Characterization of OXA-48-producing Klebsiella oxytoca isolates from a hospital outbreak in Tunisia.

Abstract

There is very limited information about OXA-48-producing Klebsiella oxytoca. The aim of this study was to describe the phenotypic and molecular characterization of OXA-48-producing K. oxytoca isolates that caused an outbreak in a hospital in Tunisia. Nineteen OXA-48-producing K. oxytoca were isolated from 2013 to 2016 in the University Hospital Farhat Hached, Sousse, Tunisia. Antibiotic susceptibility testing was performed by broth microdilution. Carbapenemase activity was investigated using the modified carbapenem inactivation method (mCIM). Phenotypic tests were also carried out to detect extended-spectrum β-lactamases. PCR was used to test for the presence of carbapenemase genes (blaIMP, blaVIM, blaNDM, blaSPM, blaAIM, blaDIM, blaGIM, blaSIM, blaKPC, blaBIC and blaOXA-48). Genetic relatedness among isolates was investigated using rep-PCR. Whole genome sequencing (WGS) was performed in three representative isolates. mCIM was positive in all isolates. None of the isolates presented an ESBL phenotype. All strains were susceptible to cefoxitin, ceftazidime, cefepime, aztreonam, imipenem, meropenem, fluoroquinolones, aminoglycosides and colistin, and resistant to piperacillin-tazobactam, ertapenem, ticarcillin and ampicillin-sulbactam. All isolates presented the blaOXA-48 gene located in a ca. 63 kb IncL plasmid, which carried no additional resistance genes. They belonged to the new ST220. Isolates from this study did not co-express an ESBL, which could complicate their detection in clinical laboratories. As OXA-48 has been mostly reported in K. pneumoniae there is a risk that the production of this enzyme is not suspected in the less common species K. oxytoca. These difficulties could play an important role in the hidden spread of this enzyme.