Nationwide Surveillance and Molecular Characterization of Critically Drug-Resistant Gram-Negative Bacteria: Results of the Research University Network Thailand Study

Abstract

A large-scale surveillance is an important measure to monitor the regional spread of antimicrobial resistance. We prospectively studied the prevalence and molecular characteristics of clinically important Gram-negative bacilli, including Escherichia coli (EC), Klebsiella pneumoniae (KP), Acinetobacter baumannii complex (ABC), and Pseudomonas aeruginosa (PA) from blood, respiratory tract, urine, and sterile sites at 47 hospitals across Thailand. Among 187,619 isolates, 93,810 isolates (50.0%) were critically drug-resistant. Of which, 12,915 isolates (13.8%) were randomly selected for molecular characterization. EC was most commonly isolated from all specimens, except the respiratory tract in which ABC was predominant. Prevalence of extended-spectrum cephalosporin resistance (ESCR) was higher in EC (42.5%) than KP (32.0%), but carbapenem-resistant (CR)-KP (17.2%) was 4.5-fold higher than CR-EC (3.8%). A majority of ESCR-/CR-EC and KP carried bla CTX-M (64.6%-82.1%). bla NDM and bla OXA-48-like were the most prevalent carbapenemase genes in CR-EC/CR-KP (74.9%/52.9% and 22.4%/54.1%, respectively). Besides, 12.9%/23.0% of CR-EC/CR-KP co-carried bla NDM and bla OXA-48-like. Among ABC, 41.9% were extensively drug-resistant (XDR), and 35.7% were multidrug-resistant (MDR), while PA showed XDR/MDR at 6.3%/16.5%. A. baumannii (AB) was the most common species among ABC isolates. The major carbapenemase gene in MDR-AB/XDR-AB was bla OXA-23-like (85.8%/93.0%), which had much higher rates than other ABC species. bla IMP , bla VIM , bla OXA-40-like, and bla OXA-58-like were also detected in ABC at lower rates. The most common carbapenemase gene in MDR-/XDR-PA was bla IMP (29.0%/30.6%), followed by bla VIM (9.5%/25.3%). The findings reiterate an alarming situation of drug resistance that requires serious control measures.

Carbapenemase Production and Epidemiological Characteristics of Carbapenem-Resistant Klebsiella pneumoniae in Western Chongqing, China

“…A case of liver abscess caused by hypervirulent K. pneumoniae (hvKP) infection was first reported in 1986 in Taiwan Province, China (Liu et al, 1986). Since then, hvKP has been reported in many countries, including China, South Korea, Japan, Spain, Madagascar, Cambodia, and Senegal (Cubero et al, 2016;Zhang Y. et al, 2016;Harada et al, 2019;Yoon et al, 2019;Huynh et al, 2020;Parrott et al, 2021). A defining feature of hvKP is its hypermucoid appearance on agar plates.…”

“…Carbapenem-resistant Klebsiella pneumoniae (CRKP) has received increasing attention worldwide because of the widespread misuse of carbapenem antibiotics, with CRKP difficult to treat ( Gong et al., 2018 ; Yungyuen et al., 2021 ). Several factors contribute to the development of CRKP resistance, among which carbapenemase-producing enzymes are the most predominant resistance mechanism ( Conte et al., 2016 ; El-Badawy et al., 2020 ; Zhang et al., 2021 ).…”

Antimicrobial Susceptibility Trends Among Gram-Negative Bacilli Causing Bloodstream Infections: Results from the China Antimicrobial Resistance Surveillance Trial (CARST) Program, 2011–2020

“… 5 , 8 , 14 However, many surveillance programs show an ongoing increase in the detection of gram-negative bacilli, many of which are multidrug-resistant (MDR), in BSI, worldwide. 17 , 18 Majority of the gram-negative bacteria in these studies have been E. coli, K. pneumoniae and P. aeruginosa . 19 , 20 Early empirical and adequate agents against these pathogens are essential to reduce the occurrence of bacterial resistance and thus improve patient outcomes.…”

Antibiofilm property and multiple action of peptide PEW300 against Pseudomonas aeruginosa

“…With the powerful protection of biofilms, these pathogens can attach to inert surfaces of medical devices, living tissues, and implanted prostheses, and successfully "escape" the damage of antibacterial agents (Ciofu and Tolker-Nielsen, 2019;Tagliaferri et al, 2019;Thi et al, 2020). The severity of pathogen infections and the invalidation of antibiotics have resulted in high morbidity and mortality (Founou et al, 2017;Zhen et al, 2019a;Manandhar et al, 2020;Yungyuen et al, 2021).…”