Piekarska Katarzyna, Zacharczuk Katarzyna, Szych Jolanta, Zawidzka Elwira, Wilk Elzbieta, Wardak Sebastian, Jagielski Marek, Gierczyński Rafał
Zakład Bakteriologii, Narodowego Instytutu Zdrowia Publicznego-Państwowego Zakładu Higieny.
Med Dosw Mikrobiol. 2010;62(1):9-20.
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 bla(KPC) 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 bla(KPC) gene from representative isolate DM0269 revealed variant 2 of KPC (KPC-2). Tested isolates were subjected to genotyping by the PFGE with XbaI. 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 B isolates appear to belong to the distinct sensu stricto strain, that has acquired the bla(KPC) 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.
在过去十年中，由产肺炎克雷伯菌碳青霉烯酶（KPC）的肠杆菌引起的人类感染在全球范围内成为一个严重的治疗和流行病学问题。产KPC的肺炎克雷伯菌菌株在美国广泛传播，随后蔓延到欧洲。最近，在波兰发现了KPC-2。在本研究中，我们检测了11株对厄他培南耐药的肺炎克雷伯菌分离株。这些分离株来自波兰华沙一家普通医院（RH）的10名患者和一家姑息治疗医院（PH）的1名患者。通过硼酸表型试验的阳性结果证实了所有测试分离株中KPC的表达。通过针对该基因核心372 bp片段的引物进行PCR，还显示所有分离株都携带bla(KPC)基因，并且通过纸片扩散法测定，除两株外，所有分离株对亚胺培南和美罗培南均耐药。对代表性分离株DM0269的完整bla(KPC)基因进行DNA序列分析，揭示了KPC的变体2（KPC-2）。通过用XbaI进行脉冲场凝胶电泳（PFGE）对测试分离株进行基因分型。基于PFGE图谱的聚类图由两个主要分支组成，相似性为82.3%。A分支包含9个分离株（93.2%），包括来自PH患者的那个分离株，而其余两个分离株（86.5%）位于B分支。A分支的5个分离株通过PFGE无法区分。A分支分离株的高度遗传相似性强烈表明院内流行的肺炎克雷伯菌KPC+严格意义菌株的传播。很可能，该菌株也转移到了姑息治疗医院。相比之下
