Wystepowanie w jednym z warszawskich szpitali paleczek Klebsiella pneumoniae wytwarzajacych karbapenemaze typu KPC

• Autorzy: Piekarska K. , Zacharczuk K. , Szych J. , Zawidzka E. , Wilk E. , Wardak S. , Jagielski M. , Gierczynski R.

Warianty tytułu

EN

Dissemination of the KPC carbapenemase producing Klebsiella pneumoniae in a hospital in Warsaw, Poland

• Języki publikacji: PL

Abstrakty

PL

Określono profile lekowrażliwości oraz podobieństwo profili Xbal-PFGE jedenastu szczepów K. pneumoniae wykazujących oporność na ertapenem. Szczepy te wyizolowano od dziesięciu pacjentów jednego z warszawskich szpitali i jednego pacjenta hospicyjnego. Analiza fenotypowa (test z kwasem boronowym) i genetyczna (PCR) badanych szczepów wykazała, że wytwarzają one karbapenemazę typu KPC. Wśród badanych szczepów wyróżniono 7 genotypów PFGE, przy czym 5 szczepów zaliczono do tego samego genotypu, co może wskazywać na ich epidemiczne szerzenie się w szpitalu. Pozostałe 6 szczepów należało do różnych genotypów. Dendrogram genetycznego podobieństwa badanych szczepów składał się z dwóch gałęzi obejmujących 2 i 9 szczepów, o podobieństwie wynoszącym odpowiednio 86,5% i 93,2%. Genetyczne zróżnicowanie badanych szczepów na dwie wyraźnie odrębne grupy może wynikać z horyzontalnego i wertykalnego transferu genu blaKP( u pałeczek K. pneumoniae występujących u pacjentów szpitala.

EN

Within the last decade, human infections caused by enterobacteria which produce the Klebsiella pneumoniae carbapenemase (KPC) became a serious therapeutic and epidemiological problem worldwide. The KPC producing strains of K. pneumoniae broadly disseminated in the USA then spread to Europe. Recently, the KPC-2 was found in Poland. In the presented study we tested 11 ertapenem resistant isolates of K. pneumoniae. The isolates were obtained from 10 patients of a regular hospital (RH) and from one patient of a palliative care hospital (PH) in Warsaw, Poland. Expression of the KPC was confirmed in all the tested isolates by the positive result of phenotypic test with boronic acid. All the isolates were also shown to harbour the blaKp( gene by PCR with primers targeting the core 372 bp fragment of the gene, and all but two were resistant to imipenem and meropenem as determined by the disc-diffusion method. The DNA sequence analysis of the complete blaK pc gene from representative isolate DM0269 revealed variant 2 of KPC (KPC-2). Tested isolates were subjected to genotyping by the PFGE with Xbal. Dendrogram based on the PFGE profiles was composed of two main branches with 82,3% of similarity. Branch A encompassed 9 isolates (93,2%), including the one from the PH- patient, while the two remaining isolates (86,5%) were located in branch B. Five isolates of the branch A were indistinguishable by the PFGE. The high genetic similarity of the branch A isolates strongly suggests the intra-hospital dissemination of epidemic K. pneumoniae KPC+ sensu stricto strain. Most probably, the strain was also transferred to the palliative care hospital. In contrast, the branch В isolates appear to belong to the distinct sensu stricto strain, that has acquired the blaKpc gene via horizontal transfer. This is the first report on the intra-hospital dissemination of the KPC producing K. pneumoniae in Poland. It is noteworthy, all the tested strains were also resistant to cefotaxime, ceftazidime, aztreonam, ciprofloxacin and sulphonamides, but sensitive to Colistin.

Słowa kluczowe

PL

Warszawa; szpitale; Enterobacteriaceae; Klebsiella pneumoniae; karbapenemaza typu KPC; karbapenemazy; wrazliwosc na leki; pacjenci; wykrywanie drobnoustrojow; analiza fenotypowa; analiza genetyczna; genotyp; podobienstwo genetyczne

• Wydawca: -
• Czasopismo: Medycyna Doświadczalna i Mikrobiologia
• Rocznik: 2010
• Tom: 62
• Numer: 1
• Opis fizyczny: s.9-20,rys.,tab.,bibliogr.

Twórcy

autor

Piekarska K.

• Zaklad Bakteriologii, Narodowy Instytut Zdrowia Publicznego - Panstwowy Zaklad Higieny, ul.Chocimska 24, 00-791 Warszawa

autor

Zacharczuk K.

autor

Szych J.

autor

Zawidzka E.

autor

Wilk E.

autor

Wardak S.

autor

Jagielski M.

autor

Gierczynski R.

Bibliografia

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