title: Emergence of Escherichia coli Sequence Type 131 (ST131) and ST3948 with KPC-2, KPC-3 and KPC-8 carbapenemases from a Long-Term Care and Rehabilitation Facility (LTCRF) in Northern Italy.
abstract: Aim of the study was to characterize KPC-producing Escherichia coli (KPC-Ec) clinical isolates among a Northern Italy Long-Term Care and Rehabilitation Facility (LTCRF) residents. Thirteen consecutive non repeated MDR E. coli isolates showing ertapenem Minimum Inhibitory Concentrations (MICs) >0.5 mg/L, collected during the period March 2011 - May 2013 from ASP "Redaelli" inpatients, were investigated. The bla KPC/CTX-M/SHV/TEM/OXA genes were identified by PCR and sequencing. KPC-Ec isolates underwent phylotyping, Pulsed-Field Gel Electrophoresis (PFGE), multilocus sequence typing (MLST) and repetitive sequence-based PCR (rep-PCR) profiling. Incompatibility groups analysis and conjugation were also performed. Eleven out of 13 isolates, resulted bla KPC-type positive, were consistently resistant to third generation cephalosporins, fluoroquinolones and trimethoprim-sulphametoxazole (84.6 %), retaining susceptibility to colistin (EUCAST guidelines). At least n = 4/11 of KPC-Ec patients received ≥48 h of meropenem therapy. Sequencing identified 9 bla KPC-2, 1 bla KPC-3 and 1 bla KPC-8 determinants. KPC-Ec plasmids belonged to IncF group (FIIk replicon); conjugation confirmed bla KPC/TEM-1/OXA-9 genes transferability for 10 KPC-Ec. Although three pulsotypes (A, B, C) were identified, all KPC-Ec belonged to phylogenetic group B2. Clone B (B-B5) caused an outbreak of infection involving nine inpatients at five wards. Rep-PCR showed relatedness for seven representative KPC-Ec isolates. Here we report a LTCRF outbreak caused by a ST131-B2 E. coli associated with bla KPC-2 and bla KPC-8 genes, and the emergence of the new ST3948. Elderly people with co-morbidities are at risk for ST131 colonization. KPC-Ec clones local monitoring appears essential both to avoid their spreading among healthcare settings, and to improve therapeutic choices for LTCRF residents.
authors.affiliation: Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy.
authors.forename: Aurora
authors.initials: A
authors.lastname: Piazza
authors.affiliation: Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy.
authors.forename: Mariasofia
authors.initials: M
authors.lastname: Caltagirone
authors.affiliation: Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Bitar
authors.affiliation: Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy.
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Nucleo
authors.affiliation: Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy.
authors.forename: Melissa
authors.initials: M
authors.lastname: Spalla
authors.affiliation: ASP "Golgi-Redaelli", via Bartolomeo d'Alviano 78, 20146, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Fogato
authors.affiliation: ASP "Golgi-Redaelli", via Bartolomeo d'Alviano 78, 20146, Milan, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: D'Angelo
authors.affiliation: Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Pagani
authors.affiliation: Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy. r.miglia@unipv.it.
authors.forename: Roberta
authors.initials: R
authors.lastname: Migliavacca
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D021821:Communicable Diseases, Emerging / Q000453:epidemiology / Q000382:microbiology*; D004926:Escherichia coli / Q000145:classification / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D029968:Escherichia coli Proteins / Q000235:genetics / Q000378:metabolism*; D005260:Female; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008297:Male; D058885:Multilocus Sequence Typing; D010802:Phylogeny; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012866:Skilled Nursing Facilities / Q000706:statistics & numerical data; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D029968:Escherichia coli Proteins; D001618:beta-Lactamases; C063912:carbapenemase
keywords: KPC-positive E. coli; Long-Term Care and Rehabilitation Facility; ST3948; Sequence Type 131 (ST131)