title: A ten-year surveillance study of carbapenemase-producing Klebsiella pneumoniae in a tertiary care Greek university hospital: predominance of KPC- over VIM- or NDM-producing isolates.
abstract: Resistance patterns and carbapenemase gene presence among Klebsiella pneumoniae isolates from the University General Hospital of Patras, Greece during a ten-year period were analysed under a surveillance programme for multi-drug-resistant bacteria. From 2005 to 2014, K. pneumoniae isolates from clinically significant specimens were identified by the Vitek 2 Advanced Expert System. Antibiotic susceptibility testing was performed by the agar disc diffusion method and Etest. The strains were tested for the presence of blaVIM, blaIMP, blaKPC, blaNDM and blaOXA-48 genes by PCR. PFGE of chromosomal Xbal DNA digests was performed. A total of 3449 K. pneumoniae isolates were recovered during the last decade. Among them, 1668 (48 %) were carbapenemase-producing: 1333 (80%) K. pneumoniae carbapenemase (KPC)-, 286 (17%) Verona imipenemase (VIM), 45 (3%) KPC- and VIM-, and four New Delhi metallo-beta-lactamase (NDM)-producing. Their resistance rates to gentamicin, colistin and tigecycline were 41%, 23% and 16%, respectively. VIM-producing K. pneumoniae were isolated in 2005 and since 2008 have been endemic. KPC-producing K. pneumoniae (KPC-Kp) isolates were introduced in 2008 and until now represent the predominant carbapenemase-producing K. pneumoniae in our institution. PFGE of 97 KPC-Kp strains identified three types: A, 84 (87%); B, 11 (11%); and E, two (2%). Eleven co-producing KPC and VIM K. pneumoniae isolates belonged to PFGE B. The four NDM-positives were classified to type F. The number of K. pneumoniae bacteraemias increased during the study period, which may be solely attributed to the increase of carbapenemase-producing isolates. The threat of carbapenemase-producing K. pneumoniae emphasizes the urgent need for implementation of infection control measures and budgetary allocations to infection control.
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Aikaterini
authors.initials: A
authors.lastname: Spyropoulou
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Matthaios
authors.initials: M
authors.lastname: Papadimitriou-Olivgeris
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Christina
authors.initials: C
authors.lastname: Bartzavali
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Sophia
authors.initials: S
authors.lastname: Vamvakopoulou
authors.affiliation: Division of Infectious Diseases, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Markos
authors.initials: M
authors.lastname: Marangos
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Iris
authors.initials: I
authors.lastname: Spiliopoulou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Evangelos D
authors.initials: ED
authors.lastname: Anastassiou
authors.affiliation: Department of Microbiology, School of Medicine, University of Patras, 26504 Rion, Patras, Greece.
authors.forename: Myrto
authors.initials: M
authors.lastname: Christofidou
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial / Q000235:genetics; D015964:Gene Expression Regulation, Bacterial / Q000502:physiology*; D015971:Gene Expression Regulation, Enzymologic / Q000502:physiology; D005838:Genotype; D006115:Greece / Q000453:epidemiology; D006761:Hospitals; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology* / Q000235:genetics; D012189:Retrospective Studies; D013997:Time Factors; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C063912:carbapenemase