title: High-level carbapenem-resistant OXA-48-producing Klebsiella pneumoniae with a novel OmpK36 variant and low-level, carbapenem-resistant, non-porin-deficient, OXA-181-producing Escherichia coli from Thailand.
abstract: Five blaOXA-48-like-carrying Enterobacteriaceae isolates collected from two Thai patients in December 2012 were characterized. Three Klebsiella pneumoniae isolates giving two different pulsed-field gel electrophoresis patterns and sequence types (ST11 and ST37) from patient 1 harbored blaOXA-48 locating on Tn1999.2, whereas two Escherichia coli isolates with the same pulsotype and ST5 from Patient 2 carried ISEcp1-associated blaOXA-181. One K. pneumoniae strain had blaSHV-12, blaDHA-1, qnrB, and qnrS, while another strain harbored blaCTX-M-15, qnrS and aac(6')-Ib-cr. The E. coli strain contained blaCTX-M-15, blaCMY-2, qnrS, and aac(6')-Ib-cr. Interestingly, the OXA-48 producers with a novel OmpK36 variant by a substitution of Gly to Asp in the L3 loop-borne PEFXG motif exhibited high-level resistance to ertapenem, imipenem, and meropenem. In contrast, the OXA-181 producer with non-porin-deficient background showed low-level resistance to ertapenem only. Both patients died because of either septic shock or pneumonia. This study showed the impact of OXA-48-like carbapenemases in porin-defective clinical isolate background, which may lead to serious therapeutic problems in the near future.
authors.affiliation: Graduate School, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Kamonwan
authors.initials: K
authors.lastname: Lunha
authors.affiliation: Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand. Electronic address: aroonwad@kku.ac.th.
authors.forename: Aroonwadee
authors.initials: A
authors.lastname: Chanawong
authors.affiliation: Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Aroonlug
authors.initials: A
authors.lastname: Lulitanond
authors.affiliation: Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Chotechana
authors.initials: C
authors.lastname: Wilailuckana
authors.affiliation: Centre for Research and Development of Medical Diagnostic Laboratories, Faculty of Associated Medical Sciences, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Nicha
authors.initials: N
authors.lastname: Charoensri
authors.affiliation: Clinical Microbiology Unit, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Lumyai
authors.initials: L
authors.lastname: Wonglakorn
authors.affiliation: Clinical Microbiology Unit, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Pimjai
authors.initials: P
authors.lastname: Saenjamla
authors.affiliation: Clinical Microbiology Unit, Srinagarind Hospital, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Prajuab
authors.initials: P
authors.lastname: Chaimanee
authors.affiliation: Research Group for Preventive Technology in Livestock, Department of Veterinary Public Health, Faculty of Veterinary Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Sunpetch
authors.initials: S
authors.lastname: Angkititrakul
authors.affiliation: Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
authors.forename: Ploenchan
authors.initials: P
authors.lastname: Chetchotisakd
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics*; D015780:Carbapenems / Q000494:pharmacology; D004251:DNA Transposable Elements; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D004927:Escherichia coli Infections / Q000382:microbiology*; D029968:Escherichia coli Proteins / Q000235:genetics*; D017809:Fatal Outcome; D005260:Female; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000382:microbiology*; D007711:Klebsiella pneumoniae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D008297:Male; D008875:Middle Aged; D058889:Molecular Typing; D018272:Porins / Q000235:genetics*; D013785:Thailand; D055815:Young Adult; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D004251:DNA Transposable Elements; D029968:Escherichia coli Proteins; C092233:OmpK36 protein, Klebsiella pneumoniae; D018272:Porins; D001618:beta-Lactamases; C000607154:beta-lactamase OXA-181, E coli; C108449:oxacillinase
keywords: Carbapenem resistance; Carbapenemases; Enterobacteriaceae; Porins; Sequence types