Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae at a Turkish centre: Is the increase of resistance a threat for Europe?

• Published in: Journal of global antimicrobial resistance. 2017-12, Vol.11, p.10-16
• Main Authors: Candevir Ulu, Aslıhan, Güven Gökmen, Tülin, Kibar, Filiz, Kurtaran, Behice, Önlen, Cansu, Kuşçu, Ferit, İnal, Ayşe Seza, Kömür, Süheyla, Yaman, Akgün, Aksu, Hasan Salih Zeki, Taşova, Yeşim
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - pharmacology; Bacterial Proteins - genetics; beta-Lactamases - genetics; Carbapenem resistance; Carbapenem-Resistant Enterobacteriaceae - drug effects; Carbapenem-Resistant Enterobacteriaceae - enzymology; Carbapenem-Resistant Enterobacteriaceae - genetics; Carbapenem-Resistant Enterobacteriaceae - isolation & purification; Carbapenems - pharmacology; Child; Child, Preschool; Cross Infection - epidemiology; Cross Infection - microbiology; Europe - epidemiology; Female; Genetic mechanism; Hospitalization; Hospitals; Humans; Infant; Intensive Care Units; Klebsiella Infections - epidemiology; Klebsiella Infections - microbiology; Klebsiella pneumoniae; Klebsiella pneumoniae - drug effects; Klebsiella pneumoniae - enzymology; Klebsiella pneumoniae - genetics; Klebsiella pneumoniae - isolation & purification; Male; Microbial Sensitivity Tests; Middle Aged; Molecular Epidemiology; NDM; Turkey - epidemiology; Young Adult
• ISSN: 2213-7165; 2213-7173
• DOI: 10.1016/j.jgar.2017.06.012

•Multiple resistance mechanisms were present in Klebsiella pneumoniae isolates in Turkey.•Most of the isolates produced OXA-48, followed by VIM and SME carbapenemase, whilst the NDM rate was 20.4%.•The most effective antibiotics were tigecycline and colistin. In recent years, carbapenem-resistant Klebsiella pneumoniae (CRKP) have become an important threat to hospitalised patients. This study aimed to identify the genetic mechanisms of carbapenem resistance in CRKP isolated from patients in a Turkish centre. During 2013–2014, a total of 98 K. pneumoniae isolated from patients at Çukurova University Balcalı Hospital (Adana, Turkey) determined phenotypically as resistant to carbapenems were screened genotypically for the presence of carbapenemase enzymes by multiplex PCR. Of the 98 patients for whom genetic investigation was made, 93 (94.9%) were adults, 56 (57.1%) were male and 81 (82.7%) were diagnosed as infected. The mean and median age were 51.8±20.5years and 55 years (range 1–89 years), respectively. The nosocomial infection rate was 87.8% (86/98). The mortality rate was 41.8% (41/98). Fifty-eight patients (59.2%) were admitted to intensive care units. Of the 12 non-nosocomial infections, 5 (41.7%) originated from the inpatient clinic of the urology department. The mean and median hospital length of stay (LOS) were 20.7±20.8days and 17days (range 0–90 days), respectively. The most common carbapenemase gene detected was blaOXA-48 (74.5%), followed by blaVIM (45.9%) and blaSME (37.8%). The blaNDM gene was detected in 20 isolates (20.4%). The most effective antibiotics were tigecycline and colistin, with susceptibility rates of 87.5% and 74.3%, respectively. Multiple resistance mechanisms were present in CRKP isolates in Turkey. Most of the isolates harboured blaOXA-48, blaVIM and blaSME genes; meanwhile, the rate of 20.4% for blaNDM is alarming.