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Updated: Mar 11, 2026
Testing the Role of Multicopy Plasmids in the Evolution of Antibiotic Resistance
Published on: May 2, 2018
In vivo transmission of a plasmid containing the KPC-2 gene in a single patient
Irene Galani1, Theofano Panagea1, Zoi Chryssouli1
14th Department of Internal Medicine, Athens University School of Medicine, University General Hospital 'Attikon', 1 Rimini Street, 124 62 Chaidari, Athens, Greece.
Abstract:
Here we describe a case of in vivo horizontal interspecies transmission of a KPC-2-producing plasmid from a Klebsiella pneumoniae to an Enterobacter aerogenes strain in the same patient. The patient's gut flora initially contained a carbapenem-susceptible E. aerogenes strain and 10 days after admission a KPC-2-positive K. pneumoniae. Three months after admission, a KPC-2-positive E. aerogenes was identified in fecal surveillance cultures. This isolate was isogenic with the initial E. aerogenes and contained a KPC-2-coding plasmid identical to that of the K. pneumoniae. The patient developed bacteraemia by the KPC-2-positive K. pneumoniae 17 days after her first colonization. In vivo horizontal transmission of blaKPC-carrying plasmids between bacterial species underscores the importance of antibiotic stewardship along with implementation of infection control measures for the containment of KPC-producers.
Insights
In a single patient, a carbapenem-resistant plasmid carrying KPC-2 genes transferred between Klebsiella pneumoniae and Enterobacter aerogenes. This highlights the need for infection control to limit the spread of carbapenem-resistant bacteria.
Area of Science:
- Microbiology
- Infectious Diseases
- Genetics
Background:
- Carbapenemase-producing Enterobacteriaceae (CPE) pose a significant global health threat.
- Horizontal gene transfer is a key mechanism for the spread of antibiotic resistance.
Purpose of the Study:
- To describe a case of in vivo horizontal interspecies plasmid transmission of KPC-2.
- To investigate the transfer of a KPC-2-producing plasmid from Klebsiella pneumoniae to Enterobacter aerogenes within a single patient.
Main Methods:
- Case report detailing clinical observations and microbiological findings.
- Bacterial strain characterization, including plasmid analysis and genetic relatedness.
Main Results:
- A carbapenem-susceptible Enterobacter aerogenes and a KPC-2-positive Klebsiella pneumoniae were identified in the patient.
- A KPC-2-positive Enterobacter aerogenes, isogenic to the initial strain and carrying an identical plasmid to K. pneumoniae, was isolated three months later.
- The patient developed KPC-2-positive K. pneumoniae bacteremia.
Conclusions:
- In vivo horizontal transmission of blaKPC-carrying plasmids between bacterial species can occur within a patient.
- Effective antibiotic stewardship and infection control measures are crucial for containing KPC-producing organisms.
