Reversion to susceptibility of a carbapenem-resistant clinical isolate of Klebsiella pneumoniae producing KPC-3.

Abstract

OBJECTIVES:

We report the case of a kidney-transplant patient, suffering an intra-abdominal abscess at the surgical site caused by a carbapenem-resistant ST258 Klebsiella pneumoniae clone, producing the KPC-3 carbapenemase. Under tigecycline treatment, the patient developed a sepsis caused by a carbapenem-susceptible ST258 K. pneumoniae strain. Complete DNA sequences of the plasmids carried by the resistant and susceptible strains from this patient were determined.

METHODS:

The complete DNA sequences of plasmids were obtained by applying the 454 Genome Sequencer FLX-PLUS procedure on a library constructed of total plasmid DNA purified from the carbapenem-resistant and -susceptible strains.

RESULTS:

In the carbapenem-resistant strain, four plasmids encoding 24 resistance genes, including blaKPC-3, and two putative virulence clusters were detected. In the susceptible strain, large rearrangements occurred in the KPC-carrying plasmid, causing the deletion of the entire Tn4401::blaKPC-3 transposon, with the consequent reversion of the strain to carbapenem susceptibility. The patient was successfully treated with carbapenems and fully recovered.

CONCLUSIONS:

The description of the plasmid content in these two strains gives interesting insights into the plasticity of KPC-carrying plasmids in K. pneumoniae.

• Authors: Laura Villa, Alessandro Capone, Daniela Fortini, Monika Dolejska, Irene Rodríguez, Fabrizio Taglietti, Paolo De Paolis, Nicola Petrosillo, Alessandra Carattoli
• Journal: The Journal of antimicrobial chemotherapy (J Antimicrob Chemother) Vol. 68 Issue 11 Pg. 2482-6 (Nov 2013) ISSN: 1460-2091 [Electronic] England
• PMID: 23800906 (Publication Type: Case Reports, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Anti-Bacterial Agents
• Bacterial Proteins
• Carbapenems
• DNA Transposable Elements
• DNA, Bacterial
• beta-Lactamases
• carbapenemase

Topics

• Abdominal Abscess (microbiology)
• Anti-Bacterial Agents (pharmacology)
• Bacterial Proteins (metabolism)
• Carbapenems (pharmacology)
• DNA Transposable Elements
• DNA, Bacterial (chemistry, genetics)
• Genomic Instability
• Humans
• Kidney Transplantation
• Klebsiella Infections (microbiology)
• Klebsiella pneumoniae (drug effects, enzymology, genetics)
• Microbial Sensitivity Tests
• Molecular Sequence Data
• Plasmids (analysis)
• Sequence Analysis, DNA
• Surgical Wound Infection (microbiology)
• Transplantation
• beta-Lactam Resistance
• beta-Lactamases (metabolism)