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National surveillance study on carbapenem non-susceptible Klebsiella pneumoniae in Taiwan: the emergence and rapid dissemination of KPC-2 carbapenemase.

Chiu SK, Wu TL, Chuang YC, Lin JC, Fung CP, Lu PL, Wang JT, Wang LS, Siu LK, Yeh KM - PLoS ONE (2013)

Bottom Line: In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss.KPC-2-KP dissemination with the same ST11 were observed in 2012.The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.

ABSTRACT

Objectives: The global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals.

Methods: We collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL), and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type.

Results: The resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 bla IMP-8 and 2 bla VIM-1). In 2012, carbapenemase genes were detected in 22.3% of isolates (41 bla KPC-2, 7 bla VIM-1, 6 bla IMP-8, and 1 bla NDM-1). More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype.

Conclusions: In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming.

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Related in: MedlinePlus

Pulsed-field gel electrophoresis profiles and dendrogram.Pulsed-field gel electrophoresis profiles and dendrogram of the 41 KPC-2-producing K. pneumoniae isolates. One major pulsotype is shown using the 80% similarity as the cut-off. All these KPC-2-producing K. pneumoniae isolates are ST11.
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pone-0069428-g001: Pulsed-field gel electrophoresis profiles and dendrogram.Pulsed-field gel electrophoresis profiles and dendrogram of the 41 KPC-2-producing K. pneumoniae isolates. One major pulsotype is shown using the 80% similarity as the cut-off. All these KPC-2-producing K. pneumoniae isolates are ST11.

Mentions: A dendrogram of the 247 isolates collected in 2012 is shown in Figure S2. The dendrogram and band patterns of KPC-2-producing K. pneumoniae strains are shown in Figure 1. One major pulsotype were identified using the 80% similarity as the cut-off on PFGE profiles. There was a clonal spread of 16 identical isolates obtained from 3 hospitals.


National surveillance study on carbapenem non-susceptible Klebsiella pneumoniae in Taiwan: the emergence and rapid dissemination of KPC-2 carbapenemase.

Chiu SK, Wu TL, Chuang YC, Lin JC, Fung CP, Lu PL, Wang JT, Wang LS, Siu LK, Yeh KM - PLoS ONE (2013)

Pulsed-field gel electrophoresis profiles and dendrogram.Pulsed-field gel electrophoresis profiles and dendrogram of the 41 KPC-2-producing K. pneumoniae isolates. One major pulsotype is shown using the 80% similarity as the cut-off. All these KPC-2-producing K. pneumoniae isolates are ST11.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3722148&req=5

pone-0069428-g001: Pulsed-field gel electrophoresis profiles and dendrogram.Pulsed-field gel electrophoresis profiles and dendrogram of the 41 KPC-2-producing K. pneumoniae isolates. One major pulsotype is shown using the 80% similarity as the cut-off. All these KPC-2-producing K. pneumoniae isolates are ST11.
Mentions: A dendrogram of the 247 isolates collected in 2012 is shown in Figure S2. The dendrogram and band patterns of KPC-2-producing K. pneumoniae strains are shown in Figure 1. One major pulsotype were identified using the 80% similarity as the cut-off on PFGE profiles. There was a clonal spread of 16 identical isolates obtained from 3 hospitals.

Bottom Line: In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss.KPC-2-KP dissemination with the same ST11 were observed in 2012.The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan.

View Article: PubMed Central - PubMed

Affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.

ABSTRACT

Objectives: The global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals.

Methods: We collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL), and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type.

Results: The resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 bla IMP-8 and 2 bla VIM-1). In 2012, carbapenemase genes were detected in 22.3% of isolates (41 bla KPC-2, 7 bla VIM-1, 6 bla IMP-8, and 1 bla NDM-1). More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype.

Conclusions: In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming.

Show MeSH
Related in: MedlinePlus