Polyclonal Endemicity of Carbapenemase-Producing Klebsiella pneumoniae in ICUs of a Greek Tertiary Care Hospital

Protonotariou, Efthimia; Meletis, Georgios; Pilalas, Dimitrios; Mantzana, Paraskevi; Tychala, Areti; Kotzamanidis, Christos; Papadopoulou, Dimitra; Papadopoulos, T.; Polemis, Michalis; Metallidis, Simeon; Skoura, Lemonia

doi:10.3390/antibiotics11020149

Cited by 17 publications

(14 citation statements)

References 45 publications

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“…Another study conducted in Iran analyzed 165 K. pneumoniae strains isolated from different samples; their PFGE analysis showed 17 clusters with an 80% similarity rate. (32) In this study, the genetic diversity among isolates was high; one reason for this could be the diversity of sample sources and because our samples were fewmany from diverse sources.…”

Section: Discussionmentioning

confidence: 85%

Genotypic characterization and detection of resistance mechanisms in carbapenem- resistant Klebsiella pneumoniae isolated from four tertiary care hospitals in Iran

Davoodi,

Soleimani,

Hosseini

et al. 2023

Preprint

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Background The global emergence of genes responsible for carbapenemases and the production of mcr in Klebsiella pneumoniae isolates pose a serious threat to public health. The study of carbapenem and colistin resistance (CLR) in K. pneumoniae has a high priority for the infection control committee. The purpose of this study was to determine the antimicrobial resistance rate and evaluate the pattern of CLR in carbapenem-resistant K. pneumoniae (CRKP) isolated from four tertiary care hospitals in Iran, as well as to describe the clonal relationship of multidrug-resistant K. pneumoniae strains. Fifty clinical isolates of CRKP were obtained from four hospitals in Iran. The mcr-harboring isolates and carbapenemase-encoding genes were screened by PCR amplification, and molecular typing (PFGE) was used to assess their spread. Among the total isolates, 38% were identified as CLR by colistin disk elution. Results Among positive isolates for carbapenemase genes, the most frequent gene was blaOXA−48. Additionally, the mcr-1 gene was detected in 6% of the obtained isolates; none of the other mcr genes were detected in the studied isolates. All isolates were grouped under four clusters (A-D). The major cluster was related to the C cluster with 23 isolates. Conclusions The prevalence of CLR K. pneumoniae was estimated to be 18% in our ICU. Colistin-resistant CRKP is becoming an emerging threat in ICU settings, limiting further treatment options. Additionally, we observed a common molecular signature among CRKP isolates. Therefore, hospitals need to implement an effective infection control system to prevent the outbreak of diverse carbapenem- and colistin-resistant isolates in the future.

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Section: Discussionmentioning

confidence: 85%

Genotypic characterization and detection of resistance mechanisms in carbapenem- resistant Klebsiella pneumoniae isolated from four tertiary care hospitals in Iran

Davoodi,

Soleimani,

Hosseini

et al. 2023

Preprint

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“…All isolates were tested phenotypically for the detection of MBL, KPC, or both carbapenemase categories using the meropenem disc test. Based on our hospital’s epidemiology, MBL-positive K. pneumoniae were considered as probable VIM or NDM producers [ 32 ]. Therefore, MBL-positive K. pneumoniae isolates were further tested with the modified Hodge test [ 33 ].…”

Section: Methodsmentioning

confidence: 99%

Replacement of the Double Meropenem Disc Test with a Lateral Flow Assay for the Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa in Clinical Laboratory Practice

et al. 2023

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The prompt detection of carbapenemases among Gram-negative bacteria isolated from patients’ clinical infection samples and surveillance cultures is important for the implementation of infection control measures. In this context, we evaluated the effectiveness of replacing phenotypic tests for the detection of carbapenemase producers with the immunochromatographic Carbapenem-Resistant K.N.I.V.O. Detection K-Set lateral flow assay (LFA). In total, 178 carbapenem-resistant Enterobacterales and 32 carbapenem-resistant Pseudomonas aeruginosa isolated in our hospital were tested with both our established phenotypic and molecular testing procedures and the LFA. The Kappa coefficient of agreement for Enterobacterales was 0.85 (p < 0.001) and 0.6 (p < 0.001) for P. aeruginosa. No major disagreements were observed and notably, in many cases, the LFA detected more carbapenemases than the double meropenem disc test, especially regarding OXA-48 in Enterobacterales and VIM in P. aeruginosa. Overall, the Carbapenem-Resistant K.N.I.V.O. Detection K-Set was very effective and at least equivalent to the standard procedures used in our lab. However, it was much faster as it provided results in 15 min compared to a minimum of 18–24 h for the phenotypic tests.

