Emergence of Carbapenem-ResistantKlebsiella pneumoniae: Progressive Spread and Four-Year Period of Observation in a Cardiac Surgery Division

Abstract

Frequent use of carbapenems has contributed to the increase to K. pneumoniae strains resistant to this class of antibiotics (CRKP), causing a problem in the clinical treatment of patients. This investigation reports the epidemiology, genetic diversity, and clinical implication of the resistance to drugs mediated by CRKP in our hospital. A total of 280 K. pneumoniae strains were collected; in particular 98/280 (35%) were CRKP. Sequencing analysis of CRKP isolated strains showed that 9/98 of MBL-producing strains carried the bla VIM-1 gene and 89/98 of the isolates were positive for bla KPC-2. Antimicrobial susceptibility tests revealed a complete resistance to third-generation cephalosporins and a moderate resistance to tigecycline, gentamicin, and fluoroquinolones with percentages of resistance of 61%, 64%, and 98%, respectively. A resistance of 31% was shown towards trimethoprim-sulfamethoxazole. Colistin was the most active agent against CRKP with 99% of susceptibility. Clonality was evaluated by PFGE and MLST: MLST showed the same clonal type, ST258, while PFGE analysis indicated the presence of a major clone, namely, pulsotype A. This finding indicates that the prevalent resistant isolates were genetically related, suggesting that the spread of these genes could be due to clonal dissemination as well as to genetic exchange between different clones.

Risk Factors Affecting Clinical Outcome in Patients with Carbapenem-Resistant K. pneumoniae: A Retrospective Study

“…In our study, we found that CRKP had a low resistance rate to compound sulfamethoxazole (21.65%), which was similar to the findings in a previous report [ 26 ]. In vitro , Su et al [ 27 ] found that compound sulfamethoxazole combined with polymyxin could quickly kill CRKP isolates within 2 to 24 h. However, there was a lack of evidence-based medicine for clinical treatment of CRKP using compound sulfamethoxazole, and this finding needed to be confirmed by further clinical studies [ 27 ].…”

Urinary tract infections: a retrospective, descriptive study of causative organisms and antimicrobial pattern of samples received for culture, from a tertiary care setting

“…have the ability to acquire resistance genes by mutations and more commonly by transmissible plasmids. 27 Progressive spread and increasing incidence of carbapenem resistance among Klebsiella spp. has become a severe public health issue.…”

Molecular characterization of class 1, 2 and 3 integrons in clinical multi-drug resistant Klebsiella pneumoniae isolates

“…Klebsiella pneumoniae (K. pneumoniae) is one of the most important causes of infection especially among hospitalized patients [1]. Multi-drug resistant (MDR) K. pneumoniae isolates are becoming increasingly prevalent in the clinical and nosocomial environments and is raised as a major threat in treatment of nosocomial infections [2]. Different mechanisms and factors involved in the development and spread of antibiotic resistance in bacterial strains.…”