Polyclonal Endemicity of Carbapenemase-Producing <i>Klebsiella pneumoniae</i> in ICUs of a Greek Tertiary Care Hospital
Efthymia Protonotariou,
Georgios Meletis,
Dimitrios Pilalas,
Paraskevi Mantzana,
Areti Tychala,
Charalampos Kotzamanidis,
Dimitra Papadopoulou,
Theofilos Papadopoulos,
Michalis Polemis,
Simeon Metallidis,
Lemonia Skoura
Affiliations
Efthymia Protonotariou
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, S. Kiriakidi str. 1, 54636 Thessaloniki, Greece
Georgios Meletis
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, S. Kiriakidi str. 1, 54636 Thessaloniki, Greece
Dimitrios Pilalas
First Propedeutic Department of Internal Medicine, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Paraskevi Mantzana
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, S. Kiriakidi str. 1, 54636 Thessaloniki, Greece
Areti Tychala
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, S. Kiriakidi str. 1, 54636 Thessaloniki, Greece
Charalampos Kotzamanidis
Hellenic Agricultural Organisation-DIMITRA, Veterinary Research Institute of Thessaloniki, Campus of Thermi, 57001 Thermi, Greece
Dimitra Papadopoulou
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, S. Kiriakidi str. 1, 54636 Thessaloniki, Greece
Theofilos Papadopoulos
Department of Microbiology and Infectious Diseases, Faculty of Veterinary Medicine, School of Health Sciences, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Michalis Polemis
Central Public Health Laboratory, National Public Health Organization, 16672 Vari, Greece
Simeon Metallidis
First Department of Internal Medicine, Infectious Diseases Division, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece
Lemonia Skoura
Department of Microbiology, AHEPA University Hospital, School of Medicine, Aristotle University of Thessaloniki, S. Kiriakidi str. 1, 54636 Thessaloniki, Greece
Carbapenemase-producing Klebsiella pneumoniae (CPKP) emerged in Greece in 2002 and became endemic thereafter. Driven by a notable variability in the phenotypic testing results for carbapenemase production in K. pneumoniae isolates from the intensive care units (ICUs) of our hospital, we performed a study to assess the molecular epidemiology of CPKP isolated between 2016 and 2019 using pulse-field gel electrophoresis (PFGE) including isolates recovered from 165 single patients. We investigated the molecular relatedness among strains recovered from rectal surveillance cultures and from respective subsequent infections due to CPKP in the same individual (48/165 cases). For the optimal interpretation of our findings, we carried out a systematic review regarding the clonality of CPKP isolated from clinical samples in ICUs in Europe. In our study, we identified 128 distinguishable pulsotypes and 17 clusters that indicated extended dissemination of CPKP within the hospital ICU setting throughout the study period. Among the clinical isolates, 122 harbored KPC genes (74%), 2 harbored KPC+NDM (1.2%), 38 harbored NDM (23%), 1 harbored NDM+OXA-48 (0.6%), 1 harbored NDM+VIM (0.6%) and 1 harbored the VIM (0.6%) gene. Multiple CPKP strains in our hospital have achieved sustained transmission. The polyclonal endemicity of CPKP presents a further threat for the selection of pathogens resistant to last-resort antimicrobial agents.
