Korean J Lab Med.  2011 Oct;31(4):298-301. 10.3343/kjlm.2011.31.4.298.

Isolation of a Klebsiella pneumoniae Isolate of Sequence Type 258 Producing KPC-2 Carbapenemase in Korea

• Roh KH
• Lee CK
• Sohn JW
• Song W
• Yong D
• Lee K

• KMID: 1781697
• DOI: http://doi.org/10.3343/kjlm.2011.31.4.298

Abstract

Carbapenem-resistant Klebsiella pneumoniae isolates producing K. pneumoniae carbapenemases (KPC) were first reported in the USA in 2001, and since then, this infection has been reported in Europe, Israel, South America, and China. In Korea, the first KPC-2-producing K. pneumoniae sequence type (ST) 11 strain was detected in 2010. We report the case of a patient with a urinary tract infection caused by KPC-2-producing K. pneumoniae. This is the second report of a KPC-2-producing K. pneumoniae infection in Korea, but the multilocus sequence type was ST258. The KPC-2-producing isolate was resistant to all tested beta-lactams (including imipenem and meropenem), amikacin, tobramycin, ciprofloxacin, levofloxacin, and trimethoprim-sulfamethoxazole, but was susceptible to gentamicin, colistin, polymyxin B, and tigecycline. The KPC-2-producing isolate was negative to phenotypic extended-spectrum beta-lactamase (ESBL) and AmpC detection tests and positive to modified Hodge test and carbapenemase inhibition test with aminophenylboronic acid.

Keyword

KPC-2; Klebsiella pneumoniae; ST258

MeSH Terms

Aged
Bacterial Proteins/antagonists & inhibitors/metabolism
Carbapenems/pharmacology
Drug Resistance, Bacterial/genetics
Female
Humans
Klebsiella pneumoniae/drug effects/genetics/*isolation & purification
Microbial Sensitivity Tests
Republic of Korea
Sequence Analysis, DNA
Urinary Tract Infections/*diagnosis/microbiology
beta-Lactamases/antagonists & inhibitors/biosynthesis/*genetics/metabolism

Figure

• 

  Fig. 1 Results obtained with a Modified Hodge test (A) and carbapenemase inhibition test (B) for carbapenem-resistant Klebsiella pneumoniae isolate (KPN 1010).Abbreviations: MEM, meropenem; APB, aminophenylboronic acid; CLX, cloxacillin; EDTA, ethylenediaminetetraacetic acid; DPA, dipicolinic acid.

Reference

1. Nordmann P, Poirel L. Emerging carbapenemases in Gram-negative aerobes. Clin Microbiol Infect. 2002; 8:321–331. PMID: 12084099.

2. Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev. 2007; 20:440–458. PMID: 17630334.

3. Nordmann P, Cuzon G, Naas T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis. 2009; 9:228–236. PMID: 19324295.

4. Yigit H, Queenan AM, Anderson GJ, Domenech-Sanchez A, Biddle JW, Steward CD, et al. Novel carbapenem-hydrolyzing β-lactamase, KPC-1, from a carbapenem-resistant strain of Klebsiella pneumoniae. Antimicrob Agents Chemother. 2001; 45:1151–1161. PMID: 11257029.

5. Giakkoupi P, Pappa O, Polemis M, Vatopoulos AC, Miriagou V, Zioga A, et al. Emerging Klebsiella pneumoniae isolates coproducing KPC-2 and VIM-1 carbapenemases. Antimicrob Agents Chemother. 2009; 53:4048–4050. PMID: 19581459.

6. Navon-Venezia S, Leavitt A, Schwaber MJ, Rasheed JK, Srinivasan A, Patel JB, et al. First report on a hyperepidemic clone of KPC-3-producing Klebsiella pneumoniae in Israel genetically related to a strain causing outbreaks in the United States. Antimicrob Agents Chemother. 2009; 53:818–820. PMID: 19029323.

7. Samuelsen Ø, Naseer U, Tofteland S, Skutlaberg DH, Onken A, Hjetland R, et al. Emergence of clonally related Klebsiella pneumoniae isolates of sequence type 258 producing plasmid-mediated KPC carbapenemase in Norway and Sweden. J Antimicrob Chemother. 2009; 63:654–658. PMID: 19218573.

8. Villegas MV, Lolans K, Correa A, Suarez CJ, Lopez JA, Vallejo M, et al. First detection of the plasmid-mediated class A carbapenemase KPC-2 in clinical isolates of Klebsiella pneumoniae from South America. Antimicrob Agents Chemother. 2006; 50:2880–2882. PMID: 16870793.

9. Wei ZQ, Du XX, Yu YS, Shen P, Chen YG, Li LJ. Plasmid-mediated KPC-2 in a Klebsiella pneumoniae isolate from China. Antimicrob Agents Chemother. 2007; 51:763–765. PMID: 17145797.

