Klebsiella pneumoniae Harboring Carbapenemase Genes in Taiwan: Its Evolution over 20 Years, 1998–2019

Lai, Chih‐Cheng; Yu, Wen-Liang

doi:10.1016/j.ijantimicag.2021.106354

Cited by 26 publications

(14 citation statements)

References 73 publications

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“…Despite some variations in the rates of strains producing different carbapenemase ( Figure 2 ) all throughout the study until the most recent data [ 20 ], OXA- and NDM-type enzyme-producing strains have been the most common ones encountered. This is in contrast with observations at other parts of the world, where in hospitals or in entire countries, noticeable changes have taken place over the years in the types of enzymes produced by CRE [ 22 , 23 , 24 ]. In some hospitals, this was attributed to the increasing use of therapies ineffective against MBL producers leading to the selection of strains expressing class B type enzymes [ 22 ].…”

Section: Discussioncontrasting

confidence: 89%

Early Years of Carbapenem-Resistant Enterobacterales Epidemic in Abu Dhabi

et al. 2022

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Recent studies showed that the current endemic of carbapenem-resistant Enterobacterales (CRE) in the Emirate of Abu Dhabi is dominated by highly resistant Klebsiella pneumoniae clones ST14, ST231, and CC147, respectively. In the absence of continuous, molecular typing-based surveillance, it remained unknown whether they lately emerged and rapidly became dominant, or they had been present from the early years of the endemic. Therefore, antibiotic resistance, the presence of carbapenemase and 16S methylase genes, and the sequence types of CRE strains collected between 2009 and 2015 were compared with those collected between 2018 and 2019. It was found that members of these three clones, particularly those of the most prevalent ST14, started dominating already in the very early years of the CRE outbreak. Furthermore, while severely impacting the overall antibiotic resistance patterns, the effect of these clones was not exclusive: for example, increasing trends of colistin or decreasing rates of tigecycline resistance were also observed among nonclonal isolates. The gradually increasing prevalence of few major, currently dominating clones raises the possibility that timely, systematic, molecular typing-based surveillance could have provided tools to public health authorities for an early interference with the escalation of the local CRE epidemic.

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Section: Discussioncontrasting

confidence: 89%

Early Years of Carbapenem-Resistant Enterobacterales Epidemic in Abu Dhabi

et al. 2022

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“…Because the number of ESBL producers and AmpC β-lactamase producers has been increasing, previous studies observed a significant decrease in susceptibilities to third-generation cephalosporins and ciprofloxacin over the two decades of our study period [ 22 ]. Additionally, carbapenem-resistant K. pneumoniae , a new major concern emerging during the last decade because of a significantly compromised efficacy of carbapenem agents, has become a focal point of infection control [ 23 , 24 ]. In a case report of carbapenemase-producing K. pneumoniae endophthalmitis by Zhou et al [ 25 ], the K. pneumoniae isolate was resistant to amikacin, ceftazidime, and carbapenems, but susceptible to polymyxin E and tigecycline.…”

Section: Discussionmentioning

confidence: 99%

Infection Sources and Klebsiella pneumoniae Antibiotic Susceptibilities in Endogenous Klebsiella Endophthalmitis

Chen

et al. 2022

Antibiotics

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Endogenous endophthalmitis is an uncommon intraocular infection with potentially devastating consequences on vision. Klebsiella pneumoniae is highly prevalent in East Asian countries, with an increasing incidence recently worldwide. This retrospective study investigates infection sources and antibiotic susceptibilities of K. pneumoniae in patients with endogenous K. pneumoniae endophthalmitis (EKE) in Northern Taiwan. One hundred and fifty-seven patients with EKE were reviewed between January 1996 and April 2019. Pyogenic liver abscess (120/157, 76.4%) was the most common infection source, followed by pneumonia (13, 8.3%), urinary tract infection (7, 4.5%), and intravenous drug use (4, 2.5%). Bilateral involvement was identified in 12.1% (19/157) of patients, especially in patients with pyogenic liver abscess (16/120, 13.3%), pneumonia (2/13, 15.4%), and urinary tract infection (1/7, 14.3%). The antibiotic susceptibility rates were 98.1%, 92.5%, 97.5%, 96.8%, 100%, 99.3%, and 100% for amikacin, cefuroxime, ceftazidime, ceftriaxone, carbapenems, ciprofloxacin, and levofloxacin, respectively. Four extended-spectrum β-lactamase-producing multidrug-resistant (MDR) K. pneumoniae isolates were identified. In conclusion, pyogenic liver abscess was the major infection source in EKE. In addition, K. pneumoniae was still highly susceptible to ceftazidime and amikacin, and the MDR K. pneumoniae isolates were not common in EKE.

