Carbapenem Nonsusceptible Klebsiella pneumoniae in Taiwan: Dissemination and Increasing Resistance of Carbapenemase Producers During 2012–2015

Abstract

Before 2011, the prevalence rates of carbapenemase-producing Klebsiella pneumoniae (CPKP) among carbapenem nonsusceptible K. pneumoniae (CnSKP) isolates were below 10% in Taiwan. The study presents the dissemination and increased antimicrobial resistance of CPKP from January 2012 to August 2015, as shown by Taiwanese multicenter surveillance. Isolates with minimum inhibitory concentrations (MICs) of >1 μg/mL for imipenem or meropenem were collected, screened for various carbapenemase genes by PCR, and tested for antimicrobial susceptibility. Among 1,457 CnSKP isolates, 1,250 were collected from medical centers. The CnSKP prevalence in medical centers increased by 1.7-fold during the study. Among all CnSKP isolates, 457 were CPKP. The CPKP rate among CnSKP increased by 1.5-fold and reached 36.8% in 2015. The CPKP nonsusceptibility rate to aztreonam, fluoroquinolones, and aminoglycosides increased yearly. Six CPKP isolates carried dual carbapenemase genes. Three Ambler classes were identified in 451 isolates with a single carbapenemase: classes A (315 blaKPC-2, 2 blaKPC-3, 28 blaKPC-17, 2 blaKPC-34), B (26 blaIMP-8, 2 blaNDM-1, 36 blaVIM-1), and D (40 blaOXA-48). The blaOXA-48 rate among CPKP increased by 6-fold over three years. Most KPC and OXA-48 producers were ST11. CnSKP was increasingly prevalent, owing to CPKP dissemination. Additionally, CPKP became more resistant during the study period.

Carbapenem-Resistant Enterobacteriaceae Infections: Taiwan Aspects

“…Furthermore, it is noteworthy that the prevalence rates of CPE [36.4%; mostly related to various bla KPC (75.9%), followed by bla OXA-48 -like (8.8%), bla V IM-1 (7.9%), and bla IMP-8 (5.7%), etc] among the studied CR- K. pneumoniae isolates (approximately 99% were non-susceptible to imipenem, and 85.8% were collected from medical centers) were estimated to have 1.5-fold increase from 2012 through 2015. Most significantly, an increasing trend was observed in the middle-western part of Taiwan ( Chiu et al, 2018 ). Data regarding important CRE studies in Taiwan and other countries are shown in Table 1 .…”

“…There were big variations in the rates of CPE among clinical CRE isolates in Taiwan as compared to those from other countries ( Lorenzoni et al, 2017 ; Woodford et al, 2017 ; Laolerd et al, 2018 ). It is notable that persistently high KPC-2 rates (73.9% in 2012, and 61.1% in 2015) and emergence of KPC-17 as well as KPC-34 since 2014 were observed ( Chiu et al, 2018 ). As the K. pneumoniae of ST11 clone accounted for 86.9% of overall CP- K. pneumoniae isolates ( Chiu et al, 2018 ), heightened infection control maneuvers are absolutely warranted for Taiwanese medical centers.…”

Cocarriage of Distinct bla KPC-2 and bla OXA-48 Plasmids in a Single Sequence Type 11 Carbapenem-Resistant Klebsiella pneumoniae Isolate

“…T he endemic spread of carbapenemase-producing Klebsiella pneumoniae in Taiwan has become problematic (1). Besides the predominance of Klebsiella pneumoniae carbapenemase (KPC)-2, oxacillinase (OXA)-48 emerged at the end of 2013 (2) and has become the second most prevalent (1).…”

“…T he endemic spread of carbapenemase-producing Klebsiella pneumoniae in Taiwan has become problematic (1). Besides the predominance of Klebsiella pneumoniae carbapenemase (KPC)-2, oxacillinase (OXA)-48 emerged at the end of 2013 (2) and has become the second most prevalent (1). Previously, we demonstrated that KPC-2 and OXA-48 accounted for 36.2% and 12.6% of carbapenem-resistant K. pneumoniae isolates, respectively, and most of them belonged to sequence type (ST) 11 (3).…”

Characterization of resistance mechanisms of Enterobacter cloacae Complex Co-resistant to Carbapenem and Colistin

“…The production of AmpC or ESBLs combined with loss or decreased expression of out membrane protein (19,20). In addition, studies have found that the susceptibility of Escherichia coli and Enterobacter cloacae to carbapenem can be increased when the AcrAB-TolC e ux pump is inhibited (21,22).…”