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Among 69 of 139 (49.6%) carbapenem-nonsusceptibleEnterobacteriaceae carryingbla KPC , 1Klebsiella pneumoniae was also positive forbla VIM . The isolate belonged to sequence type 258 (ST258) and carriedbla KPC-2 on a copy ofTn4401 a andbla VIM-4 on a class 1 integron. Genes were located on distinct plasmids belonging to Inc types A/C and FII. Elevated expression of the efflux pump AcrAB-TolC (acrA , 15.3 times) and reduced expression of outer membrane protein genesompK35 andompK37 (0.16 and 0.081 times, respectively) associated with various amino acid alterations on OmpK37 were observed. The presence of two carbapenemases in ST258K. pneumoniae is of great concern due to the ability of this organism to widely disseminate.

antimicrobial agents and chemotherapy

Klebsiella pneumoniae Isolate from a New York City Hospital Belonging to Sequence Type 258 and Carrying bla KPC-2 and bla VIM-4