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. 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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Abstract

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
Depositing User: Pure Connector
Date Deposited: 22 Mar 2016 09:18
Last Modified: 22 Jul 2020 00:33
URI: https://ueaeprints.uea.ac.uk/id/eprint/57706
DOI: 10.1093/jac/dkv476

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