Outbreak by KPC-62-producing ST307 Klebsiella pneumoniae isolates resistant to ceftazidime/avibactam and cefiderocol in a university hospital in Madrid, Spain.
In: Journal of Antimicrobial Chemotherapy (JAC), Jg. 78 (2023-05-01), Heft 5, S. 1259-1264
Online
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Zugriff:
Objectives Ceftazidime/avibactam and cefiderocol are two of the latest antibiotics with activity against a wide variety of Gram-negatives, including carbapenem-resistant Enterobacterales. We sought to describe the phenotypic and genotypic characteristics of ceftazidime/avibactam- and cefiderocol-resistant KPC- Klebsiella pneumoniae (KPC- Kp) detected during an outbreak in 2020 in the medical ICU of our hospital. Methods We collected 11 KPC- Kp isolates (6 clinical; 5 surveillance samples) resistant to ceftazidime/avibactam and cefiderocol from four ICU patients (November 2020 to January 2021), without prior exposure to these agents. All patients had a decontamination regimen as part of the standard ICU infection prevention protocol. Additionally, one ceftazidime/avibactam- and cefiderocol-resistant KPC- Kp (June 2019) was retrospectively recovered. Antibiotic susceptibility was determined by broth microdilution. β-Lactamases were characterized and confirmed. WGS was also performed. Results All KPC- Kp isolates (ceftazidime/avibactam MIC ≥16/4 mg/L; cefiderocol MIC ≥4 mg/L) were KPC + CTX-M-15 producers and belonged to the ST307 high-risk-clone (ST307-HRC). KPC-62 (L168Q) was detected in all isolates involved in the 2020 outbreak, contained in January 2021. KPC-31 (D179Y) was identified in the KPC- Kp from 2019. Cloning experiments demonstrated that both bla KPC-62 and bla KPC-31 were responsible for ceftazidime/avibactam resistance (MIC >16 mg/L) and an increased cefiderocol MIC. Additionally, mutations in OmpA and EnvZ/OmpR porin proteins (in KPC-62- Kp) and in PBP2 (in KPC-31- Kp) were found and may be involved in cefiderocol resistance. Conclusions The emergence of resistance to both ceftazidime/avibactam and cefiderocol in KPC- Kp -HRCs, together with the diversification of novel KPC enzymes displaying different antibiotic resistance phenotypes, is an epidemiological and clinical risk. [ABSTRACT FROM AUTHOR]
Titel: |
Outbreak by KPC-62-producing ST307 Klebsiella pneumoniae isolates resistant to ceftazidime/avibactam and cefiderocol in a university hospital in Madrid, Spain.
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Autor/in / Beteiligte Person: | Castillo-Polo, Juan Antonio ; Hernández-García, Marta ; Morosini, María Isabel ; Pérez-Viso, Blanca ; Soriano, Cruz ; Pablo, Raúl De ; Cantón, Rafael ; Ruiz-Garbajosa, Patricia |
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Zeitschrift: | Journal of Antimicrobial Chemotherapy (JAC), Jg. 78 (2023-05-01), Heft 5, S. 1259-1264 |
Veröffentlichung: | 2023 |
Medientyp: | academicJournal |
ISSN: | 0305-7453 (print) |
DOI: | 10.1093/jac/dkad086 |
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