Journal Article

Comparison of two carbapenem-resistant <i>Klebsiella pneumoniae</i> clones: from a contained outbreak in a paediatric population and from a national epidemic

Shmuel Benenson, Gabriela Warburg, Carlos Hidalgo-Grass, Violeta Temper, Allon E. Moses, Colin Block and Jacob Strahilevitz

in Journal of Antimicrobial Chemotherapy

Published on behalf of British Society for Antimicrobial Chemotherapy

Volume 67, issue 7, pages 1651-1654
Published in print July 2012 | ISSN: 0305-7453
Published online April 2012 | e-ISSN: 1460-2091 | DOI: http://dx.doi.org/10.1093/jac/dks115
Comparison of two carbapenem-resistant Klebsiella pneumoniae clones: from a contained outbreak in a paediatric population and from a national epidemic

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Objectives

A refractory epidemic of carbapenem-resistant Klebsiella pneumoniae (CRKP) emerged in the adult population at our hospital in 2005, as in most Israeli hospitals. Contemporaneously, a different clone of CRKP caused an easily contained outbreak in a paediatric long-term care facility (LTCF) in Jerusalem. While previously identified host-related risk factors for colonization by these organisms undoubtedly contributed to these outbreaks, it is very likely that bacterial factors might be crucial in explaining the striking differences in transmissibility between the implicated strains. We therefore sought bacterial factors associated with these different epidemiological behaviours.

Methods

Seven CRKP isolated at our hospital and the LTCF during 2008–09 were examined by antimicrobial susceptibility testing and PFGE, and further analyses of these two clones was done using multilocus sequence typing and competition experiments. Plasmids were analysed by conjugation, restriction mapping, PCR and sequencing.

Results

Both clones were multidrug resistant and harboured identical plasmids carrying the blaKPC-3 gene. The hyper-transmissible epidemic clone carried additional antibiotic resistance genes and hosted an additional plasmid. The clone from the LTCF did not demonstrate hyper-transmissible properties despite its presence in an institution of a type commonly plagued by the epidemic clone. Competition assays showed the more easily contained strain to be fitter.

Conclusions

These findings suggest that neither the presence of the plasmid carrying the blaKPC-3 gene nor relative survival fitness account for the hyper-transmissibility of the epidemic strain. The role of patient age in susceptibility to colonization by the epidemic strain should be investigated.

Keywords: Enterobacteriaceae; carbapenemases; healthcare-associated infections; competition experiments

Journal Article.  1986 words.  Illustrated.

Subjects: Medical Oncology ; Critical Care

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