An update of the evolving epidemic of blaKPC carrying Klebsiella pneumoniae in Sicily, Italy, 2014: Emergence of multiple Non-ST258 Clones

Caterina Mammina, Teresa Maria Assunta Fasciana, Anna Giammanco, Laura Saporito, Celestino Bonura, Daniela Maria Geraci, Mario Giuffre, Francesca Di Bernardo, Rita Immordino, Daniela Maria Palma, Tomaso Stampone, Maria Antonietta Saporito, Maria Stella Verde, Elisa Donato, Teresa Amato, Maria Teresa Baldi, Maria Teresa Baldi, Maria Teresa Baldi, Concetta Sodano, Teresa AmatoAnna Giammanco, Salvatore Distefano, Aurora Aleo, Giorgio Graziano

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Abstract

Background: In Italy, Klebsiella pneumoniae carbapenemase producing K. pneumoniae (KPC-Kp) strains are highly endemic and KPC producing CC258 is reported as the widely predominating clone. In Palermo, Italy, previous reports have confirmed this pattern. However, recent preliminary findings suggest that an epidemiological change is likely ongoing towards a polyclonal KPC-Kp spread. Here we present the results of molecular typing of 94 carbapenem non susceptible K. pneumoniae isolates detected during 2014 in the three different hospitals in Palermo, Italy. Methods and Results: Ninety-four consecutive, non replicate carbapenem non susceptible isolates were identified in the three largest acute general hospitals in Palermo, Italy, in the six-month period March-August 2014. They were characterized by PCR for β-lactam, aminoglycoside and plasmid mediated fluoroquinolone resistance genetic determinants. The mgrB gene of the colistin resistant isolates was amplified and sequenced. Clonality was assessed by pulsed field gel electrophoresis and multilocus sequence typing. Eight non-CC258 sequence types (STs) were identified accounting for 60% of isolates. In particular, ST307 and ST273 accounted for 29% and 18% of isolates. CC258 isolates were more frequently susceptible to gentamicin and non-CC258 isolates to amikacin. Colistin non susceptibility was found in 42% of isolates. Modifications of mgrB were found in 32 isolates. Conclusions: Concurrent clonal expansion of some STs and lateral transmission of genetic resistance determinants are likely producing a thorough change of the KPC-Kp epidemiology in Palermo, Italy. In our setting mgrB inactivation proved to substantially contribute to colistin resistance. Our findings suggest the need to continuously monitor the KPC-Kp epidemiology and to assess by a nationwide survey the possible shifting towards a polyclonal epidemic.
Original languageEnglish
Pages (from-to)e0132936-
Number of pages9
JournalPLoS One
Volume10
Publication statusPublished - 2015

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

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    Mammina, C., Fasciana, T. M. A., Giammanco, A., Saporito, L., Bonura, C., Geraci, D. M., Giuffre, M., Di Bernardo, F., Immordino, R., Palma, D. M., Stampone, T., Saporito, M. A., Verde, M. S., Donato, E., Amato, T., Baldi, M. T., Baldi, M. T., Baldi, M. T., Sodano, C., ... Graziano, G. (2015). An update of the evolving epidemic of blaKPC carrying Klebsiella pneumoniae in Sicily, Italy, 2014: Emergence of multiple Non-ST258 Clones. PLoS One, 10, e0132936-.