Abstract
Carbapenemase-producing Klebsiella pneumoniae (CPKP) emerged in Greece in 2002 and became endemic thereafter. Driven by a notable variability in the phenotypic testing results for carbapenemase production in K. pneumoniae isolates from the intensive care units (ICUs) of our hospital, we performed a study to assess the molecular epidemiology of CPKP isolated between 2016 and 2019 using pulse-field gel electrophoresis (PFGE) including isolates recovered from 165 single patients. We investigated the molecular relatedness among strains recovered from rectal surveillance cultures and from respective subsequent infections due to CPKP in the same individual (48/165 cases). For the optimal interpretation of our findings, we carried out a systematic review regarding the clonality of CPKP isolated from clinical samples in ICUs in Europe. In our study, we identified 128 distinguishable pulsotypes and 17 clusters that indicated extended dissemination of CPKP within the hospital ICU setting throughout the study period. Among the clinical isolates, 122 harbored KPC genes (74%), 2 harbored KPC+NDM (1.2%), 38 harbored NDM (23%), 1 harbored NDM+OXA-48 (0.6%), 1 harbored NDM+VIM (0.6%) and 1 harbored the VIM (0.6%) gene. Multiple CPKP strains in our hospital have achieved sustained transmission. The polyclonal endemicity of CPKP presents a further threat for the selection of pathogens resistant to last-resort antimicrobial agents.
Highlights
In recent years, hospital-acquired infections caused by carbapenem-resistant Gram negative bacteria, especially carbapenem-resistant Klebsiella pneumoniae (CRKP), have been observed worldwide causing important public health problems and posing serious infection control issues
Driven by a notable variability in the phenotypic testing results for carbapenemase production in K. pneumoniae isolates from the intensive care units (ICUs) of our hospital, we performed a study to assess the molecular epidemiology of Carbapenemase-producing Klebsiella pneumoniae (CPKP) isolated between 2016 and 2019 using pulse-field gel electrophoresis (PFGE) including isolates recovered from 165 single patients
During the study period (January 2016–June 2019) 165 single-patient clinical CRKP were analyzed; the isolates were recovered from 115 patients hospitalized in ICU 1, 6 patients in ICU 2 and 44 patients in ICU 3
Summary
Hospital-acquired infections caused by carbapenem-resistant Gram negative bacteria, especially carbapenem-resistant Klebsiella pneumoniae (CRKP), have been observed worldwide causing important public health problems and posing serious infection control issues. According to the annual report of the European Centre for Disease Prevention and Control on antimicrobial resistance in Europe, 66.3% of the reported invasive K. pneumoniae isolates in Greece during 2020 were resistant to carbapenems. High carbapenem resistance rates were observed in Romania (48%), Italy (29%) and Bulgaria (28%), while, in the majority of the EU countries, this proportion was below 10% [3]. High carbapenem resistance trends were observed in other non-EU neighboring countries: Bosnia, Herzegovina, Georgia, the Russian Federation, Serbia and Turkey reported proportions between 25% and 50% whereas, Belarus, the Republic of Moldova and the Ukraine reported proportions exceeding 50% [4]
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