Objectives: The carbapenemase KPC has disseminated globally mainly by clonal spread of KPC-producing Klebsiella pneumoniae (KPC-KP) but may also spread by horizontal-gene-transfer (HGT). We aimed to characterize the molecular features of KPC-producing Enterobacteriaceae species (KPC-Ent), in cases where more than one species is detected from the same patient, in comparison with carriage of isolated KPC-KP.Methods: The incidence of KPC-Ent cases was recorded from April 2011 until August 2012 at the Laniado Hospital (LH). Full molecular characterization was done in all cases of multiple KPC-Ent and on a random sample of KPC-KP isolated alone (n=14). Bacterial typing was done by PFGE and MLST. Plasmids were characterized by plasmid MLST (pMLST) and S1-nuclease analysis. The genetic environment of the blaKPC gene was studied by sequencing. Results: The incidence of isolated KPC-KP was 274 (16.1/month). Eight patients had multiple KPC-Ent in addition to K. pneumoniae, including E. coli (6), Enterobacter spp. (n=2) and Citrobacter freundii (n=1). All KPC-KP isolated alone (n=14) belonged to the ST-258 clone and carried the blaKPC-3 allele, located inside a 10-kb Tn4401 transposon and harbored by various plasmid types, mainly IncFII-K2 type. KPC-KP's isolated together with other KPC-Ent belonged to different ST's and carried the blaKPC-2 allele, located inside a 5-kb transposon and harbored by IncN, pMLST ST-15 type plasmid. Conclusions: This study highlight two simultaneous outbreaks of KPC-Ent: a high scale outbreak characterized by the spread of the ST-258 K. pneumoniae clone, and a HGT-related, multispecies dissemination of the blaKPC-2 gene via various pMLST ST-15 type plasmids.
