KPC-2-Producing Enterobacter cloacae and Pseudomonas putida Coinfection in a Liver Transplant Recipient

San Antonio Military Medical Center, Fort Sam Houston, Texas 782341, USA.
Antimicrobial Agents and Chemotherapy (Impact Factor: 4.48). 11/2008; 53(1):292-4. DOI: 10.1128/AAC.00931-08
Source: PubMed


Carbapenemases are among the newest resistance mechanisms to emerge in some gram-negative bacteria. We describe bacteremia
in a critically ill liver transplant recipient infected with KPC-2-producing Enterobacter cloacae and Pseudomonas putida. Although this enzyme has been previously described in Enterobacter spp., this is the first report of KPC carbapenemase in P. putida.

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    • "Additionally, in 2010, one KPC-producing P. aeruginosa strain was isolated in the USA [2]. Despite global emergence of KPC-producing strains of P. aeruginosa, it still uncommon and is thought to be sporadic (yet its rapid detection is necessary) [2], [16], [17], [18]. In our study, two KPC-producing P. aeruginosa strains were identified, which is the first report from Iran to the best of our knowledge. "
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    ABSTRACT: Wound infection associated with carbapenem-resistant Pseudomonas aeruginosa in burn patients is a growing problem. One of the main mechanisms of resistance to carbapenem antibiotics is the ability of P. aeruginosa to produce carbapenemase enzymes. Klebsiella pneumonia carbapemenase (KPC) is an important type of carbapenemase which can hydrolyze carbapenem antibiotics. The Modified Hodge Test (MHT) and boronic acid as a KPC inhibitor are two phenotypic methods used for detection of carbapenemase. The sensitivity and specificity of these two phenotypic tests for the identification of KPC can be measured by PCR. In this study, 241 P. aeruginosa strains were isolated from wounds of hospitalized burn patients. Carbapenem-resistant P. aeruginosa isolates were determined by the disk diffusion method. KPC-producing carbapenem-resistant strains were examined using the Modified Hodge Test, followed by boronic acid. Further, strains with positive responses to MHT and boronic acid tests were analyzed with the PCR molecular method. One hundred eighty-six of 241 isolates were resistant to carbapenems and 75 were positive in the MHT. Three exhibited an at least 5-mm diameter difference when meropenem was combined with boronic acid vs meropenem alone in the boronic acid test. Two strains had a specific band with primer No.1 after gel electrophoresis. This study showed that MHT, despite excellent sensitivity, has variable specificity independent of bacterial species. Further, the use of KPC inhibitors such as boronic acid did not yield favorable sensitivity and specificity among the specimens from Iranian patients. Thus, it seems that sequencing after PCR should be considered the gold standard for the detection of KPC-producing P. aeruginosa.
    03/2014; 9(1):Doc06. DOI:10.3205/dgkh000226
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    • "These genes have usually been identified in large plasmids varying in size and structure. There have been sporadic cases of in vivo transfer of a KPC-encoding plasmid between species [3] [4] as well as reports on the detection of the same plasmid in different genera co-existing in the same patient [5] [6]. In addition, at least two outbreaks involving several different genera of Enterobacteriaceae sharing the same promiscuous KPC-2-encoding plasmid have been described, one in China [7] and one in the USA [8]. "
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    ABSTRACT: Here we describe a case of in vivo horizontal interspecies transmission of a KPC-2-producing plasmid from a Klebsiella pneumoniae to an Enterobacter aerogenes strain in the same patient. The patient’s gut flora initially contained a carbapenem-susceptible E. aerogenes strain and 10 days after admission a KPC-2-positive K. pneumoniae. Three months after admission, a KPC-2-positive E. aerogenes was identified in fecal surveillance cultures. This isolate was isogenic with the initial E. aerogenes and contained a KPC-2-coding plasmid identical to that of the K. pneumoniae. The patient developed bacteraemia by the KPC-2-positive K. pneumoniae 17 days after her first colonization. In vivo horizontal transmission of blaKPC-carrying plasmids between bacterial species underscores the importance of antibiotic stewardship along with implementation of infection control measures for the containment of KPC-producers.
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    • "Despite the fact that this organism causes healthcare-related infections, clinical data on P. putida infections are lacking owing to the rarity, relatively lower virulence, and higher antimicrobial susceptibility of P. putida compared with other Pseudomonas species, especially Pseudomonas aeruginosa.2,8-10 However, recently, the emergence of multi-drug-resistant (MDR) and carbapenem-resistant P. putida has become a cause for concern.11-15 The outcome of MDR P. putida bacteremia has not been extensively investigated. "
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    ABSTRACT: Previously, Pseudomonas putida was considered a low-virulence pathogen and was recognized as a rare cause of bacteremia. Recently, however, multidrug-resistant and carbapenem-resistant P. putida isolates have emerged, causing difficult-to-treat nosocomial infections in seriously ill patients. Currently, the outcome of multidrug-resistant or carbapenem-resistant P. putida bacteremia remains uncertain. Here, we report 18 cases of P. putida bacteremia with high rates of carbapenem resistance and mortality. From January 2005 through December 2011, all cases of nosocomial P. putida bacteremia were identified and analyzed at Chonnam National University Hospital and Chonnam National University Hwasun Hospital. Electronic medical records were reviewed retrospectively. Four (22%) and five (23%) of 18 P. putida isolates were resistant to imipenem and meropenem, respectively. Common primary infection sites were central venous catheter (7, 39%), pneumonia (5, 28%), and cholangitis (2, 11%). Fourteen (78%) patients had indwelling devices related to the primary site of infection. The 30-day mortality rate was 39% (7/18): 40% (2/5) in patients with carbapenem-resistant P. putida bacteremia vs. 38% (5/13) in patients with carbapenem-susceptible P. putida bacteremia. Nosocomial P. putida bacteremia showed high resistance rates to most potent β-lactams and carbapenems and was associated with high mortality rates.
    08/2012; 48(2):91-5. DOI:10.4068/cmj.2012.48.2.91
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