Reference Centre for Detection of Antimicrobial Resistance, Department of Microbiology and Infection Control, University Hospital of North Norway, Tromsø, Norway.
Clin Microbiol Infect. 2011 Dec;17(12):1811-6. doi: 10.1111/j.1469-0691.2011.03532.x. Epub 2011 May 20.
VIM-producing Klebsiella pneumoniae (VPKP) has been identified as a source of hospital outbreaks and is prevalent particularly in the Mediterranean region. In this study we have characterized eight VPKP isolates identified in Scandinavia during 2005-2008. With the exception of one isolate, all were from patients with recent history of hospitalization abroad (Greece, n = 6; Turkey, n = 1). Multilocus sequence typing (MLST) resulted in five sequence types (STs), ST36 (n = 1), ST147 (n = 4), ST272 (n = 1), ST273 (n = 1) and ST383 (n = 1), which except for ST272 were part of putative international clonal complexes. All were multidrug resistant due to the presence of other resistance determinants, including extended-spectrum β-lactamases (CTX-M-3, SHV-5 and SHV-12), 16S rRNA methylases (ArmA) and plasmid-mediated quinolone resistance determinants (QnrS). One isolate harboured a novel VIM-variant (VIM-26) while VIM-1 and VIM-19 were detected in six and one isolate, respectively. Two different genetic structures surrounding the bla(VIM) gene were identified in four isolates. In two isolates bla(VIM-1) and bla(VIM-26) were located in an integron similar to In-e541 (intI1;bla(VIM-1/-26);aacA7; dhfrI;aadA1;3'CS) while in the other two isolates bla(VIM-1) was located in an integron lacking 3'CS but with an IS26 element in the 3'end (intI1;bla(VIM-1);aac(6')-Ib;IS26), as identified in the IncN plasmid pKOX105. The bla(VIM) -genes were located on transferable plasmids ranging from ∼40 to ∼240 kb and associated with Tn21 in four isolates. PCR-based replicon typing indicated association of bla(VIM) with IncN (n = 3) and A/C (n = 1) broad-host-range plasmids but also with unknown replicons (n = 4). In conclusion, Scandinavian VPKP is associated with importation and genetically related to international clones encoding transferable plasmid-mediated multidrug resistance.
产 VIM 肺炎克雷伯菌（VPKP）已被确定为医院暴发的源头，尤其在地中海地区流行。在这项研究中，我们对 2005 年至 2008 年间在斯堪的纳维亚发现的 8 株 VPKP 分离株进行了特征描述。除了一株分离株外，所有分离株均来自近期有国外住院史的患者（希腊，n=6；土耳其，n=1）。多位点序列分型（MLST）导致 5 种序列类型（ST），ST36（n=1）、ST147（n=4）、ST272（n=1）、ST273（n=1）和 ST383（n=1），除了 ST272 之外，这些 ST 均属于假定的国际克隆复合体。由于存在其他耐药决定因子，包括扩展谱β-内酰胺酶（CTX-M-3、SHV-5 和 SHV-12）、16S rRNA 甲基酶（ArmA）和质粒介导的喹诺酮耐药决定因子（QnrS），所有分离株均对多种药物具有耐药性。一株分离株携带一种新型 VIM-变体（VIM-26），而 6 株和 1 株分离株中分别检测到 VIM-1 和 VIM-19。在 4 株分离株中，发现了 bla(VIM)基因周围的两种不同的遗传结构。在 2 株分离株中，bla(VIM-1)和 bla(VIM-26)位于类似于 In-e541（intI1；bla(VIM-1/-26)；aacA7；dhfrI；aadA1；3'CS）的整合子中，而在另外 2 株分离株中，bla(VIM-1)位于缺乏 3'CS 的整合子中，但在 3'端有一个 IS26 元件（intI1；bla(VIM-1)；aac(6')-Ib；IS26），如 IncN 质粒 pKOX105 中所鉴定。bla(VIM)基因位于从约 40 到约 240 kb 的可转移质粒上，并与 4 株分离株中的 Tn21 相关。基于 PCR 的复制子分型表明，bla(VIM)与 IncN（n=3）和 A/C（n=1）广谱宿主范围质粒相关，也与未知的复制子相关（n=4）。总之，斯堪的纳维亚 VPKP 与进口有关，与携带可转移质粒介导的多药耐药性的国际克隆具有遗传相关性。
