KPC enzymes in the UK: an analysis of the first 160 cases outside the North-West region

Jacqueline Findlay, Katie L Hopkins (Lead Author), Michel Doumith, Daniele Meunier, Camilla Wiuff, Robert Hill, Rachel Pike, Richard Loy, Nazim Mustafa, David M. Livermore, Neil Woodford

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16 Citations (Scopus)
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Abstract

Objectives: Klebsiella pneumoniae carbapenemases (KPCs) have been increasingly reported in the UK since 2003. We analysed patient and isolate data for KPC-positive bacteria confirmed by the national reference laboratory from UK laboratories, with the exception of the North-West England region, where the epidemiology has previously been studied, from August 2003 to August 2014.
Methods: MICs were determined by BSAC agar dilution methodology. Carbapenem-resistant isolates lacking imipenem/EDTA synergy were tested by PCR for blaKPC. Multi-locus sequence typing and blaKPC sequencing was performed on a subset of isolates. Plasmid analysis was performed by transformation, PCR-based replicon typing and, in some cases, whole-plasmid sequencing. Patient data provided by the sending laboratories were reviewed.
Results: Two hundred and ten KPC-producing isolates were submitted from 71 UK laboratories outside North-West England, representing 160 patients. All were Enterobacteriaceae, predominantly K. pneumoniae (82%; 172/210), and most (91%; 191/210) were obtained from hospitalised patients. Analysis of 123 isolates identified blaKPC-2 (64%; 79/123), blaKPC-3 (27%; 33/123) and blaKPC-4 (9%; 11/123). Within K. pneumoniae, clonal group (CG) sequence type (ST) 258 was dominant (64%; 54/84), however 21 unrelated STs were also identified. Plasmid analysis identified a diverse range of plasmids of at least 11 different replicon types, found in multiple STs and species.
Conclusions: KPC enzymes are increasingly detected in Enterobacteriaceae in the UK outside North-West England, despite a lack of reported outbreaks. K. pneumoniae CG258 are the dominant hosts although plasmid spread also plays a significant role in dissemination of KPCs between other K. pneumoniae STs and enterobacterial species.
Original languageEnglish
Pages (from-to)1199-1206
Number of pages8
JournalJournal of Antimicrobial Chemotherapy
Volume71
Issue number5
Early online date3 Feb 2016
DOIs
Publication statusPublished - May 2016

Keywords

  • KPC
  • Enterobacteriaceae
  • carbapenem
  • plasmids
  • UK

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