Detection of VIM-34, a novel VIM-1 variant identified in the intercontinental ST15 Klebsiella pneumoniae clone.

Sir, Enterobacteriaceae producing metallo-b-lactamases (MBLs), and particularly VIM-type MBLs, have frequently been implicated in hospital outbreaks across Europe, blaVIM genes having been linked to Tn402 derivatives, epidemic plasmids (IncN, IncI1, IncHI2) and occasionally with particular Enterobacteriaceae clones. VIM enzymes have been classified in three clusters (VIM-1, VIM-2 and VIM-7) according to their amino acid sequences (http://www.lahey.org/ studies), VIM-1 and VIM-2 being the most widespread variants. In this study, we report the molecular epidemiology and the antibiotic susceptibility profiles of Klebsiella pneumoniae clinical isolates producing VIM-34, a novel VIM-1 variant identified in Portugal. In October 2011 and October 2012, two K. pneumoniae isolates (strains K43 and K47, respectively) showing reduced susceptibility to carbapenems (MICs 0.38–1.0 mg/L) were recovered from urine samples of hospitalized patients in a general hospital in northern Portugal (Hospital Pedro Hispano). They are the only carbapenemase-producing Enterobacteriaceae isolates identified in this hospital since the beginning of 2011, when reference protocols for carbapenemase detection were adopted. Antimicrobial susceptibility tests were performed using the Etest for b-lactams and disc diffusion for all other antimicrobial agents. These showed that all isolates were resistant to diverse cephalosporins, aztreonam,b-lactam/b-lactamase inhibitor combinations (Table 1), nalidixic acid, ciprofloxacin, chloramphenicol, gentamicin, kanamycin, netilmicin, streptomycin, tobramycin and sulphonamides, but susceptible to trimethoprim and amikacin (http://www.eucast.org/). Standard disc diffusion phenotypic tests using different b-lactams and b-lactamase inhibitors (cefotaxime, ceftazidime, imipenem; 0.2 mM EDTA, clavulanic acid), isoelectric focusing, PCR and sequencing demonstrated the production of VIM-34 (pI1⁄45.4) (GenBank accession number JX013656), a novel VIM-type enzyme differing from VIM-1 by one amino acid change (V113I, according to MBL standard numbering scheme) and co-production of SHV-1 (pI1⁄47.6) and SHV-12 (pI1⁄48.2) extended-spectrum b-lactamase. We could not identify the origin of these isolates but as both patients had multiple previous hospitalizations (including in other hospitals) and carried the same novel blaVIM type, a common nosocomial source seems more plausible than community acquisition. The blaVIM-34 from the K47 isolate was cloned in the pBGS18 (kanamycinresistance)plasmidusingprimersVIM-EcoRI(5′-GGGAATT CGCAGTCGCCCTAAAACAAAG-3′) and VIM-PstI (5′-AACTGCAGCCGCTCCA ACGATTTGTTAT-3′) (restrictionsitesareunderlined),andtheexpression vector (pBGS18/VIM-34) was further introduced into Escherichia coli DH5a, as previously reported. MICs of different b-lactams were determined using the Etest (in triplicate) and compared with those corresponding to a blaVIM-1-carrying clone obtained in the same conditions (Table 1). The VIM-34-producing E. coli recombinant yielded b-lactam MIC values similar to those observed in the VIM-1-encoding transformant (with the exception of cefoxitin; Table 1). Because our experiments were performed in an isogenic context and identical standard experimental conditions, we are able to hypothesize that the substitution V113I has a low influence on the MICs of carbapenems, although further studies of enzymatic activity are required to confirm this observation. The isolates exhibited identical XbaI-PFGE profiles and clonal identification by multilocus sequence typing(http://www.pasteur.fr/ recherche/genopole/PF8/mlst/Kpneumoniae.html) revealed that they belong to the intercontinental ST15 K. pneumoniae clone, widely disseminated in different European countries and associated with the spread of extended-spectrum b-lactamases (CTX-M-15; diverse SHV types) and/or MBLs (VIM-1, NDM-1).Conjugation assays performed by broth and/or filter mating methods using E. coli HB101 (azide and kanamycin resistant, Lac-, plasmid free) as Table 1. MICs of different b-lactam antibiotics for VIM-34-producing wild-type isolates and recombinant strains encoding VIM-34 or VIM-1