title: Outbreak of KPC-3-producing ST15 and ST348 Klebsiella pneumoniae in a Portuguese hospital.
abstract: To date, only a few sporadic cases of infections due to Klebsiella pneumoniae carbapenemase (KPC) producers have been reported in Portugal. Here, we report for the first time an outbreak of K. pneumoniae KPC-3 producers in a tertiary-care hospital during 2013. Twenty-seven ertapenem-resistant K. pneumoniae were identified in patients at a tertiary-care hospital during 2013 isolated predominantly from urine (48·1%) and blood (25·9%) cultures. All isolates were highly resistant to β-lactam antibiotics and most showed intermediate resistance to imipenem. The more frequent β-lactamases were TEM- (77·7%), CTX-M- (70·3%) and KPC-type (66·6%). KPC-3 was identified by sequencing. The bla KPC-3 gene was associated with an IncF plasmid, and efficiently transferred to E. coli J53. Pulsed-field gel electrophoresis typing revealed three clusters of isolates which were further characterized by multi-locus sequence typing as ST11, ST15 and ST348. Ertapenem-resistant ST15 was already in circulation in the hospital, related to expression of OmpK36 modified porin, but the other two sequence types had not been previously found in the hospital. We conclude that the IncF plasmid mediated transfer of KPC-3 in the outbreak and that implementation of carbapenemase gene screening in isolates from patients on admission to hospital is advisable in order to control dissemination of these antimicrobial resistance elements.
authors: Faculdade de Farmácia,Universidade de Coimbra,Portugal.
authors: D
authors: D
authors: Vubil
authors: Faculdade de Farmácia,Universidade de Coimbra,Portugal.
authors: R
authors: R
authors: Figueiredo
authors: Centro Hospitalar e Universitário de Coimbra,Portugal.
authors: T
authors: T
authors: Reis
authors: Centro Hospitalar e Universitário de Coimbra,Portugal.
authors: C
authors: C
authors: Canha
authors: Centro Hospitalar e Universitário de Coimbra,Portugal.
authors: L
authors: L
authors: Boaventura
authors: Faculdade de Farmácia,Universidade de Coimbra,Portugal.
authors: G J
authors: GJ
authors: DA Silva
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D001769:Blood / Q000382:microbiology; D016000:Cluster Analysis; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D016521:Electrophoresis, Gel, Pulsed-Field; D004926:Escherichia coli / Q000187:drug effects / Q000235:genetics; D022761:Gene Transfer, Horizontal; D005838:Genotype; D006801:Humans; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000201:enzymology* / Q000235:genetics / Q000302:isolation & purification; D058885:Multilocus Sequence Typing; D010957:Plasmids / Q000032:analysis; D011174:Portugal / Q000453:epidemiology; D062606:Tertiary Care Centers; D014556:Urine / Q000382:microbiology; D018440:beta-Lactam Resistance; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D001618:beta-Lactamases; C495220:beta-lactamase KPC-3, Klebsiella pneumoniae
keywords: 
                 β-lactamase KPC-3; Antimicrobial resistance; carbapenemase; epidemiology; outbreak