Diffusion of OXA-48 carbapenemase among urinary isolates of Klebsiella pneumoniae in non-hospitalized elderly patients

• Published in: BMC microbiology Vol. 22; no. 1; p. 30
• Main Authors: Šuto, Sandra, Bedenić, Branka, Likić, Saša, Kibel, Sara, Anušić, Maja, Tičić, Vladimira, Zarfel, Gernot, Grisold, Andrea, Barišić, Ivan, Vraneš, Jasmina
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 19-01-2022; BioMed Central; BMC
• Subjects: Aged; Aged patients; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Antibiotic resistance; Antibiotics; beta-Lactamases - genetics; beta-Lactamases - metabolism; Carbapenemase; Care and treatment; Catheters; Cephalosporins; Complications and side effects; Conjugation; Croatia - epidemiology; Diagnosis; Dosage and administration; Drug resistance in microorganisms; Drug Resistance, Multiple, Bacterial; Drug therapy, Combination; E coli; Epidemics; Epidemiology; Ertapenem; Female; Gene transfer; Genes; Gentamicin; Horizontal transfer; Hospitalization; Humans; Infections; Institutionalization; Klebsiella; Klebsiella Infections - epidemiology; Klebsiella Infections - urine; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - enzymology; Long-term care; Long-term care facility; Male; Methods; Microbial Sensitivity Tests; Middle Aged; Multilocus Sequence Typing; Older people; OXA-48; Oxacillin; Patients; Pneumonia; Public health; Resistance; Risk factors; Urinary catheterization; Urinary tract infection; Urinary tract infections; Urine; β Lactamase; Croatia; Germany; Turkey; Resistance; Urinary tract infection; OXA-48; Klebsiella pneumoniae; Long-term care facility
• ISSN: 1471-2180; 1471-2180
• DOI: 10.1186/s12866-022-02443-y

Recently, a dramatic increase of Klebsiella pneumoniae positive for OXA-48 β-lactamases was observed first in the hospital setting and later in the long-term care facilities (LTCFs) and community in the Zagreb County, particularly, in urinary isolates. The aim of the study was to analyse the epidemiology and the mechanisms of antibiotic resistance of OXA-48 carbapenemase producing K. pneumoniae strains isolated from urine of non-hospitalized elderly patients.
The isolates were classified into two groups: one originated from the LTCFs and the other from the community. Extended-spectrum β-lactamases (ESBLs) were detected by double disk-synergy (DDST) and combined disk tests in 55% of the isolates (51/92). The ESBL-positive isolates exhibited resistance to expanded-spectrum cephalosporins (ESC) and in majority of cases to gentamicin. LTCFs isolates showed a significantly lower rate of additional ESBLs and consequential resistance to ESC and a lower gentamicin resistance rate compared to the community isolates, similarly to hospital isolates in Zagreb, pointing out to the possible transmission from hospitals.ESBL production was associated with group 1 of CTX-M or SHV-12 β-lactamases. Ertapenem resistance was transferable from only 12 isolates. bla
genes were carried by IncL plasmid in 42 isolates. In addition IncFII and IncFIB were identified in 18 and 2 isolates, respectively. Two new sequence types were reported: ST4870 and ST4781.
This study showed eruptive and extensive diffusion of OXA-48 carbapenemase to LTCFs and community population in Zagreb County, particularly affecting patients with UTIs and urinary catheters. On the basis of susceptibility testing, β-lactamase production, conjugation experiments, MLST and plasmid characterization it can be concluded that there was horizontal gene transfer between unrelated isolates, responsible for epidemic spread of OXA-48 carbapenemase in the LTCFs and the community The rapid spread of OXA-48 producing K. pneumoniae points out to the shortcomings in the infection control measures.