Please use this identifier to cite or link to this item:http://hdl.handle.net/20.500.12105/8586
Nosocomial outbreak of VIM-1-producing Klebsiella pneumoniae isolates of multilocus sequence type 15: molecular basis, clinical risk factors, and outcome
Sanchez-Romero, Isabel | Asensio, Angel | Oteo-Iglesias, Jesús ISCIII | Muñoz-Algarra, María | Isidoro, Beatriz ISCIII | Vindel, Ana ISCIII | Alvarez-Avello, José | Balandín-Moreno, Bárbara | Cuevas, Oscar ISCIII | Fernandez-Romero, Sara ISCIII | Azañedo, Luisa ISCIII | Saez, David ISCIII | Campos, Jose ISCIII
Antimicrob Agents Chemother. 2012 Jan;56(1):420-7. doi: 10.1128/AAC.05036-11. Epub 2011 Oct 17.
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 β-lactamase SHV-134. bla(VIM-1) was carried in a class 1 integron and an untypeable plasmid of ∼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.
Adult | Aged | Aged, 80 and over | Anti-Bacterial Agents | Carbapenems | Case-Control Studies | Cross Infection | DNA Fingerprinting | DNA, Bacterial | Drug Resistance, Multiple, Bacterial | Electrophoresis, Gel, Pulsed-Field | Female | Hospitals | Humans | Klebsiella Infections | Klebsiella pneumoniae | Male | Microbial Sensitivity Tests | Middle Aged | Multilocus Sequence Typing | Risk Factors | Spain | Survival Rate | Treatment Outcome | beta-Lactamases | Disease Outbreaks
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