Putative horizontal transfer of carbapenem resistance between Klebsiella pneumoniae and Kluyvera ascorbata during abdominal infection: A case report

• Published in: Infection control and hospital epidemiology 2019-04, Vol.40 (4), p.494-496
• Main Authors: Raro, Otávio Hallal Ferreira, de Lima-Morales, Daiana, Barth, Afonso Luis, Paim, Tiago Galvão, Mott, Mariana Preussler, Riche, Cezar Vinícius Würdig, Teixeira, Uirá Fernandes, Waechter, Fábio Luiz, Gomes Dias, Cícero Armídio
• Format: Article
• Language: English
• Subjects: Abdomen; Adult; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antimicrobial agents; beta-Lactamases - genetics; beta-Lactamases - isolation & purification; Bile Ducts - surgery; Brazil; Carbapenems; Cross Infection - drug therapy; Cross Infection - microbiology; Cysts; Drug resistance; Drug Resistance, Multiple, Bacterial - genetics; E coli; Enterobacteriaceae Infections - drug therapy; Genes; Genomes; Humans; Infections; Klebsiella Infections - drug therapy; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - genetics; Klebsiella pneumoniae - isolation & purification; Kluyvera - drug effects; Kluyvera - genetics; Kluyvera - isolation & purification; Male; Medical instruments; Microbial Sensitivity Tests; Plasmids
• ISSN: 0899-823X; 1559-6834
• DOI: 10.1017/ice.2019.26

To the Editor—The emergence of KPC-producing Enterobacter has led to the development of serious infections related to high levels of mortality and morbidity worldwide.1,2 The rapid spread of KPCs is linked to multiple elements, such as plasmid-borne genes and the dissemination by international travelers; these bacteria are frequently multidrug resistant, causing untreatable infections.3,4 Kluyvera spp is a genus of gram-negative rods of the Enterobacteriaceae family.5 Although it is a commensal of the human gut microbiota,6 Kluyvera spp has the potential to cause septic shock, urinary tract infections, catheter-associated bloodstream infections, and abdominal infections.7 Here, we report a case of a plasmid-mediated horizontal transfer from a Klebsiella pneumoniae isolate to a Kluyvera ascorbata isolate during abdominal infection. Antimicrobial Resistance Profile of the Klebsiella pneumoniae and Kluyvera ascorbata Pathogenic Isolates and the Transconjugants TKp and TKa Antimicrobial Resistance Microorganism E. coli J53 K. pneumoniae KpOT1 K. ascorbata KaOT2 TKp TKa AMP S R R R R ASB S R R R R CFZ S R R R R CAZ S R R S S FEP S R R I I SXT S R S S S AK S I S S S GEN S I S S S CIP S R S S S MER S R R I I IMP S R R R R ERT S R R I I PTZ S R R I I MER MIC, g/mL 32 >32 2 1 Resistance genes … aph(3’)-la aac(6’)Ib-cr blaKPC-2 blaSHV-11 blaCTX-M-15 blaOXA-1 oqxA oqxB fosA mph(A) catB4 sul1 tet(A) dfrA30 blaKPC-2 blaCTX-M-56 blaKPC-2 blaKPC-2 Note. AMP, ampicillin; ASB, ampicillin-sulbactam; CFZ, cefazolin; CAZ, ceftazidime; FEP, cefepime; SXT, trimethoprim/sulfamethoxazole; AK, amikacin; GEN, gentamicin; CIP, ciprofloxacin; MER, meropenem; IMP, imipenem; ERT, ertapenem; PTZ, piperacillin/tazobactam; MIC, minimum inhibitory concentration; aph(3’)-la, aminoglycoside resistance; aac(6’)Ib-cr, fluoroquinolone and aminoglycoside resistance; blaKPC-2, β-lactam resistance; blaSHV-11, β-lactam resistance; blaCTX-M-15, β-lactam resistance; blaOXA-1, β-lactam resistance; oqxA, quinolone resistance; oqxB, quinolone resistance; fosA, fosfomycin resistance; mph(A), macrolide resistance; catB4, phenicol resistance; sul1, sulphonamide resistance; tet(A), tetracycline resistance; dfrA30, trimethoprim resistance; blaCTX-M-56, β-lactam resistance.