AUTHOR=Manageiro Vera , Romão Raquel , Moura Inês Barata , Sampaio Daniel A. , Vieira Luís , Ferreira Eugénia ,  the Network EuSCAPE-Portugal , Caniça Manuela 

TITLE=Molecular Epidemiology and Risk Factors of Carbapenemase-Producing Enterobacteriaceae Isolates in Portuguese Hospitals: Results From European Survey on Carbapenemase-Producing Enterobacteriaceae (EuSCAPE)

JOURNAL=Frontiers in Microbiology

VOLUME=9

YEAR=2018

URL=https://www.frontiersin.org/journals/microbiology/articles/10.3389/fmicb.2018.02834

DOI=10.3389/fmicb.2018.02834

ISSN=1664-302X

ABSTRACT=<p>In Portugal, the epidemiological stage for the spread of carbapenemase-producing <italic>Enterobacteriaceae</italic> (CPE) increased from sporadic isolates or single hospital clones (2010–2013), to hospital outbreaks, later. Here we report data from a 6-month study performed under the European Survey on Carbapenemase-Producing <italic>Enterobacteriaceae</italic> (EuSCAPE). During the study period, 67 isolates (61 <italic>Klebsiella pneumoniae</italic> and 6 <italic>Escherichia coli</italic>) non-susceptible to carbapenems were identified in participant hospital laboratories. We detected 37 <italic>bla</italic><sub>KPC–type</sub> (including one new variant: <italic>bla</italic><sub>KPC–21</sub>), 1 <italic>bla</italic><sub>GES–5</sub>, and 1 <italic>bla</italic><sub>GES–6</sub> plus <italic>bla</italic><sub>KPC–3</sub>, alone or in combination with other <italic>bla</italic> genes. Bioinformatics analysis of the KPC-21-producing <italic>E. coli</italic> identified the new variant <italic>bla</italic><sub>KPC–21</sub> in a 12,748 bp length plasmid. The <italic>bla</italic><sub>KPC–21</sub> gene was harbored on a non-Tn<italic>4401</italic> element, presenting upstream a partial IS<italic>Kpn6</italic> (ΔIS<italic>Kpn6/</italic>Δ<italic>traN</italic>) with the related left IR (IR<sub>L</sub>) and downstream a truncated Tn3 transposon. PFGE and MLST analysis showed an important diversity, as isolates belonged to distinct PFGE and STs profiles. In this study, we highlighted the presence of the high-risk clone <italic>E. coli</italic> sequence-type (ST) 131 clade C/H30. This worldwide disseminated <italic>E. coli</italic> lineage was already detected in Portugal among other antibiotic resistance reservoirs. This study highlights the intra- and inter-hospital spread and possible intercontinental circulation of CPE isolates.</p>