TY - JOUR
TI - Hospital outbreak due to a Klebsiella pneumoniae ST147 clonal strain co-producing KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital in Northern Greece
AU - Protonotariou, E.
AU - Poulou, A.
AU - Politi, L.
AU - Sgouropoulos, I.
AU - Metallidis, S.
AU - Kachrimanidou, M.
AU - Pournaras, S.
AU - Tsakris, A.
AU - Skoura, L.
JO - International Journal of Antimicrobial Agents
PY - 2018
VL - 52
TODO - 3
SP - 331-337
PB - Elsevier B.V.
SN - 0924-8579
TODO - 10.1016/j.ijantimicag.2018.04.004
TODO - amikacin;  aztreonam;  beta lactamase TEM 1;  carbapenem;  cefepime;  cefoxitin;  ceftriaxone;  ciprofloxacin;  colistin;  cotrimoxazole;  gentamicin;  meropenem;  piperacillin plus tazobactam;  tigecycline;  tobramycin;  antiinfective agent;  bacterial protein;  beta lactamase;  beta-lactamase KPC-2, Klebsiella pneumoniae;  carbapenemase;  OmpK35 porin, Klebsiella pneumoniae;  OmpK36 protein, Klebsiella pneumoniae;  porin;  VIM-1 metallo-beta-lactamase, adult;  aged;  antibiotic resistance;  Article;  bacterial gene;  bacterial strain;  bla KPC 2 gene;  bla TEM 1 gene;  bla VIM 1 gene;  bloodstream infection;  clinical article;  epidemic;  female;  gene loss;  genotype;  Greece;  hand washing;  human;  infection control;  intensive care unit;  Klebsiella pneumoniae;  Klebsiella pneumoniae infection;  male;  middle aged;  minimum inhibitory concentration;  monotherapy;  mortality rate;  multilocus sequence typing;  nonhuman;  plasmid;  priority journal;  pulsed field gel electrophoresis;  sequence analysis;  stop codon;  teaching hospital;  tertiary care center;  very elderly;  bacteremia;  drug effect;  epidemic;  genetics;  isolation and purification;  Klebsiella infection;  Klebsiella pneumoniae;  metabolism;  microbial sensitivity test;  microbiology;  multidrug resistance, Adult;  Aged;  Aged, 80 and over;  Anti-Bacterial Agents;  Bacteremia;  Bacterial Proteins;  beta-Lactamases;  Disease Outbreaks;  Drug Resistance, Multiple, Bacterial;  Female;  Greece;  Hospitals, Teaching;  Humans;  Intensive Care Units;  Klebsiella Infections;  Klebsiella pneumoniae;  Male;  Microbial Sensitivity Tests;  Middle Aged;  Multilocus Sequence Typing;  Porins;  Tertiary Care Centers
TODO - Here we present the characteristics of a large outbreak caused by a clonal Klebsiella pneumoniae strain producing both KPC-2 and VIM-1 carbapenemases in a tertiary teaching hospital. Between January 2013 and January 2015, 45 carbapenem-resistant K. pneumoniae isolates that gave a positive modified Hodge test and were phenotypically suspected of metallo-β-lactamase (MBL) and K. pneumoniae carbapenemase (KPC) co-production were recovered from 25 patients hospitalised in AHEPA University Hospital (Thessaloniki, Greece). All of the patients were hospitalised in the three intensive care units of the hospital and 17 (68%) of them developed bloodstream infections; the overall mortality of the patients involved in the outbreak was 48% (12/25). Molecular testing verified that all 45 K. pneumoniae isolates co-harboured blaKPC-2 and blaVIM-1 genes and were associated with OmpK35 deficiency and OmpK36 porin loss. The blaTEM-1 gene was also present in 18 isolates. Pulsed-field gel electrophoresis (PFGE) clustered all of the isolates into a single clonal type, and multilocus sequence typing (MLST) assigned them to the emerging high-risk ST147 clonal lineage. Following recognition of the outbreak, infection control measures were implemented in the affected areas. The outbreak continued for ca. 2 years and since then only sporadic cases of K. pneumoniae harbouring both carbapenemases have been detected. © 2018 Elsevier Ltd
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