Klebsiella pneumoniae is a gramnegative, nonmotile, encapsulated, lactose fermenting, facultative anaerobic, rodshaped bacterium. Klebsiella pneumoniae carbapenemase kpcproducing enterobacteriaceae have been reported in many countries, and outbreaks due to kpcproducing organisms have been reported worldwide 1,2,3. Genomic epidemiology of global klebsiella pneumoniae. Global dissemination of carbapenemaseproducing klebsiella. E nterobacteriaceae are inhabitants of the intestinal. It belongs to the family enterobacteriaceae and is a normal commensal living in the mouth and gut. Pitout,14 patrice nordmann,5,6 and laurent poirel6 division of microbiology, calgary laboratory services1, departments of pathology and laboratory medicine2.
The emergence of a hypervirulent plasmid in prevalent strains of klebsiella pneumoniae threatens the effective prevention and treatment of infections caused by this clinically untreatable pathogen, which could become a serious public health problem globally. Carbapenemase producing enterobacteria cpe infect mainly hospitalized patients but also have been spreading in longterm care facilities. Germany has reported an outbreak of carbapenemase producing ndm1 and oxa48 and colistinresistant klebsiella pneumoniae sequence type st 307. Due to the importance of drugresistant klebsiella pneumoniae and escherichia coli strains in hospitalacquired infections, we aimed to determine the phenotypic and genotypic characteristics of esbl, ampc, and carbapenemase producing isolates obtained from hospitalized patients in tehran and ilam iran. In total, six patients were found to be positive for kpckp. We worked with the universe of 59 patients with isolation of klebsiella pneumoniae producing kpc type carbapenemases according to the daily census issued by the statistics unit of the said hospital. Klebsiella pneumoniae carbapenemase kpcproducing klebsiella. Jun 12, 2015 we describe an outbreak of klebsiella pneumoniae carbapenemase kpcproducing klebsiella pneumoniae kpckp st258 that occurred in two institutions a hospital and a nursing home in the netherlands between july and december 20. Klebsiella pneumoniae an overview sciencedirect topics.
An outbreak of colistinresistant klebsiella pneumoniae. Klebsiella is a genus of enterobacteriaceae that has emerged as a significant nosocomial pathogen in neonates. The real threat of klebsiella pneumoniae carbapenemase. Those who are living in longterm care facilities or are currently hospitalized and breathing with mechanical ventilators are at even higher risk of developing a lung infection from klebsiella. Given their multidrug resistance, therapeutic options are limited and, as discussed here.
Epidemiology of carbapenemase producing klebsiella. Klebsiella pneumoniae, a common gut bacteria, causes problems when it moves outside the gut and causes infection. Treatment of klebsiella pneumoniae carbapenemaseproducing k. The diagnosis was made between july and december of 2014. Bacteria producing klebsiella pneumoniae carbapenemases kpcs are rapidly emerging as a cause of multidrugresistant infections worldwide. This procedure provides instructions for taqmanbased realtime pcr detection of. Pdf infection with klebsiella pneumoniae carbapenemase.
Edelstein, ebbing lautenbach, marie synnestvedt, neil o. It appears as a mucoid lactose fermenter on macconkey agar. The first outbreak of kpcproducing k pneumoniae outside the usa was from israel. Some klebsiella bacteria have become highly resistant to antibiotics. Drug resistance among gramnegative bacteria is a worldwide challenge.
Klebsiella pneumoniae, which commonly acquires resistance encoded. Emergence of new delhi metallobetalactamase ndm1 and. Pdf carbapenemaseproducing klebsiella pneumoniae in. We summarize the wide resistome of this pathogen, which encompasses plentiful chromosomal and plasmidencoded antibiotic. Background and aim a multicentre nationwide surveillance study was conducted in greek hospitals to evaluate epidemiology of carbapenemase producing klebsiella pneumoniae clinical isolates, and their susceptibilities to lastline antibiotics. Ndm1 producers have not been described in south africa, and this is the first instance that kpc producers have been identified in africa. Multiplex realtime pcr detection of klebsiella pneumoniae. In vitro and in vivo bactericidal activity of ceftazidime. Treatment of klebsiella pneumoniae carbapenemaseproducing. Automated and nonautomated methods for carbapenem susceptibility were evaluated for. Detection of carbapenemresistant klebsiella pneumoniae. An investigation of klebsiella pneumoniae carbapenemase kpcproducing enterobacteriaceae among patients of acute and longterm acute care hospitals was conducted in 2011. We report the development of a consistent sampling framework and the results of the. In patients with klebsiella spp infections, bacteria can be transmitted usually via.
