Molecular epidemiology of extended-spectrum- -lactamase-producing Klebsiella pneumoniae over a 10 year period in Calgary, Canada

Peirano, Gisele; Sang, Jessica Hung King; Pitondo-Silva, André; Laupland, Kevin B.; Pitout, Johann

doi:10.1093/jac/dks026

Cited by 64 publications

(50 citation statements)

References 32 publications

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“…Reduced ciprofloxacin susceptibility was observed in E. coli (12.8%), similar to rates reported in Canada and worldwide (5,7,23). However, K. pneumoniae susceptibility to ciprofloxacin (28 to 36%) (17,26) was significantly higher in other Canadian centers than observed in this study in 2009 (9.0%). More concerning was the frequent occurrence of multiclass resistance among ESBL-E. Use of alternative agents, such as piperacillin-tazobactam, have been assessed (21), but in vitro susceptibility testing is required, as decreasing susceptibility was observed over the course of this study.…”

supporting

confidence: 86%

“…Between 2007 to 2009, estimated national preva-lence of ESBL-producing E. coli was reported to be 4.1% and stable over the 3-year study period (23). Concurrently, studies in Calgary have described increasing rates of ESBL-producing K. pneumoniae (0.1% to 1.1%) and E. coli (0.3% to 14%) in the past decade (17,19). This underscores the importance of understanding local epidemiology, particularly for antimicrobial susceptibility, as local geographic changes may not be apparent in larger surveillance studies.…”

mentioning

confidence: 99%

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Decreased Susceptibility to Noncarbapenem Antimicrobials in Extended-Spectrum-β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates in Toronto, Canada

Lowe

McGeer

Muller

et al. 2012

Antimicrob Agents Chemother

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Retrospective review from 11 Canadian hospitals showed increasing incidence of extended-spectrum ␤-lactamase (ESBL)-producing Escherichia coli and Klebsiella pneumoniae from 0.12 per 1,000 inpatient days during 2005 to 0.47 per 1,000 inpatient days during 2009. By 2009, susceptibility rates of ESBL-positive E. coli/K. pneumoniae were as follows: ciprofloxacin, 12.8%/ 9.0%; TMP/SMX, 32.9%/12.2%; and nitrofurantoin, 83.8%/10.3%. Nosocomial and nonnosocomial ESBL-producing E. coli isolates had similar susceptibility profiles, while nonnosocomial ESBL-producing K. pneumoniae was associated with decreased ciprofloxacin (P ‫؍‬ 0.03) and nitrofurantoin (P < 0.001) susceptibilities. Multidrug-resistant Enterobacteriaceae strains have become a global concern. Increasing incidence of extended-spectrum ␤-lactamase-producing Enterobacteriaceae (ESBL-E) may be attributable, in part, to the successful clonal dissemination of the CTX-M-15 plasmid worldwide (2, 22). Carbapenem-resistant Enterobacteriaceae (CRE) are also emerging across the globe (3, 9, 15). Low prevalence rates (4.1%) of ESBL-producing E. coli have been described in Canada, predominantly due to CTX-M ␤-lactamases (23), and only sporadic cases of imported CRE have been reported (13,23).Infections due to ESBL-E are associated with increased morbidity, mortality, length of hospital stay, and cost (11). Therapeutic alternatives for ESBL-E are limited with increasing resistance to non-␤-lactam antibiotics (6), resulting in a high likelihood of inappropriate initial empirical therapy (8). Carbapenems continue to be the treatment choice for severe infections due to ESBL-E (16), but resistance to these agents is also emerging (9, 15).In light of these concerns regarding ESBL-E, a retrospective review of incidence rates and susceptibility profiles for ESBL-E was conducted in 11 large hospitals (five academic and six community) in Toronto, Canada, from 2005 to 2009. Participating hospital characteristics have been previously described (12). All ESBL-producing Ambler class A Escherichia coli and Klebsiella pneumoniae clinical isolates were included. Susceptibility testing was performed utilizing VITEK2 (bioMérieux, St. Laurent, Quebec, Canada) in 10 hospitals and Phoenix2 (Becton Dickenson, Mississauga, Ontario, Canada) in the remaining hospital. Isolates intermediate or resistant to an extended-spectrum cephalosporin (cefpodoxime, ceftriaxone, or ceftazidime) were confirmed as ESBL-E with double disk diffusion testing as per the 2009 CLSI standards (1). Mean incidence rates were calculated after each site was adjusted per 1,000 inpatient days. Only the first clinical isolate from any one patient was included. Isolates were defined as nosocomial if they were identified from cultures obtained 3 or more days after admission to the hospital in patients without a prior specimen yielding ESBL-E. Statistical analysis was performed utilizing the chi-squared test or the chi-squared test for trend, as well as a multivariate analysis (SAS 9.2; Cary, NC). Fig. 1. There were 1,994 E...

