Clonal Dissemination of KPC-2, VIM-1, OXA-48-Producing Klebsiella pneumoniae ST147 in Katowice, Poland

Demographic data and characteristics of the fourteen patients with K. pneumoniae co-producing KPC-2, OXA-48, VIM-1 and CTX-M-15 during the outbreak.

Patient ID/Isolate no.	Age (years)/sex	Hospital ward(s)	Date of isolation	Type of specimen	Status (type) of colonization/infection	Duration of hospitalization (days)	Underlying conditions	Antimicrobial used prior to isolation of carbapenemase producer(s)	Antimicrobial used as treatment for infections	Outcome Alive/Dead
3	74/M	OAIT	08/03/2018	Rectal swab	Colonization	03/01-14/04/2018 (102 days)	Abdominal Aortic Aneurysm (AAA)	Ciprofloxacin + Gentamycin + Itraconazole	Metronidazole	Dead
6965	60/F	OAIT	28/02/2018	Rectal swab	Colonization	08/02-01/04/2018 (53 days)	Tuberculosis, Chronic Obstructive Pulmonary Disease (COPD)	Colistin + Voriconazole	–	Dead
6976/1 6976/2	45/M	OAIT	01/03/2018 12/03/2018	Rectal swab Blood	Colonization Bacteremia	21/02-29/03/2018 (37 days)	Guillain-Barré Syndrome (GBS)	Colistin + Linezolid	Ampicillin/sulbactam + Amikacin	Alive
1	67/F	OAIT	07/03/2018	Rectal swab	Colonization	02/03-29/06/2018 (112 days)	COPD, diabetes, hypertension	Ceftriaxone + Levofloxacin	–	Dead
6968 (index case)	63/M	NR	28/02/2018	Rectal swab	Colonization	16/02-31/03/2018 (44 days)	Hypertension, atherosclerosis	Ceftriaxone + Metronidazole	–	Alive
2	69/M	NR	07/03/2018	Rectal swab	Colonization	23/02-28/03/2018 (34 days)	Post-stroke conditions	–	–	Alive
4	43/M	NR	08/03/2018	Rectal swab	Colonization	26/02-12/03/2018 (15 days)	Hypertension	Ceftriaxone + Metronidazole	–	Dead
154/25428	61/M	NR	30/07/2018	Rectal swab	Colonization	04/07-06/08/2018 (34 days)	Stroke	–	–	Dead
7/25804	70/M	NR	04/08/2018	Rectal swab	Colonization	25/07-02/08/2018 (9 days)	Stroke	Amoxicillin/clavulanic acid	–	Alive
11/25808	50/F	NR	04/08/2018	Rectal swab	Colonization	23/07-03/08/2018 (12 days)	Stroke	–	–	Alive
13/25810	77/M	NR	04/08/2018	Rectal swab	Colonization	22/07-09/08/2018 (19 days)	Hypertension, ischemic heart disease	Amoxicillin/clavulanic acid	–	Alive
6	70/F	REU	09/03/2018	Rectal swab	Colonization	26/02-14/03/2018 (17 days)	Diabetes, metastatic lung cancer	–	–	Alive
7	78/F	REU	09/03/2018	Rectal swab	Colonization	27/02-16/03/2018(18 days)	Rheumatoid Arthritis (RA), hemorrhagic diathesis, coronary disease, peptic ulcer disease, hypertension, atherosclerosis, gout	Imipenem	Vancomycin	Alive
5	90/F	REU	08/03/2018	Rectal swab	Colonization	03.03-17.03.2018 (14 days)	Atherosclerosis, acute arterial thrombosis of the lower extremity	Meropenem + Amikacin	–	Alive

1 F – Female; M – male; NR – Department of Neurology with the Stroke Subdepartment; OAIT – Department of Anaesthesiology and Intensive Care; REU – Department of Internal Medicine and Rheumatology

Gantt diagram depicting a timeline of patients’ admissions in relationship with the three wards and the length of stay in each ward. Epidemic curve based on the number of *K. pneumoniae* isolated in the time frame of the study.
Abbreviations: OAIT-Department of Anaesthesia and Intensive Care, NR-Department of Neurology with the Stroke Subdepartment, REU-Department of Internal Medicine and Rheumatology.

