Emergence of KPC-producing urease-negative Klebsiella pneumonia in Corrientes, Argentina.

DI CONZA JOSÉ; BADARACCO ELVIRA; CALZA Y.; CHAVEZ P.; GOYECHEA R.; ALMUZARA MARISA; VAY CARLOS; BANGHER M; SOLER L.; GUTKIND GABRIEL; PEÑA LAURA

Boston

Congreso; ASM Microbe 2016; 2016

American Society for Microbiology

Background: KPC-producing K. pneumoniae (KPC-Kpn) are severe nosocomial pathogens. To our knowledge, Corrientes has been free of KPC-Kpn outbreaks. This province limits and is a key for regional transit with Paraguay and Brazil. Dissemination of the hiperendemic ST 258 clone as well as ST11 and ST23 have been already reported. Our aim was to describe the molecular and clinical epidemiology of an atypical urease-negative KPC-Kpn clone. Methods: We conducted a prospective descriptive analysis of all patients with KPN-KPC infection (August 2015 to January 2016) in Corrientes, Argentina. Identification included conventional, semiautomated panels and MALDI-TOF. Antimicrobial susceptibility was performed by disk diffusion according to CLSI. Screening for carbapenemases (KPC) was performed by using APB disks, a modified Hodge and blue-Carba tests. blaKPC was confirmed by PCR and sequencing. The clonal relatedness was investigated by ERIC-PCR and MLST. Results: A patient derived in August 2015 from a limiting province rendered a KPC-producing isolate (characterized as Klebsiella (Raultella) terrigena by API 20E (98%)) from an urine colonization. As the resistance profile made was unlikely, it was submitted for MALDI-TOF confirmation, which placed it as K. pneumoniae; urease production was negative. Since then, other 12 microorganisms with the same profile were recovered in two hospitals, 4 from rectal swabs, and 8 from clinically relevant samples (3 UTIs, 1 from an hepatic abscess, 2 from respiratory syndrome, a pancreatic abscess and a mediastinitis; the last 4 died). All isolates presented the same biotype with an antibiotic multiresistance profile, being only fully susceptible to amikacin. Further, all of them displayed identical ERIC-PCR electropherotype belonging to a single clonal type ST340. Conclusions: Our findings report a KPC-producing clone with an atypical urease reaction associated with nosocomial outbreaks. It also constitutes the first description of ST340 in Argentina alerting for the emergence of a non-ST258 clone, especially considering that urease-negative BLEE-producing K. pneumonia have already been reported in Brazil.