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Emergence of Escherichia coli Sequence Type 131 (ST131) and ST3948 with KPC-2, KPC-3 and KPC-8 carbapenemases from a Long-Term Care and Rehabilitation Facility (LTCRF) in Northern Italy

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Advances in Microbiology, Infectious Diseases and Public Health

Part of the book series: Advances in Experimental Medicine and Biology ((AMIDPH,volume 901))

Abstract

Aim of the study was to characterize KPC-producing Escherichia coli (KPC-Ec) clinical isolates among a Northern Italy Long-Term Care and Rehabilitation Facility (LTCRF) residents. Thirteen consecutive non repeated MDR E. coli isolates showing ertapenem Minimum Inhibitory Concentrations (MICs) >0.5 mg/L, collected during the period March 2011 – May 2013 from ASP “Redaelli” inpatients, were investigated. The bla KPC/CTX-M/SHV/TEM/OXA genes were identified by PCR and sequencing. KPC-Ec isolates underwent phylotyping, Pulsed-Field Gel Electrophoresis (PFGE), multilocus sequence typing (MLST) and repetitive sequence-based PCR (rep-PCR) profiling. Incompatibility groups analysis and conjugation were also performed. Eleven out of 13 isolates, resulted bla KPC-type positive, were consistently resistant to third generation cephalosporins, fluoroquinolones and trimethoprim-sulphametoxazole (84.6 %), retaining susceptibility to colistin (EUCAST guidelines). At least n = 4/11 of KPC-Ec patients received ≥48 h of meropenem therapy. Sequencing identified 9 bla KPC-2, 1 bla KPC-3 and 1 bla KPC-8 determinants. KPC-Ec plasmids belonged to IncF group (FIIk replicon); conjugation confirmed bla KPC/TEM-1/OXA-9 genes transferability for 10 KPC-Ec. Although three pulsotypes (A, B, C) were identified, all KPC-Ec belonged to phylogenetic group B2. Clone B (B-B5) caused an outbreak of infection involving nine inpatients at five wards. Rep-PCR showed relatedness for seven representative KPC-Ec isolates. Here we report a LTCRF outbreak caused by a ST131-B2 E. coli associated with bla KPC-2 and bla KPC-8 genes, and the emergence of the new ST3948. Elderly people with co-morbidities are at risk for ST131 colonization. KPC-Ec clones local monitoring appears essential both to avoid their spreading among healthcare settings, and to improve therapeutic choices for LTCRF residents.

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Author information

Authors and Affiliations

  1. Laboratory of Microbiology and Clinical Microbiology, Department of Clinical Surgical Diagnostic and Pediatric Sciences, University of Pavia, Via Brambilla 74, 27100, Pavia, Italy

    Aurora Piazza, Mariasofia Caltagirone, Ibrahim Bitar, Elisabetta Nucleo, Melissa Spalla, Laura Pagani & Roberta Migliavacca

  2. ASP “Golgi-Redaelli”, via Bartolomeo d’Alviano 78, 20146, Milan, Italy

    Elena Fogato & Roberto D’Angelo

Authors
  1. Aurora Piazza
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  2. Mariasofia Caltagirone
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  3. Ibrahim Bitar
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  4. Elisabetta Nucleo
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  5. Melissa Spalla
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  6. Elena Fogato
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  7. Roberto D’Angelo
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  8. Laura Pagani
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  9. Roberta Migliavacca
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Corresponding author

Correspondence to Roberta Migliavacca .

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Editors and Affiliations

  1. Microbial Biofilm Laboratory, Fondazione Santa Lucia IRCCS, Rome, Italy

    Gianfranco Donelli

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Piazza, A. et al. (2015). Emergence of Escherichia coli Sequence Type 131 (ST131) and ST3948 with KPC-2, KPC-3 and KPC-8 carbapenemases from a Long-Term Care and Rehabilitation Facility (LTCRF) in Northern Italy. In: Donelli, G. (eds) Advances in Microbiology, Infectious Diseases and Public Health. Advances in Experimental Medicine and Biology(), vol 901. Springer, Cham. https://doi.org/10.1007/5584_2015_5017

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