Prevalence, risk factors and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in patients from Zhejiang, China, 2008–2018

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is emerging as a worldwide public health concern; however, the longterm molecular epidemiological surveillance of clinical CRKP in China is limited. We conducted a retrospective observational study (2008-2018) to assess the prevalence, susceptibility, risk factors and molecular epidemiology of clinical CRKP isolates. We found the prevalence of CRKP increased from 2.5%, 2008 to 15.8%, 2018. CRKP were significantly more frequent among hospitalized patients from ICU, and it was significantly more likely to be isolated from the capital city (Hangzhou) and the patients aged ≥60 years. Additionally, seasons and specimen types were associated with CRKP infections. The main CRKP sequence type (ST) was ST11, and bla KPC-2 was the most prevalent gene variant. Together these data reveal an increasing incidence and resistance trends among CRKP, especially the ST11-bla KPC-2-CRKP, in Zhejiang, during 2008-2018. Our findings are important for hospitals to limit its dissemination and optimize antibiotic administration.

An Outbreak of Carbapenem-Resistant Klebsiella pneumoniae in an Intensive Care Unit of a Major Teaching Hospital in Chongqing, China

“…This indicates that increasingly serious threats by ST11 are emerging. bla KPC-2 was responsible for the observed resistance in most of the CRKP isolates in the ICU, and is consistent with other reports (Shen et al, 2009;Hu et al, 2020), a typical plasmid-mediated drug resistance gene, that is widely distributed in different sizes and types of plasmids (Jain et al, 2013;Pitout et al, 2015). The success of the conjugation experiment in this study demonstrated the transferability of drug-resistant plasmids.…”

Antimicrobial resistance of Klebsiella Pneumoniae Pathogens in 2019 of Shaoxing City, Zhejiang Province: A Multi-Centre, Retrospective Study

“…CHINET surveillance showed that the national average CRKP isolation rate in 2019 was 27.6% [13]. The 2014-2018 survey in Zhejiang Province indicated that the CRKP prevalence rate in Shaoxing was 9.72%, the detection rate by our study is slightly higher than that, which is far lower than the national average level [17]. However, the hospitals covered by the above-mentioned research studies are completely different, and there are also certain differences from the six hospitals covered by this research.…”

“…ESBLs genes are mostly mediated by plasmids, which can spread between bacteria, including TEM, OXA, CTX-M, and SHV, etc, among which CTX-M is the main type contribution of the epidemiologic evolution of human ESBL infections [16]. An epidemiological survey in Zhejiang Province shows that the ESBLs rate is slightly higher than 20% in recent years [17]. The results in 2019 in the Shaoxing region are consistent with it.…”

The Epidemiology, Virulence and Antimicrobial Resistance of Invasive Klebsiella pneumoniae at a Children’s Medical Center in Eastern China

“…Notably, this rate was higher than that recorded in adults. 11 , 13 , 22 CRKP is resistant to most antimicrobial drugs and there are currently limited therapeutic options available, making infections difficult to control and resulting in high mortality rates. 12 , 13 The main mechanism of CRKP resistance is the production of enzymes, such as carbapenemases, ESBLs and AmpC, that hydrolyze antimicrobial drugs.…”