Objectives Cases of nosocomial carbapenem-resistant Klebsiella pneumoniae (CRKP) have been increasing steadily since the 1990s. In this study, we sought to assess CRKP clonal diversity and patterns of dissemination at Hospital Canselor Tuanku Muhriz (HCTM), a tertiary university hospital located in Kuala Lumpur, Malaysia. Methods: From January 2022 to December 2023, all CRKP isolates from HCTM were included in the investigation. Associated patient demographic data and clinical histories were retrieved from hospital records. Antibiotic susceptibility data for the collected isolates were obtained from the HCTM diagnostic laboratory. Molecular typing was performed using enterobacterial repetitive intergenic consensus polymerase chain reaction (ERIC-PCR) to identify genetic clusters. Based on ERIC-PCR clustering results and epidemiological investigations, selected CRKP isolates were subjected to whole-genome sequencing (WGS) to validate clonal relatedness, identify antimicrobial resistance genes, and establish phylogenomic relationships. Results: During the study period, a total of 147 CRKP isolates were recovered from various wards across HCTM. All isolates exhibited resistance to imipenem, meropenem, or ertapenem, with 124 isolates confirmed as carbapenemase producers. ERIC-PCR identified 24 genetic clusters disseminated across 23 wards within HCTM. Twelve CRKP isolates were selected for WGS based on integrated epidemiological investigation and ERIC-PCR genotyping; sequence typing revealed ST17 as the dominant circulating CRKP lineage in the intensive care unit, ward 6E, and possibly across the hospital. The carbapenemase gene bla_NDM was detected in all WGS-analyzed CRKP isolates. Conclusion: Integrating epidemiological investigation, phenotypic testing, molecular typing, and WGS is essential to understand resistance dynamics, map transmission, and guide hospital infection prevention strategies.
Objectives Klebsiella pneumoniae is known as one of the most common causes of hospitalacquired infections. Its prevalence poses substantial challenges to both hospital and public health systems, particularly due to the rise of multidrug‐resistant strains. Understanding the epidemiology and resistance properties of K. pneumoniae can inform antimicrobial stewardship and infection control programs. A cross-sectional study was employed from November 2021 to November 2023. Methods: A total of 24 isolates underwent antimicrobial susceptibility testing using the disk diffusion method, an extended-spectrum beta-lactamase (ESBL) production test, and molecular gene detection. Results: The study found that 95.8% of clinical isolates were classified as multidrug-resistant. All isolates were resistant to ampicillin (100%). A high percentage of isolates were resistant to cefazolin (91.7%), ceftriaxone (87.5%), cefotaxime (87.5%), cefepime (87.5%), ciprofloxacin (83.3%), and sulfamethoxazole-trimethoprim (83.3%). Of the 24 isolates, 87.5% harbored ESBL genes, while the frequencies for GES, NDM, SIM, and OXA-48 were 16.7%, 20.8%, 8.3%, and 41.7%, respectively. Notably, the OXA-23 and OXA-51 genes, which are typically associated with Acinetobacter baumannii, were detected in 16.7% and 20.8% of isolates, respectively. Moreover, the prevalence of virulence genes rmpA, acrAB, and tolC was 0%, 95.8%, and 87.5%, respectively. Conclusion: This study demonstrated a high level of antibiotic resistance and a significant presence of virulence genes among K. pneumoniae isolates. Consequently, these findings represent a critical public health issue that requires heightened awareness among all stakeholders, including health workers.
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Objectives We aimed to describe the epidemiological characteristics of carbapenemase-producing Enterobacteriaceae (CPE) outbreaks in healthcare settings in the Republic of Korea between 2017 and 2022.
Methods Under the national notifiable disease surveillance system, we obtained annual descriptive statistics regarding the isolated species, carbapenemase genotype, healthcare facility type, outbreak location and duration, and number of patients affected and recommended interventions. We used epidemiological investigation reports on CPE outbreaks reported to Korea Disease Control and Prevention Agency from June 2017 to September 2022.
