Transfer of Carbapenem-Resistant Plasmid | CDC EID

EID Journal Home > Volume 16, Number 6–June 2010

Volume 16, Number 6–June 2010
Dispatch
Transfer of Carbapenem-Resistant Plasmid from Klebsiella pneumoniae ST258 to Escherichia coli in Patient
Moran G. Goren, Yehuda Carmeli, Mitchell J. Schwaber, Inna Chmelnitsky, Vered Schechner, and Shiri Navon-Venezia
Author affiliations: Tel Aviv Sourasky Medical Center, Tel Aviv, Israel (M.G. Goren, Y. Carmeli, I. Chmelnitsky, V. Schechner, S. Navon-Venezia); and National Center for Infection Control, Tel Aviv (Y. Carmeli, M.J. Schwaber, S. Navon-Venezia)

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Abstract
Klebsiella pneumoniae carbapenemase (KPC) 3–producing Escherichia coli was isolated from a carrier of KPC-3–producing K. pneumoniae. The KPC-3 plasmid was identical in isolates of both species. The patient's gut flora contained a carbapenem-susceptible E. coli strain isogenic with the KPC-3–producing isolate, which suggests horizontal interspecies plasmid transfer.
Over the past 2 years, the extremely drug-resistant Klebsiella pneumoniae carbapenemase (KPC)–producing K. pneumoniae sequence type 258 (KpnST258) has emerged as an important nosocomial pathogen worldwide. It has spread in the United States and in various countries in Europe and Asia (1–3). The high level of antimicrobial drug resistance in this bacterium is conferred by a plasmid-encoded KPC, which confers resistance to all cephalosporins, monobactams, and carbapenems (4). Infection with carbapenem-resistant K. pneumoniae is associated with an increased proportion of deaths compared to carbapenem-susceptible K. pneumoniae (5). Although Klebsiella with plasmid-mediated carbapenem resistance is a major risk to hospitalized patients, spread of these resistance plasmids into Escherichia coli poses an even greater public health threat because resistant E. coli may become part of the normal gut flora and thereby become a notable source of infections among sick and the healthy persons in healthcare settings and in the community (6).

In 2008, a carbapenem-nonsusceptible E. coli–producing KPC-3 isolate (Eco2) was identified in Tel Aviv Sourasky Medical Center in Israel. Until this case, carbapenem resistance in E. coli at the hospital was related exclusively to KPC-2 production (7). KPC production in E. coli remains rare worldwide, even in areas where KPC-producing K. pneumoniae isolates are identified. We aimed to investigate the origin of KPC-3 in this E. coli isolate and to explore a possible molecular and epidemiologic link between the presence of blaKPC-3 in this species and in the KpnST258 strain prevalent in our hospital.

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