Table II

Antimicrobial resistance profiles of the studied K. pneumoniae isolates.

Patient ID/Isolate no.		3		6965		6976/1		6976/2		1		6968		2		4		154/25428		7/25804		11/25808		13/25810		6		7		5
Antibiotics:		MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S	MIC (pg/ml)	R/I/S
Penicillins	Amoxicillin/Clavulanic acid	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
Penicillins	Ampicillin	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
Cephalosporins	Cefaclor	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
	Cefuroxime	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
	Cefotaxime	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
	Cefotaxime/Cefotaxime + clavulanic acid	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R	>16/>1	R
	Ceftazidime	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
	Ceftazidime/Ceftazidime + clavulanic acid	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R	>34/>4	R
	Cefepime	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
Carbapenems	Doripenem	>32	R	16	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R
	Ertapenem	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R
	Imipenem	>32	R	>32	R	16	R	16	R	>32	R	>32	R	>32	R	>32	R	>12	R	4	S	4	S	8	I	>32	R	>32	R	>32	R
	Meropenem	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R
Quinolone	Ciprofloxacin	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R
Aminoglycosides	Amikacin	4	S	8	S	32	R	32	R	8	S	12	R	6	S	4	S	8	S	8	S	8	S	8	S	12	R	6	S	6	S
	Gentamycin	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R	64	R
	Netylmycin	128	R	4	I	64	R	64	R	128	R	32	R	16	R	16	R	12	R	16	R	16	R	16	R	32	R	16	R	16	R
	Tobramycin	64	R	64	R	32	R	32	R	64	R	64	R	64	R	64	R	32	R	64	R	64	R	64	R	64	R	64	R	64	R
Other	Aztreonam	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R
	Colistin	0.50	S	0.75	S	0.125	S	0.125	S	0.50	S	0.50	S	0.50	S	0.50	S	0.50	S	0.50	S	0.75	S	0.50	S	0.50	S	0.50	S	0.50	S
	Tetracycline	32	R	128	R	8	R	8	R	32	R	32	R	32	R	8	R	>256	R	>256	R	>256	R	>256	R	8	R	8	R	128	R
	Tigecycline	2	R	8	R	4	R	4	R	2	R	2	R	2	R	4	R	0.75	R	0.75	R	1.0	R	2	R	4	R	4	R	8	R
	Trimethoprim/Sulfamethoxazole	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R	>32	R
	Fosfomycin	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	>256	R	R>256	R	>256	R	>256	R	>256	R	>256	R

2 MIC – Minimum Inhibitory Concentration; R – Resistant; I – Susceptible, increased exposure; S – Susceptible

Dendrogram of *Xba*I-digested genomic DNA from carbapenemase-co-producing *K. pneumoniae* isolates, additionally presenting the results of PCRs for genes encoding carbapenemases and other β-lactamase. PFGE settings: similarity coefficient, Dice; optimization, 1%; tolerance, 1%; clustering method, UPGMA.

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DOI: https://doi.org/10.33073/pjm-2021-010 | Journal eISSN: 2544-4646 | Journal ISSN: 1733-1331

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Language: English

Page range: 107 - 116

Submitted on: Oct 27, 2020

Accepted on: Feb 8, 2021

Published on: Mar 19, 2021

Published by: Polish Society of Microbiologists

In partnership with: Paradigm Publishing Services

Publication frequency: 4 issues per year

Keywords:

clonal dissemination,

carbapenem-resistant Klebsiella pneumoniae,

hospital,

PFGE,

MLST

Related subjects:

Life sciences,

Microbiology and virology

© 2021 DOROTA OCHOŃSKA, HANNA KLAMIŃSKA-CEBULA, ANNA DOBRUT, MAŁGORZATA BULANDA, MONIKA BRZYCHCZY-WŁOCH, published by Polish Society of Microbiologists
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 License.

Volume 70 (2021): Issue 1 (March 2021)

Clonal Dissemination of KPC-2, VIM-1, OXA-48-Producing Klebsiella pneumoniae ST147 in Katowice, Poland

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Table I

Fig. 1.

Table II

Fig. 2.

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