An update of the evolving epidemic of blaKPC-2-carrying Klebsiella pneumoniae in Greece (2009-10)

J Antimicrob Chemother. 2011 Jul;66(7):1510-3. doi: 10.1093/jac/dkr166. Epub 2011 May 4.


Objectives: To follow the epidemic of KPC-2-producing Klebsiella pneumoniae in Greece.

Methods: KPC-2-producing isolates (n = 378) were collected during January 2009-April 2010 in 40 Greek hospitals. bla(KPC) and bla(VIM) were detected by PCR. Carbapenemase production was confirmed by spectrophotometry. Sequences flanking bla(KPC-2) and their plasmid carriers were studied. Isolates were typed by PFGE and multilocus sequence typing (MLST).

Results: All 378 isolates were bla(KPC-2) positive; 18 also carried bla(VIM-1/VIM-4). Higher isolation frequencies were observed in Athens and Crete. Isolates were classified into 13 PFGE types and 11 sequence types (STs). ST258 was predominant (n = 322), followed by ST147 (n = 20), ST383 (n = 9), ST133 (n = 6), ST274 (n = 4) and ST323 (n = 3). Of the remaining isolates, seven were distributed into five STs (11, 17, 340 and the novel 494 and 495) and seven were not typed. bla(KPC-2) could not be transferred from ST258 isolates, in contrast to isolates of ST17, ST133, ST147, ST274, ST494 and ST495. All bla(KPC-2)-encoding plasmids were of similar size (∼100 kb) and showed indistinguishable restriction fragment length polymorphism (RFLP) patterns except those from the ST340 isolates. Sequences flanking bla(KPC-2) revealed that the Tn4401a isoform was present in plasmids from all STs except ST340 containing Tn4401b. Co-production of VIM enzymes was observed in isolates of ST147, ST323 and ST383.

Conclusions: Apart from the epidemic of KPC-2-producing K. pneumoniae belonging to ST258 in Greece, diffusion of bla(KPC-2) to at least 10 additional STs has taken place. Notably, strains from three of the latter STs (147, 323 and 383) were found to carry both bla(KPC-2) and bla(VIM).

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Cluster Analysis
  • DNA, Bacterial / genetics
  • Electrophoresis, Gel, Pulsed-Field
  • Gene Transfer, Horizontal
  • Genotype
  • Greece / epidemiology
  • Humans
  • Klebsiella Infections / epidemiology*
  • Klebsiella Infections / microbiology
  • Klebsiella pneumoniae / classification
  • Klebsiella pneumoniae / enzymology*
  • Klebsiella pneumoniae / genetics
  • Klebsiella pneumoniae / isolation & purification
  • Microbial Sensitivity Tests
  • Molecular Epidemiology
  • Molecular Typing
  • Plasmids
  • beta-Lactamases / biosynthesis*
  • beta-Lactamases / genetics


  • Anti-Bacterial Agents
  • DNA, Bacterial
  • beta-Lactamases
  • beta-lactamase KPC-2, Klebsiella pneumoniae