National Surveillance Study on Carbapenem Non-Susceptible Klebsiella pneumoniae in Taiwan: The Emergence and Rapid Dissemination of KPC-2 Carbapenemase

Abstract

ObjectivesThe global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals.MethodsWe collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL), and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type.ResultsThe resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 bla IMP-8 and 2 bla VIM-1). In 2012, carbapenemase genes were detected in 22.3% of isolates (41 bla KPC-2, 7 bla VIM-1, 6 bla IMP-8, and 1 bla NDM-1). More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype.ConclusionsIn 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming.

Allocation of Klebsiella pneumoniae Bloodstream Isolates into Four Distinct Groups byompK36Typing in a Taiwanese University Hospital

“…ST11, ST15, ST37, and ST147 are important STs among carbapenem-resistant K. pneumoniae isolates in Taiwan, and they were reported to account for Ͼ70% of carbapenem-resistant isolates by Chiu et al (16). In this study, the four STs only accounted for 24 (10.6%) of all study isolates ( Table 1), suggesting that these high-risk resistant clones had been minor strains rather than evolving from preexisting successful strains.…”

“…PCR and sequencing were used to identity bla TEM variants. The carbapenemase-encoding genes were detected by PCR, with searching for bla IMP , bla VIM , bla KPC , bla NDM , and bla OXA-48 (16,25). PCR detection of plasmid-mediated quinolone resistance genes, including qnrA, qnrB, qnrC, qnrD, and aac (6=)-Ib-cr, was performed as described previously (25,30).…”

“…K. pneumoniae is also an important reservoir of antibiotic resistance determinants (1). Several clones of K. pneumoniae with a high prevalence of carbapenem resistance or extended-spectrum ␤-lactamases (ESBLs) have been distributed worldwide (11)(12)(13)(14)(15)(16). The epidemic drug-resistant clones, called "high-risk" clones (11), may play an important role in the dissemination of antimicrobial resistance.…”

“…The epidemic drug-resistant clones, called "high-risk" clones (11), may play an important role in the dissemination of antimicrobial resistance. The major international high-risk clones identified by MLST belong to sequence type 11 (ST11), ST15, ST147, and ST258 (11)(12)(13)(14)(15)(16). ST11 and ST258 were included in clonal group (CG) 258 (11,14), while ST15 and ST147 were grouped in CG15 and CG147 (11,13,14), respectively.…”

Rapid Ertapenem Susceptibility Testing and Klebsiella pneumoniae Carbapenemase Phenotype Detection in Klebsiella pneumoniae Isolates by Use of Automated Microscopy of Immobilized Live Bacterial Cells

“…arbapenem-resistant Enterobacteriaceae (CRE) are emerging as a global threat; the plasmid-borne carbapenemase gene bla KPC is the predominant mechanism conferring carbapenem resistance in North America (1)(2)(3)(4)(5). This resistance gene has been reported in most species of Enterobacteriaceae, but it is most commonly found in Klebsiella pneumoniae.…”