Outbreak of Klebsiella pneumoniae producing KPC-2 and SHV-12 in a French hospital.

M et al. Rapid detection of the O25b-ST131 clone of Escherichia coli encompassing the CTX-M-15-producing strains. 2 Clermont O, Lavollay M, Vimont S et al. The CTX-M-15-producing Escherichia coli diffusing clone belongs to a highly virulent B2 phylogenetic subgroup. 3 Karisik E, Ellington MJ, Livermore DM et al. Virulence factors in Escherichia coli with CTX-M-15 and other extended-spectrum b-lactamases in the UK. 4 Deschamps C, Clermont O, Hipeaux MC et al. Multiple acquisitions of CTX-M plasmids in the rare D 2 genotype of Escherichia coli provide evidence for convergent evolution. 7 Ender PT, Gajanana D, Johnston B et al. Transmission of an extended-spectrum-b-lactamase-producing Escherichia coli (sequence type ST131) strain between a father and daughter resulting in septic shock and emphysematous pyelonephritis. A et al. Dissemination of clonally related Escherichia coli strains expressing extended-spectrum b-lactamase CTX-M-15. Sir, The emergence and dissemination of Klebsiella pneumoniae strains harbouring carbapenemases is a serious concern. Klebsiella pneu-moniae carbapenemase (KPC) enzymes belong to molecular class A and are able to hydrolyse most b-lactams including carbapenems. Since the initial report of a KPC b-lactamase from a strain of K. pneu-moniae in 1996, KPC producers have been reported from various geographical regions. Current reports indicate that KPC-producing isolates are widespread in China, Israel, Greece, South America and the USA, where the epidemiology of KPC in the hospital setting is changing. 1 Fortunately, these strains are still rare in western and northern Europe, but their detection remains difficult. 2 Since 2003, patients hospitalized in the surgical ward of our hospital have been systematically screened on admission and weekly thereafter for intestinal carriage of bacteria producing extended-spectrum b-lactamases (ESBLs) and carbapenemases by plating rectal swabs on Drigalski agar containing 0.5 mg/L cefotaxime and MacConkey agar containing 2 mg/L ceftazidime (AES Labora-toire, Combourg, France). We report here four patients with K. pneu-moniae producing KPC-2 and SHV-12. The first case was a patient transferred in July 2009 from Crete for treatment of recurrent angiocholitis on a biliary stent. The patient was negative on the day of admission, but 3 days later a further stool sample grew with ESBL-producing K. pneumoniae. This first isolate was not suspected to produce a carbapenemase since testing for susceptibility to imipenem using a disc diffusion method showed a diameter of 24 mm and an MIC of 1.5 mg/L by Etest (Bio-Rad, Marne la Coquette, France), both considered as susceptible according to the national recommendations of the Antibiogram …