Abstract
The rapidly increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) over the past decade has increased concern in healthcare facilities and the impact on public health. The prevalence of blaKPC (KPC) in Thailand remains very low; only blaKPC-13 has been described previously. This study is the first to describe the characteristics of blaKPC-2-carrying Klebsiella pneumoniae, Escherichia coli, and Enterobacter asburiae in Thailand. The prevalence rate of blaKPC-2-carrying isolates was 0.13% among CRE isolates in our study. Based on carbapenem susceptibility testing, K. pneumoniae C1985 was resistant to meropenem and ertapenem, E. coli C1992 was resistant to meropenem, imipenem, and ertapenem, and E. asburiae C2135 was only resistant to imipenem. K. pneumoniae C1985 carried blaKPC-2, blaSHV-11, fosA, oqxA, and oqxB, while E. coli C1992 contained blaKPC-2 and mdf(A) and E. asburiae C2135 harbored blaKPC-2, blaACT-2, and qnrE1. The genetic features of blaKPC-2 in the 3 isolates revealed identical rearrangement and flanking regions. Analysis of genomic sequences from these 3 isolates revealed that the sequence types of K. pneumoniae C1985, E. coli C1992, and E. asburiae C2135 were ST4008, ST7297, and ST1249, respectively. The 3 blaKPC-2 isolates were from individual living cases. Two cases were colonization for K. pneumoniae C1985 and E. asburiae C2135 and the third case was hospital-acquired infection of E. coli C1992. Although the prevalence of blaKPC-2-carrying CRE is relatively low in this study, continued surveillance and close monitoring are warranted. In addition, prompt or early detection of CRE and strict implementation of infection control are essential to prevent outbreaks or rapid spread in hospitals.
Highlights
The rapidly increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) over the past decade has increased concern in healthcare facilities and the impact on public health
K. pneumoniae C1985, E. coli C1992, and E. asburiae C2135 were isolated from urine of a 67-year-old female, from pus in the right arm of a 45-year-old male, and from sputum of a 43-year-old female, respectively
The diagnosis of the 67-year-old female was cholangiocarcinoma and this case was classified as colonization by K. pneumoniae C1985
Summary
The rapidly increasing prevalence of carbapenem-resistant Enterobacteriaceae (CRE) over the past decade has increased concern in healthcare facilities and the impact on public health. This study is the first to describe the characteristics of blaKPC-2-carrying Klebsiella pneumoniae, Escherichia coli, and Enterobacter asburiae in Thailand. There are three main groups of enzymes responsible for most carbapenem resistance: KPC (Klebsiella pneumoniae carbapenemase) (Ambler class A), Metallo-ß-Lactamases (Ambler class B) such as NDM and IMP, and OXA-48-like (Ambler class D)[2]. These enzymes are encoded by blaKPC, blaNDM, blaIMP, and blaOXA48-like, respectively, and are frequently found worldwide[2]. The current study is the first to describe the characteristics of KPC-2-carrying K. pneumoniae, E. coli, and Enterobacter asburiae from rural areas in Thailand
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