Arrival of Klebsiella pneumoniae producing KPC carbapenemase in the United Kingdom

Neil Woodford, Jiancheng Zhang, Marina Warner, Mary E. Kaufmann, Jorge Matos, Alan MacDonald, Daniel Brudney, David Sompolinsky, Shiri Navon-Venezia, David M. Livermore

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Abstract

Background KPC-type carbapenemases are increasingly prevalent in parts of the USA and Israel and are an emerging concern in South America, Europe and China. We investigated the UK’s first two KPC-producing Klebsiella pneumoniae isolates. Methods The isolates were referred to the UK’s national reference laboratory for confirmation of carbapenem resistance. Susceptibilities were determined by agar dilution, and blaKPC and Tn4401-like elements were sought by PCR and sequencing. Isolates were compared by PFGE of XbaI- and SpeI-digested genomic DNA. Results The isolates were from patients in different UK hospitals, with no epidemiological connection. Both were resistant to carbapenems (MICs > 16 mg/L), with imipenem MICs unchanged by EDTA, and also to all other ß-lactams (including inhibitor combinations), tobramycin, amikacin and ciprofloxacin. They were susceptible to gentamicin (MICs = 1 mg/L) and colistin (MICs = 0.5 mg/L), with intermediate susceptibility to tigecycline (MICs 1–2 mg/L). The isolates belonged to the same PFGE-defined strain, highly related to a disseminated KPC-producing strain characterized previously in Tel Aviv, Israel. Like this Israeli strain, the UK isolates produced KPC-3 carbapenemase, with the blaKPC-3 gene located within a Tn4401-like element. Conclusions The first KPC-3-producing K. pneumoniae isolates detected in the UK were highly genetically related to a KPC-3-producing Israeli K. pneumoniae strain. This relatedness was consistent with the history of one UK patient, who had been hospitalized previously in Israel. However, this strain may be circulating more widely since the second UK patient had no identifiable links with Israel or other overseas countries.
Original languageEnglish
Pages (from-to)1261-1264
Number of pages4
JournalJournal of Antimicrobial Chemotherapy
Volume62
Issue number6
DOIs
Publication statusPublished - Dec 2008

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