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Spread of an OmpK36-modified ST15 Klebsiella pneumoniae variant during an outbreak involving multiple carbapenem-resistant Enterobacteriaceae species and clones

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Abstract

We aim to characterise multiple ertapenem-resistant (ERT-R, n = 15) Enterobacteriaceae isolates identified as presumptive carbapenemase producers in a Portuguese hospital in a short period of time (March–July 2010). Antibiotic susceptibility patterns, β-lactamases, genetic relatedness [pulsed-field gel electrophoresis (PFGE), multi-locus sequence typing (MLST)], plasmid content and major enterobacterial porins were investigated. Ertapenem resistance was associated with deficiencies in major porins and, in some cases, extended-spectrum β-lactamase (ESBL) or AmpC β-lactamase production among outbreak and non-outbreak clones. Most isolates (n = 8) corresponded to two ERT-R Klebsiella pneumoniae ST15 PFGE-types: (i) a sporadic variant (Kp-A-ERT, n = 1) presenting a premature stop codon in ompK36 and (ii) an epidemic variant (Kp-B-ERT, n = 7) exhibiting a new OmpK36 porin variant, which differed additionally in plasmid and antibiotic susceptibility profiles. ST14 (n = 1) and ST45 (n = 1) K. pneumoniae, ST131 (n = 1) and ST354 (n = 1) Escherichia coli, Enterobacter asburiae (n = 1), Enterobacter cloacae (n = 1) and Enterobacter aerogenes (n = 1) ERT-R clones were also sporadically detected. Porin changes in these isolates included non-sense mutations [ompK35, ompK36, ompF; minimum inhibitory concentration (MIC) = 4–32 mg/l], IS-mediated porin disruptions (ompK36, ompC; MIC = 12–>32 mg/l) or alterations in the L3 loop (ompK36; MIC = 4–16 mg/l). We describe, for the first time in Portugal, the simultaneous emergence of multiple ERT-R Enterobacteriaceae species and clones in a short period of time. Moreover, our results support that a CTX-M-15-producing ST15 K. pneumoniae with an OmpK36-modified porin might successfully spread in the nosocomial setting.

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Acknowledgements

This work was supported by a Marie Curie Intra European Fellowship within the 7th European Community Framework Programme (grant number PIEF-GA-2009-255512 to A.N.) and by Fundação para a Ciência e Tecnologia (grant number PEst-C/EQB/LA0006/2011). Raquel Branquinho and Filipa Grosso were supported by fellowships from Fundação para a Ciência e Tecnologia de Portugal (grant numbers SFRH/BD/61410/2009 and SFRH/BD/31647/2006, respectively).

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. REQUIMTE, Laboratório de Microbiologia, Faculdade Farmácia, Universidade do Porto, Rua Jorge Viterbo Ferreira, 228, 4050-313, Porto, Portugal

    Â. Novais, C. Rodrigues, R. Branquinho, P. Antunes, F. Grosso & L. Peixe

  2. Laboratório Microbiologia, Hospitais da Universidade de Coimbra, Coimbra, Portugal

    L. Boaventura & G. Ribeiro

  3. Faculdade de Ciências da Nutrição e Alimentação, Universidade do Porto, Porto, Portugal

    P. Antunes

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  1. Â. Novais
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Correspondence to L. Peixe.

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Novais, Â., Rodrigues, C., Branquinho, R. et al. Spread of an OmpK36-modified ST15 Klebsiella pneumoniae variant during an outbreak involving multiple carbapenem-resistant Enterobacteriaceae species and clones. Eur J Clin Microbiol Infect Dis 31, 3057–3063 (2012). https://doi.org/10.1007/s10096-012-1665-z

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