title: Clonal dissemination of multilocus sequence type ST15 KPC-2-producing Klebsiella pneumoniae in Bulgaria.
abstract: A total of 36 consecutive clinical and two fecal-screening carbapenem-resistant Klebsiella pneumoniae isolates from two Bulgarian university hospitals (Varna and Pleven) were investigated. Susceptibility testing, conjugation experiments, and plasmid replicon typing were carried out. Beta-lactamases were characterized by isoelectric focusing, PCR, and sequencing. Clonal relatedness was investigated by RAPD and multilocus sequence typing (MLST). Most of the isolates demonstrated multidrug resistance profile. Amikacin and tigecycline retained good activity with susceptibility rates of 95 and 87%, respectively. The resistance rate to colistin was 63%. Six RAPD- and MLST-types were identified: the dominating MLST-type was ST15 (27 isolates), followed by ST76 (six isolates), and ST1350 (two isolates). ST101, ST258, and ST151 were detected once. All except one of the K. pneumoniae produced KPC-2, mostly in combination with CTX-M-15, while for one isolate (ST101) the enzymes OXA-48 and CTX-M-14 were found. All KPC-2-producing transconjugants revealed the presence of IncFII plasmid. The OXA-48- and CTX-M-14-producing isolate showed the presence of L/M replicon type. The dissemination of KPC-2-producing K.pneumoniae in Bulgaria is mainly due to the sustained spread of successful ST15 clone and to a lesser extent of ST76 clone. This is the first report of OXA-48 producing ST101 K. pneumoniae in Bulgaria.
authors: Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria.
authors: Rumyana
authors: R
authors: Markovska
authors: Department of Microbiology, Medical University of Varna, Varna, Bulgaria.
authors: Temenuga
authors: T
authors: Stoeva
authors: MICOER, Munich, Germany.
authors: Ines
authors: I
authors: Schneider
authors: Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria.
authors: Lyudmila
authors: L
authors: Boyanova
authors: Pleven University Hospital, Pleven, Bulgaria.
authors: Valentina
authors: V
authors: Popova
authors: Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria.
authors: Daniela
authors: D
authors: Dacheva
authors: Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria.
authors: Radka
authors: R
authors: Kaneva
authors: MICOER, Munich, Germany.
authors: Adolf
authors: A
authors: Bauernfeind
authors: Molecular Medicine Center, Medical University of Sofia, Sofia, Bulgaria.
authors: Vanyo
authors: V
authors: Mitev
authors: Department of Medical Microbiology, Medical University of Sofia, Sofia, Bulgaria.
authors: Ivan
authors: I
authors: Mitov
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002031:Bulgaria; D015780:Carbapenems / Q000627:therapeutic use*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics; D016521:Electrophoresis, Gel, Pulsed-Field / Q000379:methods; D006801:Humans; D007710:Klebsiella Infections / Q000175:diagnosis / Q000188:drug therapy*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000235:genetics* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D058885:Multilocus Sequence Typing / Q000379:methods; D010957:Plasmids / Q000235:genetics; D019105:Random Amplified Polymorphic DNA Technique / Q000379:methods; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems; C456080:beta-lactamase CTX-M-14; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases; C547585:beta-lactamase KPC-2, Klebsiella pneumoniae; C108449:oxacillinase
keywords: Bulgaria; KPC-2; Klebsiella pneumoniae; OXA-48; ST15