10. Rhee JY, Park YK, Shin JY, Choi JY, Lee MY, Peck KR, et al. KPC-producing extreme drug-resistant Klebsiella pneumoniae isolate from a patient with diabetes mellitus and chronic renal failure on hemodialysis in South Korea. Antimicrob Agents Chemother. 2010; 54:2278–2279. PMID: 20211897.

11. Pournaras S, Poulou A, Voulgari E, Vrioni G, Kristo I, Tsakris A. Detection of the new metallo-β-lactamase VIM-19 along with KPC-2, CMY-2 and CTX-M-15 in Klebsiella pneumoniae. J Antimicrob Chemother. 2010; 65:1604–1607. PMID: 20522444.

12. Marchaim D, Navon-Venezia S, Schwaber MJ, Carmeli Y. Isolation of imipenem-resistant Enterobacter species: emergence of KPC-2 carbapenemase, molecular characterization, epidemiology, and outcomes. Antimicrob Agents Chemother. 2008; 52:1413–1418. PMID: 18227191.

13. Lee K, Kim CK, Yong D, Jeong SH, Yum JH, Seo YH, et al. Improved performance of the modified Hodge test with MacConkey agar for screening carbapenemase-producing Gram-negative bacilli. J Microbiol Methods. 2010; 83:149–152. PMID: 20801167.

14. Song W, Jeong SH, Kim JS, Kim HS, Shin DH, Roh KH, et al. Use of boronic acid disk methods to detect the combined expression of plasmid-mediated AmpC β-lactamases and extended-spectrum β-lactamases in clinical isolates of Klebsiella spp., Salmonella spp., and Proteus mirabilis. Diagn Microbiol Infect Dis. 2007; 57:315–318. PMID: 17174510.

15. Giske CG, Gezelius L, Samuelsen Ø, Warner M, Sundsfjord A, Woodford N. A sensitive and specific phenotypic assay for detection of metallo-β-lactamases and KPC in Klebsiella pneumoniae with the use of meropenem disks supplemented with aminophenylboronic acid, dipicolinic acid and cloxacillin. Clin Microbiol Infect. 2011; 17:552–556. PMID: 20597925.

16. Patzer JA, Walsh TR, Weeks J, Dzierzanowska D, Toleman MA. Emergence and persistence of integron structures harbouring VIM genes in the Children's Memorial Health Institute, Warsaw, Poland, 1998-2006. J Antimicrob Chemother. 2009; 63:269–273. PMID: 19095681.

17. Smith Moland E, Hanson ND, Herrera VL, Black JA, Lockhart TJ, Hossain A, et al. Plasmid-mediated, carbapenem-hydrolysing β-lactamase, KPC-2, in Klebsiella pneumoniae isolates. J Antimicrob Chemother. 2003; 51:711–714. PMID: 12615876.

18. Zarfel G, Hoenigl M, Leitner E, Salzer HJ, Feierl G, Masoud L, et al. Emergence of New Delhi metallo-β-lactamase, Austria. Emerg Infect Dis. 2011; 17:129–130. PMID: 21192874.

19. Diancourt L, Passet V, Verhoef J, Grimont PA, Brisse S. Multilocus sequence typing of Klebsiella pneumoniae nosocomial isolates. J Clin Microbiol. 2005; 43:4178–4182. PMID: 16081970.

20. Park YJ, Yu JK, Park KG, Park YG, Lee S, Kim SY, et al. Prevalence and contributing factors of nonsusceptibility to imipenem or meropenem in extended-spectrum β-lactamase-producing Klebsiella pneumoniae and Escherichia coli. Diagn Microbiol Infect Dis. 2011; in press.

21. Kitchel B, Rasheed JK, Patel JB, Srinivasan A, Navon-Venezia S, Carmeli Y, et al. Molecular epidemiology of KPC-producing Klebsiella pneumoniae isolates in the United States: clonal expansion of multilocus sequence type 258. Antimicrob Agents Chemother. 2009; 53:3365–3370. PMID: 19506063.

22. Cai JC, Zhou HW, Zhang R, Chen GX. Emergence of Serratia marcescens, Klebsiella pneumoniae, and Escherichia coli Isolates possessing the plasmid-mediated carbapenem-hydrolyzing β-lactamase KPC-2 in intensive care units of a Chinese hospital. Antimicrob Agents Chemother. 2008; 52:2014–2018. PMID: 18332176.

23. Anderson KF, Lonsway DR, Rasheed JK, Biddle J, Jensen B, McDougal LK, et al. Evaluation of methods to identify the Klebsiella pneumoniae carbapenemase in Enterobacteriaceae. J Clin Microbiol. 2007; 45:2723–2725. PMID: 17581941.