Characterization of KPC-type carbapenemase-producing Klebsiella pneumoniae strains isolated in the Arabian Peninsula

Sir, Since its first description in 1996, variants of KPC have spread throughout the world mostly in the ST258 clone of Klebsiella pneumoniae within isoforms of the Tn4401 transposon located on various plasmids.1 While the Middle East is considered as a reservoir of various carbapenemase-producing bacteria, to date the only Enterobacteriaceae carrying the blaKPC gene reported from the Arabian Peninsula has been an Escherichia coli ST131 strain isolated in Kuwait.2 In a collection of 34 carbapenem-non-susceptible Enterobacteriaceae strains, comprising all clinically relevant, non-repeat isolates recovered in Rashid Hospital, Dubai, United Arab Emirates (UAE) between March 2012 and February 2014, we identified by PCR3: 3 blaNDM and 1 blaOXA-48-likeE. coli; and 3 blaNDM, 6 blaOXA-48-like, 17 blaNDM + blaOXA-48-like and 2 blaKPCK. pneumoniae. Since blaKPC-positive K. pneumoniae has not been described from this region to date, we subjected the two blaKPC-positive K. pneumoniae isolates (ABC220 and ABC224) to detailed investigations. K. pneumoniae ABC220 was isolated in October 2012 from a necrotizing wound of a previously healthy, 40-year-old Filipino male, 25 days after he had been admitted for perforated appendix and sepsis. K. pneumoniae ABC224 was recovered in May 2013 from the sputum of an 80-year-old UAE national with multiple chronic illnesses, continuously hospitalized for >1 year in a different ward for left leg amputation and sepsis. Prior to the isolation of these strains, various samples from both patients had been repeatedly negative for carbapenem-resistant Enterobacteriaceae.