Emergence of OXA-48-Producing Klebsiella pneumoniae in Taiwan

Abstract

The isolation of OXA-48-producing Enterobacteriaceae has increased dramatically in Mediterranean countries in the past 10 years, and has recently emerged in Asia. Between January 2012 and May 2014, a total of 760 carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) isolates were collected during a Taiwan national surveillance. Carbapenemases were detected in 210 CnSKP isolates (27.6%), including 162 KPC-2 (n = 1), KPC-3, KPC-17, and NDM-1 (n = 1 each), OXA-48 (n = 4), IMP-8 (n = 18), and VIM-1 (n = 24). The four bla OXA-48 CnSKP isolates were detected in late 2013. Herein we report the emergence OXA-48-producing K. pneumoniae isolates in Taiwan. PFGE analysis revealed that the four isolates belonged to three different pulsotypes. Three isolates harboured bla CTX-M genes and belonged to MLST type ST11. In addition, the plasmids belonged to the incompatibility group, IncA/C. One isolate belonged to ST116 and the plasmid incompatibility group was non-typeable. The sequence upstream of the bla OXA-48 gene in all four isolates was identical to pKPOXA-48N1, a bla OXA-48-carrying plasmid. This is the first report of OXA-48-producing Enterobacteriaceae in Taiwan and the second report to identify bla OXA-48 on an IncA/C plasmid in K. pneumoniae. Given that three isolates belong to the same pandemic clone (ST11) and possess the IncA/C plasmid and similar plasmid digestion profile that indicated the role of clonal spread or plasmid for dissemination of bla OXA-48 gene, the emergence of OXA-48-producing K. pneumoniae in Taiwan is of great concern.

Evaluation of Phenotypic and Genotypic Characteristics of Carbapnemases-producing Enterobacteriaceae and Its Prevalence in a Referral Hospital in Tehran City

“…It was subsequently re-identified in Iran (20,27). The widespread prevalence of OXA-48-positive carbapenem resistant K. pneumoniae strains has been reported in several Asian and European countries including Turkey, Saudi Arabia, Taiwan, China, Russia and France which has become an expanding problem (11,32,(38)(39)(40)(41)(42).…”

The rapid spread of carbapenem-resistant Enterobacteriaceae

“…Molecular characterization of bla OXA-48-like variants is recommended, as expression of bla OXA-48 in E. coli does not always yield carbapenem resistance in vitro , but it can prevent clearance of infections [Haverkate 2015]. Emerging cases of bla OXA-48 in Taiwan from January 2012 to May 2014 suggest expanding ability to confer carbapenem resistance in the Enterobacteriaceae [Ma 2015]. bla OXA-48 was responsible for carbapenem resistance in a collection of Raoultella planticola isolates from January 2011 to December 2015 at a Turkish hospital [Demiray 2016].…”

Nosocomial spread of OXA-232-producing Klebsiella pneumoniae ST15 in a teaching hospital, Shanghai, China

“…Diverse sequence types (STs) of dominant OXA-48-producing K. pneumoniae have been identified in outbreaks or solitary case reports worldwide [3]. ST11 and ST116 were present in Taiwan, China [6]. An outbreak of OXA-48-producing K. pneumoniae ST147 and ST383 has been reported [7], while other clones, such as ST37 and ST307, have also been identified sporadically [8].…”