title: Clonal Spread of Colistin-Resistant Klebsiella pneumoniae Coproducing KPC and VIM Carbapenemases in Neonates at a Tunisian University Hospital.
abstract: In this study, we have attempted to report the first clonal spread of colistin-resistant Klebsiella pneumoniae coproducing KPC and VIM carbapenemases in the neonatal unit of Rabta Teaching Hospital of Tunis (Tunisia). This retrospective study was performed from January 1, 2014 to December 31, 2014 in the Microbiology Laboratory at the Rabta University Hospital of Tunis. Twenty-one nonreplicate colistin-resistant K. pneumoniae were isolated from 19 patients hospitalized in the neonatal unit and 2 patients in the adult intensive care unit (ICU). Most of the strains were isolated from invasive specimens. Pulsed-field gel electrophoresis (PFGE) and PCR analysis and nucleotide sequencing of the blaKPC and blaVIM genes were performed. Mortality was reported in 92% of cases. All the strains were resistant to colistin (minimum inhibitory concentration [MICs] ranged from 8 to 12 mg/L). The MICs for imipenem of K. pneumoniae isolates ranged from 3 to 256 mg/L for 13 strains that were characterized as intermediate or resistant. The MICs for ertapenem were higher than 32 mg/L for the 19 resistant strains. All the isolates were sensitive to tigecycline and chloramphenicol. PFGE analysis revealed two clones (I and II). Twenty of the 21 colistin-resistant, carbapenem-resistant K. pneumoniae isolates belonged to clone I. Only one strain was related to clone II. PCR analysis and nucleotide sequencing revealed that the 20 isolates belonged to clone I, coproduced the blaKPC and blaVIM genes. A single strain (clone II), which was isolated in the ICU, did not produce KPC and VIM carbapenemases. All strains did not produce OXA-48.
authors: 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia .
authors: Hajer
authors: H
authors: Battikh
authors: 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia .
authors: Chiraz
authors: C
authors: Harchay
authors: 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia .
authors: Amal
authors: A
authors: Dekhili
authors: 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia .
authors: Khaoula
authors: K
authors: Khazar
authors: 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia .
authors: Fehima
authors: F
authors: Kechrid
authors: 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia .
authors: Meriem
authors: M
authors: Zribi
authors: 2 Neonatal Unit, Rabta Teaching Hospital , Tunis, Tunisia .
authors: Afef
authors: A
authors: Masmoudi
authors: 1 Microbiology Laboratory, Rabta University Hospital , Tunis, Tunisia .
authors: Chedlia
authors: C
authors: Fendri
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000096:biosynthesis* / Q000235:genetics; D015373:Bacterial Typing Techniques; D002701:Chloramphenicol / Q000494:pharmacology; D002999:Clone Cells; D003091:Colistin / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial / Q000235:genetics*; D016521:Electrophoresis, Gel, Pulsed-Field; D000077727:Ertapenem; D005260:Female; D015870:Gene Expression; D006785:Hospitals, University; D006801:Humans; D015378:Imipenem / Q000494:pharmacology; D007231:Infant, Newborn; D007710:Klebsiella Infections / Q000188:drug therapy / Q000382:microbiology* / Q000401:mortality / Q000473:pathology; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects / Q000201:enzymology* / Q000235:genetics; D008297:Male; D008911:Minocycline / Q000031:analogs & derivatives / Q000494:pharmacology; D012189:Retrospective Studies; D016019:Survival Analysis; D000078304:Tigecycline; D014416:Tunisia; D001618:beta-Lactamases / Q000096:biosynthesis* / Q000235:genetics; D047090:beta-Lactams / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D047090:beta-Lactams; D002701:Chloramphenicol; D000078304:Tigecycline; D015378:Imipenem; D001618:beta-Lactamases; C063912:carbapenemase; D008911:Minocycline; D000077727:Ertapenem; D003091:Colistin
keywords: KPC; VIM; colistin resistant