Results Among the 168 reports analyzed, Klebsiella pneumoniae (85.1%) was the most frequently reported species, while K. pneumoniae carbapenemase (KPC, 82.7%) was the most common carbapenemase genotype. Both categories increased from 2017 to 2022 (p<0.01). General hospitals had the highest proportion (54.8%), while tertiary general hospitals demonstrated a decreasing trend (p<0.01). The largest proportion of outbreaks occurred exclusively in intensive care units (ICUs, 44.0%), and the frequency of concurrent outbreaks in ICUs and general wards increased over time (p<0.01). The median outbreak duration rose from 43.5 days before the coronavirus disease 2019 (COVID-19) pandemic (2017–2019) to 79.5 days during the pandemic (2020–2022) (p=0.01), and the median number of patients associated with each outbreak increased from 5.0 to 6.0 (p=0.03). Frequently recommended interventions included employee education (38.1%), and 3 or more measures were proposed for 45.2% of outbreaks.
Conclusion In the Republic of Korea, CPE outbreaks have been consistently dominated by K. pneumoniae and KPC. The size of these outbreaks increased during the COVID-19 pandemic. Our findings highlight the need for continuing efforts to control CPE outbreaks using a multimodal approach, while considering their epidemiology.
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<sec>
<title>Objectives</title>
<p>Carbapenem resistance is a serious clinical and public health threat. Carbapenemase can confer carbapenem resistance, and most carbapenemase genes are plasmid encoded so resistance can easily spread. In this study, we aimed to develop a novel system based on the TaqMan platform for the rapid detection of 6 clinically prevalent carbapenemase genes: <italic>Klebsiella pneumoniae</italic> carbapenemase, New Delhi metallo-β-lactamase, oxacillinase, imipenem-hydrolyzing, Verona integron-encoded metallo-β-lactamase, and Guiana extended-spectrum β-lactamase.</p></sec>
<sec>
<title>Methods</title>
<p>The triplex assay was verified by testing genomic DNA of 6 carbapenemase-producing <italic>Klebsiella pneumoniae</italic>. It was validated with a blinded panel of 310 Enterobacteriaceae isolates, including 225 carbapenemase-producers and 85 non-producers, by direct colony triplex real-time polymerase chain reaction (PCR). The real-time PCR was performed using the ABI 7500 fast instrument (Applied Biosystems, CA, USA) and specific primers for each carbapenemase target were designed to include modified peptide-nucleic acid oligonucleotides.</p></sec>
<sec>
<title>Results</title>
<p>No amplification was detected among the negative samples. The result showed 100% concordance with the genotypes previously identified. The entire assay, including DNA extraction and real-time PCR, was completed within 2 hours.</p></sec>
<sec>
<title>Conclusion</title>
<p>The newly developed triplex real-time PCR assay was useful for the rapid, accurate and simultaneous detection of 6 carbapenemase genes in Enterobacteriaceae, suggesting its potential to allow an early decision on the appropriate treatment, management, and prevention of the spread of resistant infections in hospitals.</p></sec>
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Objectives
Plasmid-mediated AmpC β-lactamases (PMABLs) and carbapenemases are emerging groups of antimicrobial-resistance determinants. The aims of the study were to evaluate the occurrence of PMABLs and carbapenemases in clinical isolates of <i>Klebsiella pneumoniae</i> and compare the test performance of various phenotypic methods for detection of these enzymes in Iran. Methods
A total of 100 <i>K. pneumoniae</i> isolates were collected from clinical specimens obtained in Valiasr Hospital. AmpC production in all isolates was determined using the AmpC disk test, the cephamycin Hodge test, the AmpC Etest, and the boronic acid combined-disk test. In addition, carbapenemase production was determined using the modified Hodge test, the EDTA disk synergy test, and the boronic acid combined-disk test. The performances of various phenotypic methods were evaluated by the comparison of their results with polymerase chain reaction (PCR) method as the gold standard. Results
Of the 100 isolates, 19 (19%) were demonstrated to harbor the PMABL-resistance gene by the multiplex PCR method. The PCR result indicated the presence of carbapenemase genes in 12 isolates. The performance of various phenotypic tests carried out for detection of carbapenemase-producing isolates varied widely, ranging in sensitivity from 30% to 100% and in specificity from 90.8% to 100%. Conclusion
This is the first report of <i>MOX</i>-type AmpC β-lactamase and <i>bla</i><sub><i>GES</i></sub> in <i>K. pneumoniae</i> in Iran. A comparison of the phenotypic methods showed that a combination of cefoxitin plus boronic acid is optimal for detecting plasmid-mediated AmpC enzymes in <i>K. pneumoniae</i>, whereas the implementation of molecular methods is often complex, requires specially trained personnel, and is associated with higher costs.
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