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Volume 11
Issue 2
10.18683/germs.2021.1254
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Article

Polyclonal Spread of Colistin Resistant Klebsiella pneumoniae in Croatian Hospitals and Outpatient Setting

by
Tatjana Tot
1,
Sara Kibel
2,
Sanda Sardelić
3,
Khalil Nemer
4,
Ana Benčić
5,
Jasmina Vraneš
6,7,
Marija Krilanović
8,
Marko Jelić
9,
Marko Tripković
10,
Marina Bubonja-Šonje
11 and
Branka Bedenić
12,*
1
General Hospital Karlovac, Andrije Štampar Street 3, 47000 Karlovac, Croatia
2
University of Osijek School of Medicine, Josip Huttler Street 4, 31000 Osijek, Croatia
3
University Hospital Centre Split, Spinčić Street, 21000 Split, Croatia
4
Public Health Institute of Sisak Moslavina County, Kralj Tomislav Street 1, 44000 Sisak, Croatia
5
University Hospital Centre Sestre Milosrdnice, Vinogradska 29, 10000 Zagreb, Croatia
6
School of Medicine, University of Zagreb, Šalata 3, 10000 Zagreb, Croatia
7
Andrija Štampar Teaching Public Health Institute, Mirogojska 16, 10000 Zagreb, Croatia
8
Public Health Institute of Dubrovnik-Neretva County, dr. Ante Šercer street 4a, 20000 Dubrovnik, Croatia
9
University Hospital for Infectious Diseases, Mirogojska 8, 10000 Zagreb, Croatia
10
University Hospital Center Zagreb, Kišpatićeva 12, 10000 Zagreb, Croatia
11
University Hospital Center Rijeka, School of Medicine University of Rijeka, Braće Branchetta 20/1, 51000 Rijeka, Croatia
12
University of Zagreb School of Medicine, Clinical Department for Clinical and Molecular Microbiology, University Hospital Center Zagreb, Kišpatić Street 12, Zagreb, Croatia
 
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Author to whom correspondence should be addressed.
GERMS 2021, 11(2), 163-178; https://doi.org/10.18683/germs.2021.1254 (registering DOI)
Submission received: 5 November 2020 / Revised: 21 March 2021 / Accepted: 17 April 2021 / Published: 2 June 2021
Versions Notes

Abstract

Introduction: Recently, a marked increase in the rate of colistin resistant Klebsiella pneumoniae was observed in Croatian hospitals and the outpatient setting. This prompted us to analyze the molecular epidemiology of these isolates and the mechanisms of spread. Methods: In total 46 colistin-resistant K. pneumoniae isolates from five hospitals and the community were analyzed. The presence of genes encoding broad and extended-spectrum β-lactamases, plasmid-mediated AmpC β-lactamases and carbapenemases was determined by PCR. Plasmids were characterized by PCR based replicon typing. Isolates were genotyped by pulsed-field gel electrophoresis. Virulence traits such as hemolysins, hyperviscosity and resistance to serum bactericidal activity were determined by phenotypic methods. Results: High resistance rates were observed for cefuroxime, ceftazidime, cefotaxime, ceftriaxone and ertapenem, ciprofloxacin and gentamicin. The majority of OXA-48 producing isolates were resistant to ertapenem but susceptible to imipenem and meropenem. Nine strains transferred ertapenem resistance to E. coli recipient strain. Thirty-nine strains were phenotypically positive for ESBLs and harbored group 1 of CTX-M β-lactamases. OXA-48 was detected in 39 isolates, KPC-2 in four and NDM-1 in one isolate. The isolates belonged to six PFGE clusters. All isolates were found to be resistant to serum bactericidal activity and all except four strains positive for KPC, produced β-hemolysins. String test indicating hypermucosity was positive in only one KPC producing organism. Conclusions: The study demonstrated the ability of K. pneumoniae to accumulate different resistance and virulence determinants. We reported dissemination of colistin resistant K. pneumoniae in five hospitals, located in different geographic regions of Croatia and in the outpatients setting. mcr genes responsible for transferable colistin resistance were not found, indicating that resistance was probably due to chromosomal mutations.
Keywords: colistin resistance; carbapenemase; Klebsiella pneumoniae; OXA-48; KPC colistin resistance; carbapenemase; Klebsiella pneumoniae; OXA-48; KPC

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MDPI and ACS Style

Tot, T.; Kibel, S.; Sardelić, S.; Nemer, K.; Benčić, A.; Vraneš, J.; Krilanović, M.; Jelić, M.; Tripković, M.; Bubonja-Šonje, M.; et al. Polyclonal Spread of Colistin Resistant Klebsiella pneumoniae in Croatian Hospitals and Outpatient Setting. GERMS 2021, 11, 163-178. https://doi.org/10.18683/germs.2021.1254

AMA Style

Tot T, Kibel S, Sardelić S, Nemer K, Benčić A, Vraneš J, Krilanović M, Jelić M, Tripković M, Bubonja-Šonje M, et al. Polyclonal Spread of Colistin Resistant Klebsiella pneumoniae in Croatian Hospitals and Outpatient Setting. GERMS. 2021; 11(2):163-178. https://doi.org/10.18683/germs.2021.1254

Chicago/Turabian Style

Tot, Tatjana, Sara Kibel, Sanda Sardelić, Khalil Nemer, Ana Benčić, Jasmina Vraneš, Marija Krilanović, Marko Jelić, Marko Tripković, Marina Bubonja-Šonje, and et al. 2021. "Polyclonal Spread of Colistin Resistant Klebsiella pneumoniae in Croatian Hospitals and Outpatient Setting" GERMS 11, no. 2: 163-178. https://doi.org/10.18683/germs.2021.1254

APA Style

Tot, T., Kibel, S., Sardelić, S., Nemer, K., Benčić, A., Vraneš, J., Krilanović, M., Jelić, M., Tripković, M., Bubonja-Šonje, M., & Bedenić, B. (2021). Polyclonal Spread of Colistin Resistant Klebsiella pneumoniae in Croatian Hospitals and Outpatient Setting. GERMS, 11(2), 163-178. https://doi.org/10.18683/germs.2021.1254

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