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Tracking KPC-3-producing ST-258 Klebsiella pneumoniae outbreak in a third-level hospital in Granada (Andalusia,Spain) by risk factors and molecular characteristics
Authors:Soria-Segarra  Carmen  González-Bustos  Pablo  López-Cerero  Lorena  Fernández-Cuenca  Felipe  Rojo-Martín  María Dolores  Fernández-Sierra  María Amelia  Gutiérrez-Fernández  José
Institution:1.Department of Internal Medicine, School of Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
;2.Program in Clinical Medicine and Public Health, University of Granada-Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
;3.Department of Internal Medicine, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria ibs.Granada, Granada, Spain
;4.Department of Microbiology and Infectious Diseases. Laboratorio de Tipado Molecular de Andalucía, Programa PIRASOA, Hospital Virgen Macarena, Seville, Spain
;5.Department of Microbiology, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria - ibs.Granada, Avenida de las Fuerzas Armadas, 2, 18014, Granada, Spain
;6.Department of Preventive Medicine, Hospital Universitario Virgen de las Nieves-Instituto de Investigación Biosanitaria - ibs.Granada, Granada, Spain
;7.Department of Microbiology, School of Medicine, University of Granada-Instituto de Investigación Biosanitaria - ibs.Granada, Granada, Spain
;
Abstract:

The objective of this study was to determine clinical-epidemiological characteristics of the patients and the genetic characteristics of carbapenemase KPC-3-producing Klebsiella pneumoniae isolates belonging to sequence type ST258. The eligible study population was all patients with isolates detected between October 2015 and March 2017. Clinical–epidemiological and microbiological data were gathered on risk factors associated with infection by this clone. Antimicrobial susceptibility was determined using MicroScan system and diffusion in agar. Genes encoding carbapenemases were detected using PCR and Sanger sequencing. The sequence type was assigned by MLST, and the genetic relationship among clinical isolates was determined by pulsed field electrophoresis and by analysis of the genetic environment. The study included 23 individuals with isolates of KPC-3/ST258; the mean age was 77 year, and mean stay pre-isolation was 32 days; 81% received empirical antimicrobial treatment. Isolates were only susceptible to gentamicin (CIM?≤?2 mg/L), tigecycline (CIM?≤?1 mg/L), and colistin (CIM?≤?2 mg/L). The isolates belonged to ST258, with five pulse types or subgroups. All isolates showed amplification of KPC, which was identified as KPC-3 variant. Gene blaKPC-3 was flanked by insertion sequences Kpn6 and Kpn7 within Tn4401 transposon isoform a. We report, for the first time in Spain, an 18-month outbreak by KPC-3-producing ST258 K. pneumoniae. Its acquisition was associated with a history of antimicrobial therapy, with three treatment options, and with high mortality. The detection of different pulse types is attributable to different introductions of the clone in our setting, supporting the need for multi-resistant isolate surveillance studies.

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