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“…Moreover, Wu et al (2021) reported that the bla KPC–2 was the most common carbapenemase gene in CRKP isolated from patients with bacteremia at a hospital in northern Taiwan from 2013 to 2018. A 22-year (1998–2019) observation to determine the evolution of carbapenemase genes in K. pneumoniae in Taiwan discovered that the endemicity has changed from bla IMP–8 , bla NDM–1 , and bla VIM–1 to the most common bla KPC–2 and rapidly emerging bla OXA–48 ( Lai and Yu, 2021 ). These results are consistent with our finding that the distribution of bla OXA–48–like was dramatically increased after 2018.…”

Section: Discussionmentioning

confidence: 99%

A Longitudinal Nine-Year Study of the Molecular Epidemiology of Carbapenemase-Producing Enterobacterales Isolated From a Regional Hospital in Taiwan: Predominance of Carbapenemase KPC-2 and OXA-48

et al. 2022

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Enterobacterales clinical isolates are now being resistant to clinically achievable concentrations of most commonly used antibiotics that makes treatment of hospitalized patients very challenging. We hereby determine the molecular characteristics of carbapenemase genes in carbapenem-resistant Enterobacterales (CRE) isolates in Taiwan. A total of 455 CRE isolates were identified between August 2011 to July 2020. Minimum inhibitory concentrations for selected carbapenems were tested using Vitek 2, and carbapenemase genes were determined using polymerase chain reaction in combination with sequencing. Phenotypic detection of carbapenemase was determined by modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM) to validate our PCR screening results. Pulsed-field gel electrophoresis (PFGE) was used to determine the clonality of carbapenemase-producing Enterobacterales (CPE) isolates, and the transferability of carbapenemase-carrying plasmids was determined by conjugation assays. A slight increase in carbapenem-resistant E. coli (CREC) was observed, however, the prevalence of carbapenem-resistant K. pneumoniae (CRKP) was steady, during 2011–2020. The dominant species among our CRE was K. pneumoniae (270/455, 59.3%), followed by E. coli (81/455, 17.8%), Morganella morganii (32/455, 7.0%), and Enterobacter cloacae (25/455, 5.5%). From 2011 to 2020, the total percentage of CPE increased steadily, accounting for 61.0% of CRE in 2020. Moreover, 122 of 455 CRE isolates (26.8%) were CPE. Among the CPE isolates, the dominant carbapenemase gene was blaOXA–48–like (54/122, 44.3%), and the second most common carbapenemase gene was blaKPC–2 (47/122, 38.5%). The sensitivity and specificity for mCIM to detect carbapenemase in the 455 isolates were both 100% in this study. The PFGE results showed that 39 carbapenemase-producing E. coli and 69 carbapenemase-producing K. pneumoniae isolates carrying blaKPC–2 and/or blaNDM–5 could be classified into 5 and 12 clusters, respectively. In conclusion, our results showed an increase in CPE isolates in Taiwan. Moreover, the distribution of carbapenemase and antimicrobial susceptibility in CPE were associated with PFGE typing.

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Klebsiella pneumoniae Harboring Carbapenemase Genes in Taiwan: Its Evolution over 20 Years, 1998–2019

Cited by 26 publications

References 73 publications

Early Years of Carbapenem-Resistant Enterobacterales Epidemic in Abu Dhabi

Early Years of Carbapenem-Resistant Enterobacterales Epidemic in Abu Dhabi

Infection Sources and Klebsiella pneumoniae Antibiotic Susceptibilities in Endogenous Klebsiella Endophthalmitis

A Longitudinal Nine-Year Study of the Molecular Epidemiology of Carbapenemase-Producing Enterobacterales Isolated From a Regional Hospital in Taiwan: Predominance of Carbapenemase KPC-2 and OXA-48

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