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“…For example, in Greece, the most common carbapenem-resistant microorganism is K. pneumoniae , with most strains being KPC producers. However, non-carbapenemase mechanisms are also common, and certain studies have demonstrated that double carbapenemase production (e.g., KPC + VIM) can be encountered in up to 25% of isolates [ 121 , 122 , 123 ]. OXA-type carbapenemase production is uncommon in non- Acinetobacter cases, with rare isolations of K. pneumoniae strains co-expressing OXA-48-like enzymes in addition to other carbapenemases [ 122 ].…”

Section: Carbapenemase Detection—rational Testing and Treatment Optio...mentioning

confidence: 99%

“…However, non-carbapenemase mechanisms are also common, and certain studies have demonstrated that double carbapenemase production (e.g., KPC + VIM) can be encountered in up to 25% of isolates [ 121 , 122 , 123 ]. OXA-type carbapenemase production is uncommon in non- Acinetobacter cases, with rare isolations of K. pneumoniae strains co-expressing OXA-48-like enzymes in addition to other carbapenemases [ 122 ]. Epidemiological data regarding the resistance phenotypes of other carbapenem-resistant Gram-negative bacteria such as E. coli are missing, but no double carbapenemase production has been reported.…”

Section: Carbapenemase Detection—rational Testing and Treatment Optio...mentioning

confidence: 99%

Antimicrobial and Diagnostic Stewardship of the Novel β-Lactam/β-Lactamase Inhibitors for Infections Due to Carbapenem-Resistant Enterobacterales Species and Pseudomonas aeruginosa

Ferous,

Anastassopoulou,

Pitiriga

et al. 2024

Antibiotics

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Carbapenem-resistant Gram-negative bacterial infections are a major public health threat due to the limited therapeutic options available. The introduction of the new β-lactam/β-lactamase inhibitors (BL/BLIs) has, however, altered the treatment options for such pathogens. Thus, four new BL/BLI combinations—namely, ceftazidime/avibactam, meropenem/vaborbactam, imipenem/relebactam, and ceftolozane/tazobactam—have been approved for infections attributed to carbapenem-resistant Enterobacterales species and Pseudomonas aeruginosa. Nevertheless, although these antimicrobials are increasingly being used in place of other drugs such as polymyxins, their optimal clinical use is still challenging. Furthermore, there is evidence that resistance to these agents might be increasing, so urgent measures should be taken to ensure their continued effectiveness. Therefore, clinical laboratories play an important role in the judicious use of these new antimicrobial combinations by detecting and characterizing carbapenem resistance, resolving the presence and type of carbapenemase production, and accurately determining the minimum inhibitor concentrations (MICs) for BL/BLIs. These three targets must be met to ensure optimal BL/BLIs use and prevent unnecessary exposure that could lead to the development of resistance. At the same time, laboratories must ensure that results are interpreted in a timely manner to avoid delays in appropriate treatment that might be detrimental to patient safety. Thus, we herein present an overview of the indications and current applications of the new antimicrobial combinations and explore the diagnostic limitations regarding both carbapenem resistance detection and the interpretation of MIC results. Moreover, we suggest the use of alternative narrower-spectrum antibiotics based on susceptibility testing and present data regarding the effect of synergies between BL/BLIs and other antimicrobials. Finally, in order to address the absence of a standardized approach to using the novel BL/BLIs, we propose a diagnostic and therapeutic algorithm, which can be modified based on local epidemiological criteria. This framework could also be expanded to incorporate other new antimicrobials, such as cefiderocol, or currently unavailable BL/BLIs such as aztreonam/avibactam and cefepime/taniborbactam.

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Polyclonal Endemicity of Carbapenemase-Producing Klebsiella pneumoniae in ICUs of a Greek Tertiary Care Hospital

Cited by 17 publications

References 45 publications

Genotypic characterization and detection of resistance mechanisms in carbapenem- resistant Klebsiella pneumoniae isolated from four tertiary care hospitals in Iran

Genotypic characterization and detection of resistance mechanisms in carbapenem- resistant Klebsiella pneumoniae isolated from four tertiary care hospitals in Iran

Replacement of the Double Meropenem Disc Test with a Lateral Flow Assay for the Detection of Carbapenemase-Producing Enterobacterales and Pseudomonas aeruginosa in Clinical Laboratory Practice

Antimicrobial and Diagnostic Stewardship of the Novel β-Lactam/β-Lactamase Inhibitors for Infections Due to Carbapenem-Resistant Enterobacterales Species and Pseudomonas aeruginosa

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