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Fourteen outbreaks in Hungary between 2005 and 2008 caused by extended-spectrum beta-lactamase-producing Klebsiella pneumoniae (ESBL-KP) were epidemiologically investigated and the isolated pathogens were characterized by molecular techniques. Ten of the fourteen outbreaks occurred in adult wards and four in neonatal units affecting a total number of 73 patients. The 54% [40] of the patients developed bloodstream infections and 21.9%–21.9% [16] pneumonia and surgical site infections, respectively. The overall rate of mortality proved high: 36.9% [27]. Outbreaks in adults affected more patients, had higher attack rates, were more prolonged in duration and had a 6.9-fold higher mortality rate than outbreaks observed in neonates. The outbreaks in neonates were caused by SHV-type ESBL-producing klebsiellae, while in the “adult outbreaks” exclusively CTX-M-type ESBL-KP strains were involved. While the outbreak strains isolated from neonatal units could be assigned to a variety of pulsotypes, the previously described K. pneumoniae epidemic clones, ST15 and ST147, could be identified among the pathogens causing outbreaks in adult units.

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The proportion of Escherichia coli non-susceptible to 3rd generation cephalosprins from invasive clinical samples has risen in Hungary from 5.1 per cent in 2006 to 15.5 per cent in 2011. The prevalence of ESBL-production in E. coli of animal origin remains unknown. During the first stage of a probe forty-five human and 18 animal ESBL-producing E. coli strains isolated in 2006-2007 were investigated. The human strains were representatively selected from a collection of 113 ESBL-producing isolates sent to the national reference center from local laboratories across the country. A variety of ESBLs were detected (SHV-2, -5, -12, CTX-M-32) with CTX-M-15 being the most common in human and CTX-M-1 the dominant in animal isolates. Genetic characterization revealed that thirty-six human isolates (80 per cent) belonged to either the phylogenetic group (PG) B2 or D. Conversely, 15 animal isolates (83 per cent) proved to be members of the A and B1 commensal PGs. Furthermore 46 per cent of human isolates (21/45) from 12 centres belonged to the international O25-ST131/B2 clone while nine isolates from seven centers showed the O15 serotype. Pulsed-field gel electrophoresis (PFGE) detected 22 and 11 diverse pulsotypes among 45 human and 18 animal isolates, respectively. The human and animal strains did not share any pulsotypes.

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Acta Microbiologica et Immunologica Hungarica
Authors: Béla Kádár, Béla Kocsis, Ákos Tóth, Ivelina Damjanova, Máté Szász, Katalin Kristóf, Károly Nagy, and Dóra Szabó

In this study antibiotic combinations for multidrug-resistant Klebsiella pneumoniae strains were investigated. The study included a colistin-susceptible and a colistin-resistant KPC-2 producing K. pneumoniae ST258 strains isolated in 2008 and 2009 during an outbreak in Hungary. Antibiotic combinations were analyzed by checkerboard technique and fractional inhibitory concentration indices were calculated. The following antibiotics were tested: ceftazidime, cefotaxime, ceftriaxone, ampicillin, imipenem, ertapenem, amikacin, tobramycin, ciprofloxacin, levofloxacin, moxifloxacin, rifampicin, polymyxin B and colistin. Combinations including 0.25 μg/ml colistin plus 1 μg/ml rifampicin, 0.25 μg/ml polymyxin B plus 1 μg/ml rifampicin, 1 μg/ml imipenem plus 2 μg/ml tobramycin, were found synergistic.These in vitro synergistic combinations suggest potential therapeutical options against infections caused by KPC-2 producing, multidrug-resistant K. pneumoniae ST258.

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