Klebsiella pneumoniae carbapenemase (KPC)-producing Klebsiella pneumoniae ST258 isolated from a Japanese patient without a history of foreign travel - a new public health concern in Japan: a case report

Abstract Background Thus far, studies on Klebsiella pneumoniae carbapenemase (KPC)-producing organisms have only been reported in those with a history of foreign travel, and a specific Japanese KPC-producing isolate has not yet been reported. Case presentation We describe a Japanese patient, with no history of travel to foreign countries, admitted due to aspiration pneumonia, and a KPC-producing isolate detected in his sputum. Fortunately, his pneumonia resolved. His close contacts did not have a history of foreign travel, and the isolate was not detected in other patients. Conclusions The potential for KPC-producing organisms to become endemic in Japan is currently of great concern

Evaluation of an Automated Rapid Diagnostic Assay for Detection of Gram-Negative Bacteria and Their Drug-Resistance Genes in Positive Blood Cultures

<div><p>We evaluated the performance of the Verigene Gram-Negative Blood Culture Nucleic Acid Test (BC-GN; Nanosphere, Northbrook, IL, USA), an automated multiplex assay for rapid identification of positive blood cultures caused by 9 Gram-negative bacteria (GNB) and for detection of 9 genes associated with β-lactam resistance. The BC-GN assay can be performed directly from positive blood cultures with 5 minutes of hands-on and 2 hours of run time per sample. A total of 397 GNB positive blood cultures were analyzed using the BC-GN assay. Of the 397 samples, 295 were simulated samples prepared by inoculating GNB into blood culture bottles, and the remaining were clinical samples from 102 patients with positive blood cultures. Aliquots of the positive blood cultures were tested by the BC-GN assay. The results of bacterial identification between the BC-GN assay and standard laboratory methods were as follows: <i>Acinetobacter</i> spp. (39 isolates for the BC-GN assay/39 for the standard methods), <i>Citrobacter</i> spp. (7/7), <i>Escherichia coli</i> (87/87), <i>Klebsiella oxytoca</i> (13/13), and <i>Proteus</i> spp. (11/11); <i>Enterobacter</i> spp. (29/30); <i>Klebsiella pneumoniae</i> (62/72); <i>Pseudomonas aeruginosa</i> (124/125); and <i>Serratia marcescens</i> (18/21); respectively. From the 102 clinical samples, 104 bacterial species were identified with the BC-GN assay, whereas 110 were identified with the standard methods. The BC-GN assay also detected all β-lactam resistance genes tested (233 genes), including 54 <i>bla</i>_CTX-M, 119 <i>bla</i>_IMP, 8 <i>bla</i>_KPC, 16 <i>bla</i>_NDM, 24 <i>bla</i>_OXA-23, 1 <i>bla</i>_OXA-24/40, 1 <i>bla</i>_OXA-48, 4 <i>bla</i>_OXA-58, and 6 <i>bla</i>_VIM. The data shows that the BC-GN assay provides rapid detection of GNB and β-lactam resistance genes in positive blood cultures and has the potential to contributing to optimal patient management by earlier detection of major antimicrobial resistance genes.</p></div

Drug susceptibility of β-lactams of E. coli harboring or not harboring.

<p>Drug susceptibility of β-lactams of E. coli harboring or not harboring.</p

Identification of resistance genes in blood culture samples with the BC-GN assay.

<p>a Resistance genes which were harbored by bacterial species inoculated into blood culture bottles or isolated from sepsis patients.</p><p>b, c See footnotes b and c in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0094064#pone-0094064-t003" target="_blank">Table 3</a>.</p><p>d Numbers of genes which were correctly identified with the BC-GN assay.</p><p>e Numbers of genes which were not detected with the BC-GN assay.</p><p>f Concordance rate between the BC-GN assay and the conventional methods for resistance-genes identification.</p><p>g CI indicates confidence interval</p

Primers used in this study.

<p>Primers used in this study.</p

Identification of bacterial isolates in blood culture samples with the BC-GN assay.

<p>a Bacterial species inoculated into blood culture bottles or bacterial species identified in clinical samples of blood culture bottles.</p><p>b Blood culture samples into which bacterial isolates were inoculated.</p><p>c Clinical blood culture samples obatined from sepsis patients.</p><p>d Numbers of isolates which were correctly identified with the BC-GN assay.</p><p>e Numbers of isolates which were not detected with the BC-GN assay.</p><p>f Numbers of isolates which were incorrectly identified with theBC-GN assay.</p><p>g Numbers of bacterial species which were identified in clinical samples with the conventional methods. Some of the samples contained 2 or 3 bacterial species.</p><p>h Concordance rate between the BC-GN assay and the conventional methods for bacterial identification.</p><p>i CI indicates confidence interval</p><p>j A sample inoculated with K. pneumoniae was identified as Enterobacter spp. with the assay.</p

Bacterial species and Antimicrobial resistance genes identified by the BC-GN assay.

<p>Bacterial species and Antimicrobial resistance genes identified by the BC-GN assay.</p