A Seven-Year Microbiological and Molecular Study of Bacteremias Due to Carbapenemase-Producing Klebsiella Pneumoniae : An Interrupted Time-Series Analysis of Changes in the Carbapenemase Gene's Distribution after Introduction of Ceftazidime/Avibactam

• Published in: Antibiotics (Basel) 2022-10, Vol.11 (10), p.1414
• Main Authors: Papadimitriou-Olivgeris, Matthaios, Bartzavali, Christina, Karachalias, Eleftherios, Spiliopoulou, Anastasia, Tsiata, Ekaterini, Siakallis, Georgios, Assimakopoulos, Stelios F, Kolonitsiou, Fevronia, Marangos, Markos
• Format: Article
• Language: English
• Subjects: Antibiotics; Antimicrobial agents; bloodstream infection; carbapenem-resistance; Carbapenemase; Ceftazidime; Emergency medical care; Epidemiology; Genes; Hematology; Hospitalization; Klebsiella; Klebsiella pneumoniae; KPC; NDM; Patients; Pediatrics; Staphylococcus infections; Time series; VIM
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics11101414

Background: Ceftazidime/avibactam (CZA) is a new option for the treatment of KPC-producing Klebsiella pneumoniae. The aim of this study was to determine resistance patterns and carbapenemase genes among K. pneumoniae (CP-Kp) bacteremic isolates before and after CZA introduction. Methods: K. pneumoniae from blood cultures of patients being treated in a Greek university hospital during 2015−21 were included. PCR for blaKPC, blaVIM, blaNDM and blaOXA-48 genes was performed. Results: Among 912 K. pneumoniae bacteremias: 725 (79.5%) were due to carbapenemase-producing isolates; 488 (67.3%) carried blaKPC; 108 (14.9%) blaVIM; 100 (13.8%) blaNDM; and 29 (4%) carried a combination of blaKPC, blaVIM or blaNDM. The incidence of CP-Kp bacteremias was 59 per 100,000 patient-days. The incidence of CP-Kp changed from a downward pre-CZA trend to an upward trend in the CZA period (p = 0.007). BSIs due to KPC-producing isolates showed a continuous downward trend in the pre-CZA and CZA periods (p = 0.067), while BSIs due to isolates carrying blaVIM or blaNDM changed from a downward trend in the pre-CZA to an upward trend in the CZA period (p < 0.001). Conclusions: An abrupt change in the epidemiology of CP-Kp was observed in 2018, due to the re-emergence of VIM-producing isolates after the suppression of KPC-producing ones via the use of CZA.