Session: Slide Session: KPC β-Lactamase Continues to Go Global
Tuesday, October 28, 2008: 12:00 AM
Room: Independence A (Grand Hyatt)
Background:To date blaKPC-containing K. pneumoniae isolates (KPC-Kp) are responsible for hospital-acquired infections. KPC-Kp have not yet been detected in community and long-term care facility (LTCF) settings. Here, we report the recent identification of KPC-Kp in several patients from a LTACF located in South Florida. Methods: In a one month period (March 21st - April 18th, 2008), all K. pneumoniae isolates showing reduced susceptibility to carbapenems (MICs ≥ 4 mg/L) detected at Integrated Regional Laboratories (Ft. Lauderdale, FL) were studied. Phenotype screening for KPC production was performed with the modified Hodge test. PCR and sequence analysis for blaKPC, blaTEM, blaSHV, blaCTX-M was also performed. Clonal relatedness of isolates was investigated with the DiversiLab Microbial Typing System (Bacterial BarCode, bioMérieux). Results: We identified 10 non-duplicate K. pneumoniae isolates with reduced susceptibility to carbapenems. Seven isolates were collected from different patients recovered at the LTACF, whereas the remaining 3 isolates were from patients recovered at two hospitals in the same region. All isolates were positive by Hodge test for carbapenemases and PCR for blaKPC. The KPC-Kp from LTACF possessed blaKPC-3, blaTEM-1, and blaSHV-11. Of these, 5 isolates were included in a single genotype (>98% homology), whereas the remaining 2 shared a ≥ 93% homology with the first group. The 3 KPC-Kp detected in hospitalized patients were not related to the LTACF isolates. However, one of them was highly-related by typing to a KPC-Kp strain detected in Ohio. Conclusions: This report documents the dissemination of KPC-Kp strains outside the hospital environment. The spread of KPC-Kp in a LTACF (and nationally) represents a serious infection control and therapeutic challenge in a new clinical setting.