National Medicines Institute, 00-725 Warsaw, Poland.
Antimicrob Agents Chemother. 2011 Dec;55(12):5493-9. doi: 10.1128/AAC.05118-11. Epub 2011 Sep 19.
After the first report in May 2008, the National Reference Center for Susceptibility Testing confirmed 113 cases of infection or colonization by KPC-producing members of the family Enterobacteriaceae in Poland by the end of 2009. The vast majority of patients were found in 18 hospitals; three patients were diagnosed at outpatient clinics. Most of the institutions were in the Warsaw area, including three hospitals with the highest numbers of cases. When available, the data on previous hospitalizations often indicated that these hospitals were the probable acquisition sites; one patient arrived from New York. The group of 119 unique isolates consisted of Klebsiella pneumoniae (n = 114), followed by Klebsiella oxytoca (n = 3), and Escherichia coli (n = 2). The K. pneumoniae isolates were dominated by the clone sequence type 258 (ST258) (n = 111); others were ST11 and ST23. The ST258 group was heterogeneous, with 28 pulsed-field gel electrophoresis (PFGE) subtypes, ∼25 plasmid profiles, and nine β-lactamase patterns differing by KPC variants (KPC-2 mainly), and SHV-12, CTX-M-3, and TEM-1-like enzymes. Plasmids carrying bla(KPC) genes varied in size (~48 to 250 kb), structure, and conjugation potential. Transferable IncFII(K) plasmids of ~110 to 160 kb, probably pKpQIL or its derivatives, were observed in all K. pneumoniae clones and in K. oxytoca. Also prevalent were nontypeable pETKp50-like plasmids of ~50 kb, found in K. pneumoniae ST258 and E. coli isolates (ST93 and ST224). Two K. pneumoniae-E. coli pairs from single patients might represent the in vivo transfer of such plasmids. The striking diversity of KPC producers at the early stage of dissemination could result from several introductions of these bacteria into the country, their multidirectional evolution during clonal spread, and transfer of the plasmids.
自 2008 年 5 月首次报告以来，国家药敏检测参考中心于 2009 年底确认波兰有 113 例产 KPC 型肠杆菌科成员的感染或定植病例。绝大多数患者出现在 18 家医院；3 例患者在门诊被诊断。大多数机构都在华沙地区，包括 3 家病例数量最多的医院。在有可用数据的情况下，之前的住院记录通常表明这些医院是可能的感染源；有 1 例患者来自纽约。119 株独特分离株的组成包括肺炎克雷伯菌（n=114）、产酸克雷伯菌（n=3）和大肠埃希菌（n=2）。肺炎克雷伯菌分离株主要由克隆序列型 258（ST258）（n=111）组成；其他为 ST11 和 ST23。ST258 组具有异质性，28 种脉冲场凝胶电泳（PFGE）亚型、25 种质粒图谱和 9 种β-内酰胺酶模式，其区别在于 KPC 变体（主要为 KPC-2）、SHV-12、CTX-M-3 和 TEM-1 样酶。携带 bla（KPC）基因的质粒大小（48 至 250 kb）、结构和接合能力各异。在所有肺炎克雷伯菌克隆和产酸克雷伯菌中均观察到大小约为 110 至 160 kb 的可转移 IncFII（K）质粒，可能是 pKpQIL 或其衍生物。也普遍存在大小约为 50 kb 的不可分型 pETKp50 样质粒，在肺炎克雷伯菌 ST258 和大肠埃希菌分离株（ST93 和 ST224）中发现。来自单个患者的 2 对肺炎克雷伯菌-大肠埃希菌可能代表这些质粒在体内的转移。在传播的早期阶段，KPC 产生菌的惊人多样性可能是由于这些细菌多次引入该国，在克隆传播过程中的多向进化以及质粒的转移。
