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A novel KPC-166 in ceftazidime/avibactam resistant ST307 Klebsiella pneumoniae causing an outbreak in intensive care COVID Unit, Italy.
Piazza, Aurora; Mattioni Marchetti, Vittoria; Bielli, Alessandra; Biffignandi, Gherard Batisti; Piscopiello, Francesca; Giudici, Riccardo; Tartaglione, Livia; Merli, Marco; Vismara, Chiara; Migliavacca, Roberta.
Afiliación
  • Piazza A; Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy. Electronic address: aurora.piazza@unipv.it.
  • Mattioni Marchetti V; Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy. Electronic address: vittoria.mattionimarchetti@unipv.it.
  • Bielli A; Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Electronic address: alessandra.bielli@ospedaleniguarda.it.
  • Biffignandi GB; Department of Biology and Biotechnology "L. Spallanzani", University of Pavia, Pavia, Italy. Electronic address: gherard.batistibiffign01@universitadipavia.it.
  • Piscopiello F; Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy. Electronic address: francesca.piscopiello@unipv.it.
  • Giudici R; Department of Anesthesia and Critical Care, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Electronic address: riccardo.giudici@gmail.com.
  • Tartaglione L; Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Electronic address: Livia.Tartaglione@ospedaleniguarda.it.
  • Merli M; Infectious Diseases Clinic, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Electronic address: marco.merli@ospedaleniguarda.it.
  • Vismara C; Chemical-clinical and Microbiological Analysis, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy. Electronic address: chiara.vismara@ospedaleniguarda.it.
  • Migliavacca R; Unit of Microbiology and Clinical Microbiology, Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy. Electronic address: roberta.migliavacca@unipv.it.
J Microbiol Immunol Infect ; 57(3): 457-469, 2024 Jun.
Article en En | MEDLINE | ID: mdl-38584042
ABSTRACT

INTRODUCTION:

Aim of the study was the molecular characterization of 21 ceftazidime/avibactam resistant (CZA-R) Klebsiella pneumoniae strains, collected in the period October 2021-March 2022 from an Intensive Care COVID Unit in a Northern Italian Hospital.

METHODS:

After growth on selective/chromogenic culture media and susceptibility tests assessment, resistance genes content was ascertained for all the isolates by the HybriSpot 12 multiplexing, PCR and Whole-Genome Sequencing (WGS). Clonality was assessed by PFGE and MLST according to the Pasteur scheme. A SNPs-based phylogenetic tree was obtained comparing representative isolates and global genomes. The blaKPC gene horizontal transmission was evaluated by conjugation experiments. blaKPC-166 was cloned in a pCR2.1 vector and transformed in chemically competent TOP10 cells.

RESULTS:

Sixteen inpatients resulted positive for colonization and/or infection by KPC-producing K. pneumoniae (KPC-Kp) strains. The 21 CZA-R KPC-Kp isolates obtained showed MDR phenotype; susceptibility to meropenem was always retained. All the CZA-R KPC-Kp presented a novel blaKPC variant, named blaKPC-166, showing a single nucleotide substitution (T811C) compared to the blaKPC-94; but related to blaKPC-2. TWO DIFFERENT PULSOTYPES WERE DETECTED A in 18/21 and B in 1/21 cases, two strains from the same patient being untypable by PFGE. Interestingly, the outbreak was sustained by the high-risk clone ST307, although the ST22, ST6342, ST6418 and ST6811 have also been identified and associated to KPC-166. Worryingly, blaKPC-166 could be transferred horizontally and, after cloning, it conferred resistance to CZA.

DISCUSSION:

This novel variant confers CZA-resistance and carbapenems susceptibility restoration. As KPC-166 was found expressed by multiple Kp clones, greater efforts should be made to prevent the further dissemination of such strains in Italian clinical settings.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Beta-Lactamasas / Infecciones por Klebsiella / Pruebas de Sensibilidad Microbiana / Ceftazidima / Brotes de Enfermedades / Combinación de Medicamentos / Compuestos de Azabiciclo / Unidades de Cuidados Intensivos / Klebsiella pneumoniae / Antibacterianos Límite: Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: J Microbiol Immunol Infect Asunto de la revista: ALERGIA E IMUNOLOGIA / MICROBIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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XML
PubMed Links
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Beta-Lactamasas / Infecciones por Klebsiella / Pruebas de Sensibilidad Microbiana / Ceftazidima / Brotes de Enfermedades / Combinación de Medicamentos / Compuestos de Azabiciclo / Unidades de Cuidados Intensivos / Klebsiella pneumoniae / Antibacterianos Límite: Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: J Microbiol Immunol Infect Asunto de la revista: ALERGIA E IMUNOLOGIA / MICROBIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Reino Unido