Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016

Galani, Irene; Karaiskos, Ilias; Karantani, Irene; Papoutsaki, Vassiliki; Maraki, Sofia; Papaioannou, Vassiliki; Kazila, Polyzo; Tsorlini, H.; Charalampaki, Nikoletta; Toutouza, Marina; Vagiakou, Helen; Παππάς, Κωνσταντίνος; Kyratsa, Anna; Κοντοπούλου, Κωνσταντίνα; Legga, Olga; Petinaki, Efthymia; Papadogeorgaki, Helen; Chinou, E.; Souli, María; Giamarellou, Helen

doi:10.2807/1560-7917.es.2018.23.30.1700775

Cited by 72 publications

(60 citation statements)

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“…In the present study, 100% and over 50% of the KPCproducers were resistant to temocillin according to the systemic and urinary breakpoints, respectively. Our data are however in line with a report from Greece describing low temocillin activity against KPC-producers: 97.3% and 42% were resistant according to systemic and urinary breakpoints, respectively [24]. The low number of KPC-producing isolates is a limitation of the study, but the set of clinical isolates tested was representative of the population of KPC-producing isolates cultured from clinical specimens between 2010 and 2017 in Poland.…”

Section: Discussionsupporting

confidence: 86%

Activity of temocillin against ESBL-, AmpC-, and/or KPC-producing Enterobacterales isolated in Poland

Kuch

Zieniuk

Żabicka

et al. 2020

Eur J Clin Microbiol Infect Dis

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We evaluated the in vitro effectiveness of temocillin and several commonly used antimicrobials against Enterobacterales bacteria in isolates from Polish patients. We tested 400 isolates: 260 extended-spectrum β-lactamase (ESBL)-and/or ampC β-lactamase (AmpC)-producing isolates; 40 Klebsiella pneumoniae carbapenemase (KPC)-producing isolates; and 100 ESBL-, AmpC-, and KPC-negative isolates. The minimal inhibitory concentrations (MICs) of temocillin and 16 other antimicrobials were determined by reference microdilution. We also determined the activities of fosfomycin and ceftazidime/avibactam in KPC-producing isolates. The antibiotic sensitivities were interpreted according to EUCAST, BSAC, and CLSI criteria. Overall, 91% of the isolates were susceptible to temocillin using the urinary tract infection breakpoint (≤ 32 mg/L), and 61.8% were susceptible using the systemic infection breakpoint (≤ 8 mg/L). Meropenem and imipenem were the most active drugs (MIC 50 values of 0.06 and 0.5 mg/L, respectively). Colistin and ertapenem (both MIC 50 = 0.12 mg/L) were less active than meropenem or imipenem, but some strains were 77% susceptible to each of them. Among the KPC-producing isolates, 42.5% had MIC values of ≤ 32 mg/L (urinary tract infection breakpoint), but 100% were resistant to temocillin (systemic infection breakpoint). Ceftazidime/avibactam was active against 100% of the KPC-producing isolates, and fosfomycin was active against 40%. The empirical susceptibility rate observed among the urinary isolates suggests that temocillin may be considered as an alternative to carbapenems in the absence of KPC-producing bacteria. With regard to isolates from other sources, temocillin might be useful as a documented therapy agent or an empirical treatment in hospitals with a low prevalence of ESBL/AmpC-producing strains.

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Section: Discussionsupporting

confidence: 86%

Activity of temocillin against ESBL-, AmpC-, and/or KPC-producing Enterobacterales isolated in Poland

Kuch

Zieniuk

Żabicka

et al. 2020

Eur J Clin Microbiol Infect Dis

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“…Of note, soon after the introduction of NDM in the country, the EuSCAPE project conducted between November 2013 and April 2014 in 10 hospitals all over Greece found it to rank as the second most frequent carbapenemase [ 5 ]. This was also reported by a subsequent nationwide multicentre study during the period 2014–2016 [ 20 ], indicating further dissemination. Moreover, according to a report published in 2015 [ 21 ], while KPC-2 production provides Enterobacteriaceae with intermediate resistance or even decreased susceptibility to meropenem in many cases, NDM-1 production allows HLR to meropenem.…”

