Abstract
BackgroundThe increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is a growing problem globally, particularly in low- to middle-income countries (LMICs). Previous studies have shown high rates of CRE colonisation among patients at hospitals in LMICs, with increased risk of hospital-acquired infections.MethodsWe isolated carbapenem-resistant Klebsiella pneumoniae (CRKP) from faecal samples collected in 2017 from patients at admission and discharge at a Vietnamese neonatal intensive care unit (NICU). 126 CRKP were whole-genome sequenced. The phylogenetic relationship between the isolates and between clinical CRKP isolates collected in 2012–2018 at the same hospital were investigated.ResultsNDM-type carbapenemase-(61%) and KPC-2-encoding genes (41%) were the most common carbapenem resistance genes observed among the admission and discharge isolates. Most isolates (56%) belonged to three distinct clonal clusters of ST15, carrying blaKPC-2, blaNDM-1 and blaNDM-4, respectively. Each cluster also comprised clinical isolates from blood collected at the study hospital. The most dominant ST15 clone was shown to be related to isolates collected from the same hospital as far back as in 2012.ConclusionsHighly resistant CRKP were found colonising admission and discharge patients at a Vietnamese NICU, emphasising the importance of continued monitoring. Whole-genome sequencing revealed a population of CRKP consisting mostly of ST15 isolates in three clonally related clusters, each related to blood isolates collected from the same hospital. Furthermore, clinical isolates collected from previous years (dating back to 2012) were shown to likely be clonally descended from ST15 isolates in the largest cluster, suggesting a successful hospital strain which can colonise inpatients.
Highlights
The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is a growing problem globally, in low- to middle-income countries (LMICs)
Prevalence of carbapenem-resistant Klebsiella pneumoniae (CRKP) at admission and discharge and baseline patient statistics Faecal samples were collected at admission and discharge from a total of 326 patients at the study neonatal intensive care unit (NICU) (Table 1)
Patients which were CRKP-positive at discharge had significantly longer NICU stays compared to patients which were CRKPnegative at discharge (P < 0.001)
Summary
The increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) is a growing problem globally, in low- to middle-income countries (LMICs). Previous studies have shown high rates of CRE colonisation among patients at hospitals in LMICs, with increased risk of hospital-acquired infections. The prevalence of antibiotic-resistant bacteria is increasing globally, leading to elevated healthcare costs and patient mortality. Data on the burden of carbapenem-resistant Enterobacteriaceae (CRE) is currently scarce in LMICs, Stewardson et al [4] showed in a recent study, with data from ten LMICs, that bloodstream infections caused by CRE were associated with increased length of hospital stays and mortality. A point prevalence study conducted in 2012 and 2013 found a total prevalence of 30%, with Klebsiella pneumoniae being the most common Enterobacteriaceae to cause HAIs, 15% of which were resistant to carbapenems [5]. At the ICUs of three Vietnamese paediatric referral hospitals during the same period, the rate of HAI was reported to be 33% with K. pneumoniae being the most common causative agent [6]. 55% of K. pneumoniae isolates were reported to be resistant to carbapenems
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