Emergence of KPC-producing Klebsiella pneumoniae in Uruguay: infection control and molecular characterization

• Main Authors: C. Marquez, A. Ingold, N. Echeverría, A. Acevedo, R. Vignoli, V. García-Fulgueiras, J. Viroga, O. Gonzalez, V. Odizzio, K. Etulain, E. Nuñez, H. Albornoz, G. Borthagaray, A. Galiana
• Format: Article
• Language: English
• Published: Elsevier 2014-05-01
• Series: New Microbes and New Infections
• Subjects: Antibiotic resistance; infection control; KPC
• Online Access: http://www.sciencedirect.com/science/article/pii/S2052297514500492

We describe the first outbreak of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP), the infection control measures adopted and the shift in resistance patterns of isolates during antibiotic treatment. The ST258 KPC-KP strain exhibited a multiresistant antibiotic phenotype including co-resistance to gentamycin, colistin and tigecycline intermediate susceptibility. Isolates before and after treatment had different behaviour concerning their antibiotic susceptibility and the population analysis profile study. A progressive increase in the aminoglycosides (acquiring amicacin resistance) and β-lactam MICs, and a decreased susceptibility to fosfomycin was observed throughout the administration of combined antimicrobial regimens including meropenem. A high meropenem resistance KPC-KP homogeneous population (MIC 256 Jg/mL), could arise from the meropenem heterogeneous low-level resistance KPC-KP population (MIC 8 Jg/mL), by the selective pressure of the prolonged meropenem therapy. The kpc gene was inserted in a Tn4401 isoform a, and no transconjugants were detected. The core measures adopted were successful to prevent evolution towards resistance dissemination.