Section: Discussionsupporting

confidence: 82%

Eight-year trends in the relative isolation frequency and antimicrobial susceptibility among bloodstream isolates from Greek hospitals: data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance – WHONET-Greece, 2010 to 2017

et al. 2020

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Background Antimicrobial resistance (AMR) changes over time and continuous monitoring provides insight on trends to inform both empirical treatment and public health action. Aims To survey trends in relative isolation frequency (RIF) and AMR among key bloodstream pathogens using data from the Greek Electronic System for the Surveillance of AMR (WHONET-Greece). Methods This observational study looked into routine susceptibility data of 50,488 blood culture isolates from hospitalised patients in 25 tertiary hospitals, participating in the WHONET-Greece for trends over time between January 2010 and December 2017. Only the first isolate per species from each patient was included. Hospital wards and intensive care units (ICUs) were analysed separately. Results During the study, the RIF of Acinetobacter baumannii increased in wards, as did the proportion of A. baumannii isolates, which were non-susceptible to most antibiotics in both wards and ICUs. Coincidently, Klebsiella pneumoniae RIF declined while the respective rates of non-susceptible isolates to carbapenems and gentamicin increased. Pseudomonas aeruginosa RIF remained stable but decreasing proportions of non-susceptible isolates to all studied antibiotics, except imipenem were observed. Escherichia coli RIF increased as did the proportion of isolates non-susceptible to third-generation cephalosporins, carbapenems and fluoroquinolones. Concerning Staphylococcus aureus , a decline in the percentage of meticillin resistant isolates in ICUs was found, while the percentages of Enterococcus faecium isolates with non-susceptibility to vancomycin stayed stable. Conclusions Recognising these trends over time is important, since the epidemiology of AMR is complex, involving different ‘bug and drug’ combinations. This should be taken into consideration to control AMR.

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“…CZA demonstrates high in vitro activity against nonmetallo-β-lactamase-producing K. pneumoniae strains in Greece [8]. To date, there are two reports on sporadic cases of CZA resistant K. pneumoniae from Greece, due to the production of KPC-23 [10], or VEB-25 [5].…”

Section: Discussionmentioning

confidence: 99%

“…CZA MICs (tested with a fixed avibactam concentration of 4 mg/L) ranged from 32 to 64 mg/L (Supplementary Table 1). PCR and sequencing analysis [8], showed that all isolates harboured bla KPC-2 as the sole carbapenemase gene. In addition to KPC-2, all eight isolates produced sulfhydryl reagent variable β-lactamase (SHV)-11, OXA-10, Temoniera β-lactamase (TEM)-1 and an extended spectrum β-lactamase (ESBL) of VEB-type.…”

Section: Microbiological and Molecular Analysesmentioning

confidence: 98%

“…An insertion sequence (IS)1999 was located upstream of both bla VEB -variants providing a strong promoter for bla VEB expression. The two whole genome sequences were deposited in the Sequence Read Archive (SRA) under the following accession numbers: PRJNA602658 (for the bla VEB-PFGE analysis classified the studied isolates in two pulsotypes [8], with < 80% Dice similarity index. The first pulsotype included only the KP121, isolated in November 2018, while all the strains isolated in the period September-October 2019, belonged to one clone (second pulsotype).…”

Section: Microbiological and Molecular Analysesmentioning

confidence: 99%

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Outbreak of KPC-2-producing Klebsiella pneumoniae endowed with ceftazidime-avibactam resistance mediated through a VEB-1-mutant (VEB-25), Greece, September to October 2019

et al. 2020

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From September to October 2019, seven patients colonised or infected with a ceftazidime-avibactam (CZA)-resistant Klebsiella pneumoniae carbapenemase (KPC)-2-producing K. pneumoniae were detected in two intensive care units of a Greek general hospital. The outbreak strain was sequence type (ST)147 and co-produced KPC-2 and the novel plasmid-borne Vietnamese extended-spectrum β-lactamase (VEB)-25 harbouring a K234R substitution associated with CZA resistance. Epidemiological investigations revealed that the resistance was probably acquired by horizontal transmission independently from previous CZA exposure.

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Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016

Abstract: on behalf of the study collaborators. Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014. Euro Surveill. 201823(31):pii=1700775. https://doi

Cited by 72 publications

References 31 publications

Activity of temocillin against ESBL-, AmpC-, and/or KPC-producing Enterobacterales isolated in Poland

Activity of temocillin against ESBL-, AmpC-, and/or KPC-producing Enterobacterales isolated in Poland

Eight-year trends in the relative isolation frequency and antimicrobial susceptibility among bloodstream isolates from Greek hospitals: data from the Greek Electronic System for the Surveillance of Antimicrobial Resistance – WHONET-Greece, 2010 to 2017

Outbreak of KPC-2-producing Klebsiella pneumoniae endowed with ceftazidime-avibactam resistance mediated through a VEB-1-mutant (VEB-25), Greece, September to October 2019

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