Department of Microbiology, Medical School, University of Athens, Athens, Greece.
J Antimicrob Chemother. 2013 Jan;68(1):84-8. doi: 10.1093/jac/dks356. Epub 2012 Sep 3.
First detected in Enterobacteriaceae isolates in Turkey, the OXA-48 carbapenemase has gradually disseminated in the wider Mediterranean area and Europe. Despite reports from other European regions, until now no such isolates have been detected in Greece. We describe the characteristics of the first outbreak caused by OXA-48-producing Klebsiella pneumoniae in Greece.
From December 2011 to March 2012, 13 ertapenem-resistant K. pneumoniae isolates, which were positive by the modified Hodge test while remaining negative by phenotypic screening for metallo-β-lactamase (MBL) and KPC production, were recovered from nine patients. Patient records were retrieved to access patterns of acquisition. Resistance genes were identified by PCR and sequencing. ompK35, ompK36 and the genetic environment of the bla(OXA-48) gene were investigated. Plasmid profiling, conjugation experiments, PFGE and multilocus sequence typing (MLST) were performed.
All isolates harboured the bla(OXA-48) gene along with the bla(CTX-M-15) and bla(OXA-1) genes. The bla(OXA-48) gene was located on a self-transferable IncL/M-type plasmid of ~62 kb, which harboured no other resistance genes. IS1999 was located upstream of the bla(OXA-48) gene. Genetic disruptions of the ompK35 and ompK36 genes were not detected. The isolates belonged to a unique PFGE clone and MLST assigned them to sequence type ST11. All cases were characterized as hospital acquired and none of them was linked to immigration or history of travel in endemic areas.
Carbapenem resistance due to MBL and KPC carbapenemases is currently on an endemic scale in Greece and this report highlights the wider undetected dissemination of yet another carbapenemase in this region.
OXA-48 碳青霉烯酶最初在土耳其的肠杆菌科分离株中被发现，已逐渐在更广泛的地中海地区和欧洲传播。尽管有来自其他欧洲地区的报告，但迄今为止，在希腊尚未发现此类分离株。我们描述了希腊首次由产 OXA-48 肺炎克雷伯菌引起的暴发的特征。
从 2011 年 12 月至 2012 年 3 月，从 9 名患者中分离出 13 株厄他培南耐药肺炎克雷伯菌，这些分离株经改良 Hodge 试验阳性，而金属β-内酰胺酶（MBL）和 KPC 产酶表型筛选阴性。检索患者记录以了解获得模式。通过 PCR 和测序鉴定耐药基因。研究了 bla（OXA-48）基因的 ompK35、ompK36 和遗传环境。进行了质粒图谱分析、接合实验、PFGE 和多位点序列分型（MLST）。
所有分离株均携带 bla（OXA-48）基因，同时携带 bla（CTX-M-15）和 bla（OXA-1）基因。bla（OXA-48）基因位于约 62kb 的可自我转移的 IncL/M 型质粒上，该质粒不携带其他耐药基因。IS1999 位于 bla（OXA-48）基因上游。未检测到 ompK35 和 ompK36 基因的遗传中断。分离株属于独特的 PFGE 克隆，MLST 将其分配到序列型 ST11。所有病例均为医院获得性，均与移民或前往流行地区无关。
由于 MBL 和 KPC 碳青霉烯酶导致的碳青霉烯类耐药性目前在希腊呈地方性流行，本报告强调了该地区另一种碳青霉烯酶的更广泛的未被发现的传播。
