Rapid dissemination of MDR CTX-M-15-producing K. pneumoniae epidemic clone in Hungary
Abstract number: o118
Damjanova I., Tóth Á., Ozsvár Z., Bauer E., Pászti J., Füzi M.
Multi-centre spread of MDR CTX-M-15-producing K. pneumoniae epidemic clone was detected in Hungary in 2003. Continuous screening for such isolates was performed from January 2004 until October 2005 and results of this survey were presented.
Three of 206 (2004) and 124 of 394 (2005) KP clinical isolates submitted to the National ESBL Reference laboratory from 23 Hungarian hospitals were selected according their high resistance to cefotaxime, aminoglycosides, tetracycline and ciprofloxacine. Susceptibility to antimicrobials by disc-diffusion method and ESBL expression were detected according to NCCLS criteria. Molecular typing was performed by TEM-, SHV-, CTX-M, and ISEcp1 PCRs, sequence analysis of PCR amplicons and XbaI-PFGE. Resistance to cefotaxime was transferred by conjugation to rifampin-R E. coli J53. Plasmid extraction was performed by alkaline lysis.
A total of 127 ESBL-KP isolates were collected from various hospital infection samples from 23 Hungarian hospitals. Of these 42 isolates were collected from parallel nosocomial outbreaks reported from ICUs of two different hospitals in 2005. In the first outbreak (Fejér county) 29 isolates were recovered from 25 inpatients (44% mortality; median age 64 years, range 4381; median length of stay was 30 days, range 672) from surgical wounds (8), lower respiratory tract (8), urine (6), blood (4), conjunctiva (1), bile (1) and sputum (1). In the second outbreak (Budapest) 13 isolates were recovered from 13 inpatients (median age 64.2 years, range 4474; mean length of stay was 27.3 days, range 1187) from blood (8), urine (2), trachea (1), sputum (1), vaginal secretion (1). Environmental samples have not discerned any apparent source for these outbreaks. PFGE analysis revealed strong clonal link between the 127 isolates and those of previously described epidemic clone. blaCTX-M-15 was detected on similar large plasmids in all selected isolates and their transconjugants. ISEcp1 was not found.
Till the end of 2004 the SHV was the most common b-lactamase detected in KP nosocomial isolates in Hungary. Since the beginning of 2005 the ESBL-KP clinical isolates were predominantly CTX-M-15 producers. There was evidence that the background of this ESBL change is the countrywide spread of an MDR CTX-M-15-producing KP epidemic clone. Their eruptive dissemination in 23 geographically distinct hospitals emphasizes the necessity of immediate intervention and epidemiological monitoring.
|Session name:||XXIst ISTH Congress|
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