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supporting

confidence: 86%

mentioning

confidence: 99%

Decreased Susceptibility to Noncarbapenem Antimicrobials in Extended-Spectrum-β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates in Toronto, Canada

Lowe

McGeer

Muller

et al. 2012

Antimicrob Agents Chemother

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“…CG17, comprising six STs, occurred in four centers and dominated in BM, France (42.1%), due to ST16, ST20, and ST630. Previously, CG17 was reported as the key clonal group among ESBL producers in Canada (17) and was notable in other studies worldwide (13,16,31). CG101 was represented only by ST101 in two sites, highly prevailing in FS in Rome (58.5%).…”

mentioning

confidence: 74%

Comparative Population Analysis of Klebsiella pneumoniae Strains with Extended-Spectrum β-Lactamases Colonizing Patients in Rehabilitation Centers in Four Countries

Baraniak

Izdebski

Fiett

et al. 2013

Antimicrob Agents Chemother

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The international project MOSAR was conducted in five rehabilitation centers; patients were screened for rectal carriage of extended-spectrum ␤-lactamase (ESBL)-producing members of the Enterobacteriaceae. Among 229 Klebsiella pneumoniae isolates, four clonal groups (CG) or complexes (CC) prevailed: CG17 in France, CG101 in Italy, CG15 in Spain, and CC147 in Israel. ESBLs, mainly CTX-Ms, were produced by 226 isolates; three isolates expressed AmpC-like cephalosporinases. High genetic diversity of K. pneumoniae populations was observed, with specific characteristics at each center.

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“…The two studies conducted in Spain, 2 years apart at two hospitals in Galicia and Catalonia, indicated a marked increase in prevalence over this period: 22% in 2006 and 32% in 2008. In the United States (2009 to 2011), E. coli ST131 accounted for 54%, 10%, and 64% of the ESBL-producing E. coli isolates in the general population, children, and veterans, respectively (45,93,141 (78,145,146).…”

Section: Prevalence and Epidemiology Of E Coli St131 Among Human CLImentioning

confidence: 99%

Escherichia coli ST131, an Intriguing Clonal Group

2014

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SUMMARY In 2008, a previously unknown Escherichia coli clonal group, sequence type 131 (ST131), was identified on three continents. Today, ST131 is the predominant E. coli lineage among extraintestinal pathogenic E. coli (ExPEC) isolates worldwide. Retrospective studies have suggested that it may originally have risen to prominence as early as 2003. Unlike other classical group B2 ExPEC isolates, ST131 isolates are commonly reported to produce extended-spectrum β-lactamases, such as CTX-M-15, and almost all are resistant to fluoroquinolones. Moreover, ST131 E. coli isolates are considered to be truly pathogenic, due to the spectrum of infections they cause in both community and hospital settings and the large number of virulence-associated genes they contain. ST131 isolates therefore seem to contradict the widely held view that high levels of antimicrobial resistance are necessarily associated with a fitness cost leading to a decrease in pathogenesis. Six years after the first description of E. coli ST131, this review outlines the principal traits of ST131 clonal group isolates, based on the growing body of published data, and highlights what is currently known and what we need to find out to provide public health authorities with better information to help combat ST131.

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Molecular epidemiology of extended-spectrum- -lactamase-producing Klebsiella pneumoniae over a 10 year period in Calgary, Canada

Abstract: Our study highlights the importance of molecular epidemiology in providing insight into the emergence, characteristics and distribution of STs among ESBL-producing K. pneumoniae.

Cited by 64 publications

References 32 publications

Decreased Susceptibility to Noncarbapenem Antimicrobials in Extended-Spectrum-β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates in Toronto, Canada

Decreased Susceptibility to Noncarbapenem Antimicrobials in Extended-Spectrum-β-Lactamase-Producing Escherichia coli and Klebsiella pneumoniae Isolates in Toronto, Canada

Comparative Population Analysis of Klebsiella pneumoniae Strains with Extended-Spectrum β-Lactamases Colonizing Patients in Rehabilitation Centers in Four Countries

Escherichia coli ST131, an Intriguing Clonal Group

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