Before 2011, the prevalence rates of carbapenemase producing klebsiella pneumoniae cpkp among carbapenem nonsusceptible k. Klebsiella pneumoniae in healthcare settings hai cdc. Kpc is an enzyme that degrades penicillin, cephalosporin, and broadspectrum. Emergence of carbapenemresistant hypervirulent klebsiella. Carbapenemase producing organisms cpo refers to bacteria in the family of enterobacteriaceae e. Klebsiella pneumoniae carbapenemase2 kpc2, b new delhi metallo. Carbapenemase producing klebsiella pneumoniae in hospital, singapore, 2011. Minimum inhibitory concentrations mics were evaluated by etest, colistin mics were also evaluated by broth. Carbapenemaseproducing klebsiella pneumoniae bloodstream. Oct 28, 2019 germany has reported an outbreak of carbapenemase producing ndm1 and oxa48 and colistinresistant klebsiella pneumoniae sequence type st 307. Introduction to klebsiella pneumoniae carbapenemases.
Klebsiella species are examples of enterobacteriaceae, a. Klebsiella pneumoniae carbapenemase kpcproducing k. Prevalence of virulence plasmids in bloodstream isolates of klebsiella pneumoniae and crkp obtained from patients at two hospitals in hong kong published. Treatment of carbapenemresistant klebsiella pneumoniae. As of 21 october 2019, 17 patients in three hospitals and one rehabilitation clinic in mecklenburgwest pomerania in northeast germany have been affected. From early this decade, enterobacteriaceae that produce klebsiella pneumoniae carbapenemases kpc were reported in the usa and. Carbapenemaseproducing klebsiella pneumoniae ncbi nih. Risk of infection and carriage rates of klebsiella spp. The accurate and prompt identifica the accurate and prompt identifica tion of klebsiella pneumoniae carbapenemase kpc is a key to limiting the spread of these bacteria. Outbreak of klebsiella pneumoniae carbapenemase producing klebsiella aerogenes strains in a tertiary hospital in china min hao,1,2 zhen shen,1,2 meiping ye,1,2 fupin hu,1,2 xiaogang xu,1,2 yang yang,1,2 shi wu,1,2 dongfang lin,1,2 xiaohua qin,1,2 minggui wang1,2 1institute of antibiotics, huashan hospital, fudan university, shanghai, peoples. Klebsiella is a gramnegative, anaerobic bacterium, which under the microscope is shaped like a rod. Carbapenemase producing klebsiella pneumoniae strains cpkps have become a major public health problem worldwide. The occurrence of carbapenemase genes among species of enterobacteriaceae was as follows. Carbapenemase production was detected in the majority 85% of cre.
We summarize the wide resistome of this pathogen, which encompasses plentiful chromosomal and plasmidencoded antibiotic resistance. It appears as a mucoid lactose fermenter on macconkey agar although found in the normal flora of the mouth, skin, and intestines, it can cause destructive changes to human and animal lungs if aspirated, specifically to the alveoli. Phenotypic and genotypic characterization of esbl, ampc. Detection and treatment options for klebsiella pneumoniae. Carbapenem nonsusceptible klebsiella pneumoniae in taiwan.
Carbapenemresistant klebsiella pneumoniae is emerging rapidly worldwide. Eurosurveillance epidemic diffusion of kpc carbapenemase. This organism is also surrounded by a capsule, which increases its virulence by acting as a physical barrier to evade the hosts immune response. Bloodstream infection caused by kpcproducing klebsiella. Although found in the normal flora of the mouth, skin, and intestines, it can cause destructive changes to human and animal lungs if aspirated. Outbreak of klebsiella pneumoniae carbapenemaseproducing. A tenyear surveillance study of carbapenemase producing klebsiella pneumoniae in a tertiary care greek university hospital. Klebsiella pneumoniae carbapenemase kpcproducing klebsiella pneumoniae.
