KPC enzymes in the UK: an analysis of the first 160 cases outside the North-West region

Findlay, Jacqueline, Hopkins, Katie L., Doumith, Michel, Meunier, Daniele, Wiuff, Camilla, Hill, Robert, Pike, Rachel, Loy, Richard, Mustafa, Nazim, Livermore, David M. ORCID: and Woodford, Neil (2016) KPC enzymes in the UK: an analysis of the first 160 cases outside the North-West region. Journal of Antimicrobial Chemotherapy, 71 (5). pp. 1199-1206. ISSN 0305-7453

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Objectives: Klebsiella pneumoniae carbapenemases (KPCs) have been increasingly reported in the UK since 2003. We analysed patient and isolate data for KPC-positive bacteria confirmed by the national reference laboratory from UK laboratories, with the exception of the North-West England region, where the epidemiology has previously been studied, from August 2003 to August 2014. Methods: MICs were determined by BSAC agar dilution methodology. Carbapenem-resistant isolates lacking imipenem/EDTA synergy were tested by PCR for blaKPC. Multi-locus sequence typing and blaKPC sequencing was performed on a subset of isolates. Plasmid analysis was performed by transformation, PCR-based replicon typing and, in some cases, whole-plasmid sequencing. Patient data provided by the sending laboratories were reviewed. Results: Two hundred and ten KPC-producing isolates were submitted from 71 UK laboratories outside North-West England, representing 160 patients. All were Enterobacteriaceae, predominantly K. pneumoniae (82%; 172/210), and most (91%; 191/210) were obtained from hospitalised patients. Analysis of 123 isolates identified blaKPC-2 (64%; 79/123), blaKPC-3 (27%; 33/123) and blaKPC-4 (9%; 11/123). Within K. pneumoniae, clonal group (CG) sequence type (ST) 258 was dominant (64%; 54/84), however 21 unrelated STs were also identified. Plasmid analysis identified a diverse range of plasmids of at least 11 different replicon types, found in multiple STs and species. Conclusions: KPC enzymes are increasingly detected in Enterobacteriaceae in the UK outside North-West England, despite a lack of reported outbreaks. K. pneumoniae CG258 are the dominant hosts although plasmid spread also plays a significant role in dissemination of KPCs between other K. pneumoniae STs and enterobacterial species.

Item Type: Article
Uncontrolled Keywords: kpc,enterobacteriaceae,carbapenem,plasmids,uk
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
UEA Research Groups: Faculty of Medicine and Health Sciences > Research Groups > Epidemiology and Public Health
Faculty of Medicine and Health Sciences > Research Groups > Public Health and Health Services Research (former - to 2023)
Depositing User: Pure Connector
Date Deposited: 22 Mar 2016 09:18
Last Modified: 22 Oct 2022 00:33
DOI: 10.1093/jac/dkv476


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