Carbapenem Nonsusceptible Klebsiella pneumoniae in Taiwan: Dissemination and Increasing Resistance of Carbapenemase Producers During 2012\u20132015

Sheng-Kang Chiu,Chang-Phone Fung,Jann-Tay Wang,Ling Ma,Ming-Chin Chan,Jung-Chung Lin,Kuo-Ming Yeh,Yin-Ching Chuang,Po-Liang Lu,Tsu-Lan Wu,Yi-Tsung Lin

doi:10.1038/s41598-018-26691-z

Abstract

Before 2011, the prevalence rates of carbapenemase-producing Klebsiella pneumoniae (CPKP) among carbapenem nonsusceptible K. pneumoniae (CnSKP) isolates were below 10% in Taiwan. The study presents the dissemination and increased antimicrobial resistance of CPKP from January 2012 to August 2015, as shown by Taiwanese multicenter surveillance. Isolates with minimum inhibitory concentrations (MICs) of >1 μg/mL for imipenem or meropenem were collected, screened for various carbapenemase genes by PCR, and tested for antimicrobial susceptibility. Among 1,457 CnSKP isolates, 1,250 were collected from medical centers. The CnSKP prevalence in medical centers increased by 1.7-fold during the study. Among all CnSKP isolates, 457 were CPKP. The CPKP rate among CnSKP increased by 1.5-fold and reached 36.8% in 2015. The CPKP nonsusceptibility rate to aztreonam, fluoroquinolones, and aminoglycosides increased yearly. Six CPKP isolates carried dual carbapenemase genes. Three Ambler classes were identified in 451 isolates with a single carbapenemase: classes A (315 blaKPC-2, 2 blaKPC-3, 28 blaKPC-17, 2 blaKPC-34), B (26 blaIMP-8, 2 blaNDM-1, 36 blaVIM-1), and D (40 blaOXA-48). The blaOXA-48 rate among CPKP increased by 6-fold over three years. Most KPC and OXA-48 producers were ST11. CnSKP was increasingly prevalent, owing to CPKP dissemination. Additionally, CPKP became more resistant during the study period.

Highlights

Klebsiella pneumoniae is a common cause of bacteremia, pneumonia, urinary tract infection, and liver abscess1. β-lactam antibiotics are often deemed the primary therapeutic option for these infections[2]
In three major regional hospitals, 137 isolates nonsusceptible to carbapenem were identified from 6,446 clinical K. pneumoniae isolates during the study period, and the average prevalence of carbapenem nonsusceptible K. pneumoniae (CnSKP) was 2.13%
The average prevalence of CnSKP was 1.10%, with 114,065 clinical isolates screened during the study period

Summary

Introduction

Klebsiella pneumoniae is a common cause of bacteremia, pneumonia, urinary tract infection, and liver abscess1. β-lactam antibiotics are often deemed the primary therapeutic option for these infections[2]. The molecular epidemiology of carbapenemase-producing K. pneumoniae (CPKP) varies by country. In the United States, K. pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) was first reported in 20018 and subsequently caused outbreaks in New York City[9]. K. pneumoniae isolates producing NDM-1 and KPC-2 were identified in Taiwanese patients returning from India and China, respectively[19,20]. After the arrival of KPC-2 producers, the molecular epidemiology and antimicrobial resistance profile of CnSKP and CPKP in Taiwan has not been examined well. We analyzed these trends from 2012 to 2015 to better understand and possibly prevent their global spread

Methods

Results

Conclusion