Dissemination of successful international clone ST15 and clonal complex 17 among Bulgarian CTX-M-15 producing K. pneumoniae isolates

https://doi.org/10.1016/j.diagmicrobio.2017.08.012Get rights and content

Highlights

  • First full description of MLST types in Bulgarian ESBL producing K. pneumoniae

  • First description of IncR plasmid in Bulgaria

  • Epidemic international ST15 clone and CC17 K. pneumoniae were widespread.

  • Dissemination of F, A/C2, and M2 replicons was detected.

  • Clonal and plasmid distribution requires enhanced infection control measures.

Abstract

A total of 82 extended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae and 4 Klebsiella oxytoca isolates were collected in 2014 from four geographical areas in Bulgaria and their multilocus sequence type (MLST) and transferability of the ESBL encoding genes were investigated. The predominant type was CTX-M-15 (87%), followed by CTX-M-3 (9%), SHV-12 or SHV-2 (2%) and CTX-M-14 (1%). The CTX-M-15 producers belonged to ST15 (34.1%) and to a lesser extent to CC17 (ST16, ST17, ST336). The CTX-M-15 transconjugants showed a presence of R, A/C2 and F replicons. The CTX-M-3 producers were assigned to ST29, ST70, ST432, ST542 and ST15 types and the transconjugants carried M2 replicons. To the best of our knowledge, this is the first report that fully describes the MLST types among Bulgarian ESBL producing K. pneumoniae and the first report of the detection of IncR plasmid replicon type in our country.

Section snippets

Background

Klebsiella pneumoniae is an important bacterial pathogen, causing different hospital and community acquired infections (Wang et al., 2013). The increasing frequency of isolation of highly resistant K. pneumoniae strains is due to the wide distribution of specific epidemic clones, as well as to dissemination of epidemic plasmids (Carattoli, 2013; Woodford et al., 2011). For Bulgaria, European Centre for Disease Prevention and Control (ECDC) reported alarming levels of invasive K. pneumoniae

Material and methods

Between January 2014 and October 2014, 86 consecutive nonduplicated clinically significant Klebsiella isolates (82 K. pneumoniae and 4 Klebsiella oxytoca isolates), resistant to cefotaxime or/and ceftazidime, were obtained from 86 patients hospitalized in Intensive Care Units (ICUs) (n = 27), surgical wards (n = 16), urology wards (n = 19), pediatric wards (n = 5) and internal medicine wards (n = 19) of six Bulgarian hospitals in four towns: Sofia – Medical Institute, Ministry of Interior (310 beds), 20 K.

Results and discussion

All 86 tested isolates exhibited a nonsusceptible phenotype characterized by resistance or intermediate susceptibility (R + I) to aminopenicillins-inhibitor combinations (in 83%), cephalosporins (ceftazidime, 93%; cefotaxime; 100%; cefepime, 100%; cefoxitin 13%), aminoglycosides (tobramycin, 87%; gentamicin, 77%), and fluoroquinolones (ciprofloxacin, 87%; levofloxacin, 63%). Resistance rates to tetracycline and trimethoprim/sulfamethoxazole were 37% and 70%, respectively. The isolates were highly

Financial Support

This study was supported by Contract No 13/2016, Project No. 437/2016 of the Council of Medical Science at the Medical University of Sofia, Bulgaria.

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