Prevalence of extended-spectrum beta-lactamase and carbapenemase-producing bloodstream isolates of Klebsiella pneumoniae in a tertiary care hospital. (17th February 2018)

• Record Type: Journal Article
• Authors: Abodakpi, Henrietta; Chang, Kai-Tai; Sánchez Díaz, Ana María; Cantón, Rafael; Lasco, Todd M.; Chan, Katrina; Sofjan, Amelia K.; Tam, Vincent H.
• Is Part Of: Journal of chemotherapy. Volume 30:Number 2(2018)
• Page Start: 115
• Page End: 119
• Publication Date: 2018-02-17
• Subjects: Gram-negative bacteria -- Multidrug resistance -- Resistance mechanism -- Bacteremia; Chemotherapy -- Periodicals; Drug Therapy -- Periodicals; 615.58
• DOI: 10.1080/1120009X.2017.1399233
• Languages: English
• ISSNs: 1120-009X

Abstract

Abstract : To improve prescribing of empiric therapy, the local molecular epidemiology of extended-spectrum beta-lactamases (ESBLs) and Klebsiella pneumoniae carbapenemases (KPCs) in bloodstream isolates of K. pneumoniae were evaluated. Isolates resistant to third generation cephalosporins were screened phenotypically for ESBLs and carbapenemases, and subsequently confirmed by PCR for the presence of ESBL ( bla TEM, bla SHV and bla CTX-M ) and carbapenemase ( bla KPC, bla VIM, bla NDM and bla OXA-48 ) genes. Hydrolytic activity (functional gene expression) was quantified using a nitrocefin degradation assay and correlated to ceftazidime or meropenem MIC. Clonality was assessed by repetitive element-based PCR. Beta-lactamases were functionally expressed in 13 isolates (15.5%); 7 (53.8%) harboured bla CTX-M-15 and 6 (46.2%) carried the bla KPC-2 gene. Correlation of hydrolytic activity to MIC yielded a coefficient of 98% for isolates expressing ESBLs alone and 56% for carbapenemase producers. Four unique ESBL-expressing clones and five carbapenem-resistant clones were identified. All 13 resistant isolates were susceptible to ceftazidime/avibactam (MIC ≤ 8/4 mg/L).