Journal
ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
Volume 56, Issue 1, Pages 420-427Publisher
AMER SOC MICROBIOLOGY
DOI: 10.1128/AAC.05036-11
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Funding
- Ministerio de Ciencia e Innovacion, Instituto de Salud Carlos III
- Spanish Network for Research in Infectious Diseases [REIPI C03/14, REIPI RD06/0008]
- Fondo de Investigaciones Sanitarias [FIS PI09/917]
- Instituto de Salud Carlos III [MPY 022/09]
- Direccion General de Salud Publica, Ministry of Health, Spain [DGVI 1409/10 TS 15]
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We study the epidemiology, molecular basis, clinical risk factors, and outcome involved in the clonal dissemination of VIM-1-producing Klebsiella pneumoniae isolates in the hospital setting. All patients infected/colonized by carbapenem-nonsusceptible K. pneumoniae (CNSKP) in 2009 were included. Molecular epidemiology was studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Antibiotic resistance genes were analyzed by PCR and sequencing. Plasmids were studied by PFGE with S1 nuclease digestion and for incompatibility group by a PCR-based replicon typing scheme. Risk factors associated with CNSKP colonization/infection were assessed by an observational case-control study. All 55 patients studied were infected (n = 28) or colonized ( n = 27) by VIM-1-producing K. pneumoniae. All but one acquired isolates of a single clone ( PFGE cluster 1 [C1], sequence type 15 [ST15]), while another clone ( PFGE C2, ST340) was detected in four patients. C1 isolates also produced the new extended-spectrum beta-lactamase SHV-134. bla(VIM-1) was carried in a class 1 integron and an untypeable plasmid of similar to 50 bp. The number of days that the patient received mechanical ventilation, the use of parenteral nutrition, previous treatment with linezolid, and treatment with extended-spectrum cephalosporins for more than 7 days were detected to be independent risk factors for CNSKP acquisition. The VIM-1-producing K. pneumoniae ST15 clone has a high capacity to spread among intensive care unit patients with severe underlying conditions. A high rate of associated mortality and great difficulty in controlling the spread of this clone, without permanent behavioral changes in the personnel, were observed.
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