Here we report the second outbreak of the italian ...

Objectives: The CCP is an important group of B-lactamases, including their distribution among the nosocomial setting in Enterobacteriaceae. KPC-2 and -3 are more widespread, found mostly on plasmids in K. pneumonia. KPC-positive K. pneumonia (CPT-KP) have been reported in many European countries. After the first description of KPC-CP in Italy in 2009, only a few reports have been published. Here we report on the second Italian outbreak, discussing on the clinical and molecular features. Methods: 22 K. pneumonia isolates collected during 2010 in San Gerard's Hospital in Monza was analyzed as a representative of 58 isolates involved in the outbreak. Antibiotic susceptibility tests were conducted Vitek 2. IPC and imipenem were confirmed meropenema ETest for isolates that were strattera 40mg positive for carbapenemase production (detected phenyl boric acid test). Clonal distribution was assessed by pre-PCR, RAPD, PFGE and MLST. Some strains were subjected to PCR analysis and sequencing to determine the structure of resistance determinants. Results: 22 strains studied showed, MDR phenotype to be susceptible only to kolistyn, gentamicin and Tigecycline. The results of genotyping methods were consistent and showed that all but one clonal isolates related and belonged to ST 258. All isolates were confirmed to be blaKPC-2 positive sequencing. In addition, the investigated strains were positive blaCTX-M-15 and all but one to blaSHV-12 ESBLs. 36 additional isolates showing the same movie was about fenotypycheskyy associated with the epidemic cluster. Conclusion: In November 2009 in San Gerard hospital № KPC-KP strains were isolated. In the period under review, 22 clonal related KPC-MP were obtained. Isolates belonged to ST 258, as first described by Italian KPC-CP. This clone is primarily responsible for spreading around the world these resistance determinants. Molecular analysis showed the presence in all isolates blaKPC-2, and blaCTX-M-15 and all but one blaSHV-12 b-lactamases. Only the KPC-CP does not isolate clonal at the outbreak clone was positive for blaSHV-a key and was obtained from a patient transferred from another hospital. This is a different clone representing an exception in the Italian epidemiological scenario in which all of the KPC-CP belonged ST258. Pre-PCR approach described here appears to be fast and reliable method to study the clonal relationship KPC-CP. .