The emergence of carbapenem resistant Klebsiella pneumoniae in Malaysia: correlation between microbiological trends with host characteristics and clinical factors

Abstract

BackgroundCarbapenem resistant Enterobacteriaceae is a growing concern worldwide including Malaysia. The emergence of this pathogen is worrying because carbapenem is one of the 'last-line' antibiotics. The main objective of this study was to determine the prevalence of genetic mechanisms and clinical risk factors of carbapenem resistant Klebsiella pneumoniae (K. pneumoniae) in Malaysia.MethodsIn this study, seventeen carbapenem resistant K. pneumoniae strains isolated from a tertiary teaching hospital in 2013 were studied. Minimal inhibitory concentration (MIC) of the bacterial strains was determined and genes associated with carbapenemases and extended-spectrum-beta-lactamases (ESBLs) were sequenced and compared with the closest representatives published in public domains. All strains were also sub-typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Statistical analyses were performed to determine the correlation between risk factors for acquiring carbapenem resistant K. pneumoniae and in-hospital mortality.ResultsThe predominant carbapenemase was bla OXA-48, detected in 12 strains (70.59%). Other carbapenemases detected in this study were bla KPC-2, bla IMP-8, bla NMC-A and bla NDM-1. Nine different pulsotypes were identified and nine strains which were affiliated with ST101, the predominant sequence type had similar PFGE patterns (similarity index of 85%). Based on univariate statistical analysis, resistance to imipenem and usage of mechanical ventilation showed a statistically significant effect separately to in-hospital mortality.ConclusionThe diverse genetic mechanisms harbored by these carbapenem resistant K. pneumoniae facilitates its spread and complicates its detection. Thus, correlation between microbiological trends with host characteristics and clinical factors will provide a better insight of rational treatment strategies and pathogen control.

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

“…In our study, the ratio of male to female was 1.66, while in Kuwait, Arabian Peninsula, Malaysian studies, the male to female ratios were 0.9, 1.8, and 1.2, respectively. (30)(31)(32). In our study, 52.77% of the resistant group died, which was significantly (P=0.043) in contrast to the carbapenem-sensitive group, where only 12.87% died.…”

“…Similarly, in Solgi's study in Isfahan, 77% of the cases were isolated from intensive care units (20). However, in the Malaysian study, the highest percentages were observed in the surgical ward (25%) and internal ward (25%), some of whom were also admitted to the intensive care unit (32).…”

“…This study found CPE with OXA-48, NDM and KPC genes together or alone, in a hospital in Tehran. The co-production of OXA-48-and NDM; OXA-48 and KPC with NDM -producing K. pneumoniae has been reported in some Asian and European countries (30)(31)(32)(34)(35)(36). Beyond the dominance of OXA-48-like and NDM producing strains, it was also notable that almost half of the collection co-produced these two enzymes.…”

“…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).…”

Biofilm formation and antimicrobial resistance in Klebsiella pneumoniae isolated from patients visiting a tertiary care center of Nepal

“…The emergence of antibiotic-resistant strains of K. pneumoniae has become a cause of concern because extended-spectrum β-lactamases (ESBL) and carbapenemase producing strains have been isolated frequently from most of the part of the world [8]. ESBLs are plasmidmediated enzymes that are responsible for resistance to all penicillins and cephalosporins, including the sulbactam and clavulanic acid combinations and monobactams such as aztreonam [9].…”