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Antimicrobial Agents and Chemotherapy, December 2004, p. 4793-4799, Vol. 48, No. 12
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.12.4793-4799.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.

Outbreak of Klebsiella pneumoniae Producing a New Carbapenem-Hydrolyzing Class A ß-Lactamase, KPC-3, in a New York Medical Center

Neil Woodford,1* Philip M. Tierno Jr.,2 Katherine Young,3 Luke Tysall,1 Marie-France I. Palepou,1 Elaina Ward,1 Ronald E. Painter,3 Deborah F. Suber,3 Daniel Shungu,3 Lynn L. Silver,3 Kenneth Inglima,2 John Kornblum,4 and David M. Livermore1

Antibiotic Resistance Monitoring and Reference Laboratory, Specialist and Reference Microbiology Division—Colindale, Health Protection Agency, London, United Kingdom,1 Departments of Microbiology & Pathology, Tisch Hospital, NYU Medical Center,2 New York City Department of Health, Public Health Laboratory, New York, New York,4 Human and Animal Infectious Disease Research, Merck Research Laboratories, Rahway, New Jersey3

Received 6 May 2004/ Returned for modification 31 July 2004/ Accepted 16 August 2004

From April 2000 to April 2001, 24 patients in intensive care units at Tisch Hospital, New York, N.Y., were infected or colonized by carbapenem-resistant Klebsiella pneumoniae. Pulsed-field gel electrophoresis identified a predominant outbreak strain, but other resistant strains were also recovered. Three representatives of the outbreak strain from separate patients were studied in detail. All were resistant or had reduced susceptibility to imipenem, meropenem, ceftazidime, piperacillin-tazobactam, and gentamicin but remained fully susceptible to tetracycline. PCR amplified a blaKPC allele encoding a novel variant, KPC-3, with a His(272)->Tyr substitution not found in KPC-2; other carbapenemase genes were absent. In the outbreak strain, KPC-3 was encoded by a 75-kb plasmid, which was transferred in vitro by electroporation and conjugation. The isolates lacked the OmpK35 porin but expressed OmpK36, implying reduced permeability as a cofactor in resistance. This is the third KPC carbapenem-hydrolyzing ß-lactamase variant to have been reported in members of the Enterobacteriaceae, with others reported from the East Coast of the United States. Although producers of these enzymes remain rare, the progress of this enzyme group merits monitoring.

* Corresponding author. Mailing address: ARMRL, SRMD—Colindale, Health Protection Agency, 61 Colindale Ave., London NW9 5HT, United Kingdom. Phone: 44-20-8327-7255. Fax: 44-20-8327-6264. E-mail: neil.woodford{at}hpa.org.uk.

Antimicrobial Agents and Chemotherapy, December 2004, p. 4793-4799, Vol. 48, No. 12
0066-4804/04/$08.00+0     DOI: 10.1128/AAC.48.12.4793-4799.2004
Copyright © 2004, American Society for Microbiology. All Rights Reserved.



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