ColE-type plasmids identified in most isolates. All K. pneumoniae isolates had a characteristic insertion in the ompK35 gene resulting in a frameshift and early termination, but only the ST512 isolate had a GlyAsp insertion in loop 3 of OmpK36 that may contribute to increased resistance. The clinical epidemiology of blaKPC emergence in Australia thus appears to reflect the global dominance of K. pneumoniae CC292 (and perhaps E. coli ST131). Some, but not all, patients carrying these isolates had previously been hospitalised outside Australia, suggesting multiple discrete importation events of closely related strains, as well as undetected nosocomial spread.
authors.affiliation: Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Westmead Millennium Institute, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia.
authors.forename: Sally R
authors.initials: SR
authors.lastname: Partridge
authors.affiliation: Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Westmead Millennium Institute, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia.
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Ginn
authors.affiliation: Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Agnieszka M
authors.initials: AM
authors.lastname: Wiklendt
authors.affiliation: Centre for Infectious Diseases and Microbiology Laboratory Services, Westmead Hospital, Westmead, NSW, Australia.
authors.forename: Justin
authors.initials: J
authors.lastname: Ellem
authors.affiliation: Dorevitch Pathology, Department of Microbiology, Footscray, Vic., Australia.
authors.forename: Jenny S J
authors.initials: JS
authors.lastname: Wong
authors.affiliation: Department of Microbiology, Royal Perth Hospital, Perth, WA, Australia; School of Pathology and Laboratory Medicine, University of Western Australia, Perth, WA, Australia.
authors.forename: Paul
authors.initials: P
authors.lastname: Ingram
authors.affiliation: Department of Infectious Diseases, Western Health, Footscray, Vic., Australia.
authors.forename: Stephen
authors.initials: S
authors.lastname: Guy
authors.affiliation: Dorevitch Pathology, Department of Microbiology, Heidelberg, Vic., Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Garner
authors.affiliation: Centre for Infectious Diseases and Microbiology, University of Sydney, Westmead Hospital, Westmead, NSW, Australia; Westmead Millennium Institute, Westmead, NSW, Australia; Marie Bashir Institute for Infectious Diseases and Biosecurity, University of Sydney, Sydney, NSW, Australia. Electronic address: jonathan.iredell@sydney.edu.au.
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Iredell
mesh_terms: D001426:Bacterial Proteins / Q000235:genetics*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field; D005798:Genes, Bacterial; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects / Q000201:enzymology / Q000235:genetics*; D060885:Multiplex Polymerase Chain Reaction; D009517:New South Wales; D010957:Plasmids; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: K. pneumoniae; Plasmid; ST258; bla(KPC); ompk