Molecular epidemiology of KPC-producing Klebsiella pneumoniae from invasive infections in Italy: increasing diversity with predominance of the ST512 clade II sublineage

Viola Conte, Monica Monaco, Tommaso Giani, Fortunato D'Ancona, Maria Luisa Moro, Fabio Arena, Marco Maria D'Andrea, Gian Maria Rossolini, Annalisa Pantosti, AR-ISS Study Group on Carbapenemase-Producing K. pneumoniae

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Abstract

OBJECTIVES: The spread of carbapenem-resistant Enterobacteriaceae (CRE) represents one of the most worrisome problems for clinical medicine worldwide. In Italy, the Antibiotic-Resistance-Istituto Superiore di Sanità surveillance network, in collaboration with the Committee for Antimicrobial Agents of the Italian Society of Clinical Microbiologists, promoted a study to investigate the carbapenem-resistance mechanisms, clonal relatedness and capsular typing of a recent collection of carbapenem-resistant Klebsiella pneumoniae (CR-KP).

METHODS: A total of 17 laboratories distributed across Italy collected all consecutive non-replicate CR-KP isolated from invasive infections during two different study periods (2011-12 and 2013). Carbapenemase genes were searched for by filter hybridization and confirmed by PCR and sequencing. KPC-producing K. pneumoniae (KPC-KP) were typed by PFGE and MLST. Capsular types were identified by wzi gene typing.

RESULTS: Of the collected K. pneumoniae isolates (n = 461), the overall proportion of CR-KP was 36.2% (n = 167). The majority (97%) of the CR-KP were positive for the blaKPC gene. Among the KPC-KP population, nine different STs were detected with the majority of isolates (94%) belonging to the clonal group (CG) 258. A subpopulation that belonged to ST512 and showed an identical PFGE profile represented the majority (57%) of KPC-KP strains, with a countrywide distribution. Capsular characterization showed the predominance of the wzi154, cps-2 capsular type (88.8% of all CG258 strains). ST258 strains were associated with both cps-1 and cps-2 capsular types, while ST512 was associated with cps-2 only.

CONCLUSIONS: Although a trend to a polyclonal evolution of the Italian KPC-KP was noted, this study showed that the KPC-KP population remained largely oligoclonal with the wide diffusion of an ST512 lineage carrying cps-2 capsular type and producing the KPC-3 enzyme.

Original languageEnglish
Pages (from-to)3386-3391
Number of pages6
JournalJournal of Antimicrobial Chemotherapy
Volume71
Issue number12
DOIs
Publication statusPublished - Dec 2016

Keywords

  • Journal Article

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    Conte, V., Monaco, M., Giani, T., D'Ancona, F., Moro, M. L., Arena, F., D'Andrea, M. M., Rossolini, G. M., Pantosti, A., & AR-ISS Study Group on Carbapenemase-Producing K. pneumoniae (2016). Molecular epidemiology of KPC-producing Klebsiella pneumoniae from invasive infections in Italy: increasing diversity with predominance of the ST512 clade II sublineage. Journal of Antimicrobial Chemotherapy, 71(12), 3386-3391. https://doi.org/10.1093/jac/dkw337