Klebsiella pneumoniae carbapenemase carbapenems disease outbreaks infection control. Neutrophilic and necrotizing with an exudate and fibrin filling the airspaces. Treatment of klebsiella pneumoniae carbapenemase kpc infections. Antimicrobial resistance in bacterial pathogens and. Management of kpcproducing klebsiella pneumoniae infections. Pdf treatment of klebsiella pneumoniae carbapenemase. Global spread of carbapenemase producing enterobacteriaceae. Characteristics of 46 carbapenemaseproducing klebsiella pneumoniae isolates collected in a hospital in portugal, 202018 pfge type st isolation year no. Outbreak of klebsiella pneumoniae carbapenemaseproducing k. Increasing antimicrobial drug resistance, including carbapenemresistant k. Klebsiella pneumoniae antimicrobial drug resistance, united. Emergence of klebsiella pneumoniae carbapenemase kpc. Clinical and epidemiological characterization of an. Outbreak of klebsiella pneumoniae carbapenemaseproducing citrobacter freundii at a tertiary acute care facility in miami, florida volume 38 issue 3 adriana jimenez, jose g.
Pitout,14 patrice nordmann,5,6 and laurent poirel6 division of microbiology, calgary laboratory services1, departments of pathology and laboratory medicine2, microbiology, immunology, and infectious diseases3, university of calgary, alberta, canada. The emergence of carbapenemresistant gramnegative pathogens poses a serious threat to public health worldwide. Carbapenems, such as imipenem and meropenem, are often used to treat infections caused by extendedspectrum betalactamase esblproducing. The enzyme may confer lowlevel carbapenem resistance, and the failure of susceptibility methods to identify this resistance has been reported.
Potential antibiotic combination therapy algorithm for the treatment of carbapenemresistant klebsiella pneumoniae infections stratified to site of infection and antibiogram results. This report documents emergence of new delhi metallobetalactamase ndm1 and klebsiella pneumoniae carbapenemase kpc2 in k. Klebsiella pneumoniae is an important multidrugresistant mdr pathogen affecting humans and a major source for hospital infections associated with high morbidity and mortality due to limited treatment options. Pdf klebsiella pneumoniae carbapenemase kpcproducing. Markogiannakis2 1 first department of propaedeutic medicine, university of athens and 2 department of. In the united states and other locations, an increasingly common mechanism of carbapenem resistance is the klebsiella pneumoniae carbapenemase kpc 2, 10, 15, 18, 19, 24, 26, 27. Pdf treatment of klebsiella pneumoniae carbapenemase kpc.
We collected 120 carbapenemase producing enterobacteriaceae. Klebsiella pneumoniae is a bacterium that normally lives inside human intestines, where. Epidemiology and resistance phenotypes of carbapenemase. Klebsiella pneumoniae is a gramnegative, nonmotile, encapsulated, lactosefermenting, facultative anaerobic, rodshaped bacterium. Jun 29, 2019 outbreak of klebsiella pneumoniae carbapenemaseproducing klebsiella aerogenes strains in a tertiary hospital in china min hao,1,2 zhen shen,1,2 meiping ye,1,2 fupin hu,1,2 xiaogang xu,1,2 yang yang,1,2 shi wu,1,2 dongfang lin,1,2 xiaohua qin,1,2 minggui wang1,2 1institute of antibiotics, huashan hospital, fudan university, shanghai, peoples republic of china. Six of the 17 cases presented with clinical symptoms of infection, while 11 were identified. Antimicrobial susceptibility testing of ceftazidimeavibactam combined with aztreonam disclosed the synergism of two drugs in 90% 2730. As of 21 october 2019, 17 patients in three hospitals and one. Klebsiella pneumoniae is an encapsulated gramnegative bacterium that is frequently found in the flora of the mouth, skin and intestines as well as in natural environments 1. The spread of enterobacteriaceae, primarily klebsiella pneumoniae, producing kpc, vim, imp, and ndm carbapenemases, is causing an unprecedented public health crisis. People are at risk of developing klebsiella pneumonia if they are diabetic, chronic alcoholics or have an underlying lung disease. Risk factors and clinical impact of klebsiella pneumoniae carbapenemase producing k. When bacteria such as klebsiella pneumoniae produce an enzyme known as a carbapenemase referred to as kpcproducing organisms, then the class of antibiotics called carbapenems will not work to kill the bacteria and treat the infection.
They are resistant because they produce an enzyme called a carbapenemase that disables the drug molecule. The kpc3producing strain from israel is genetically linked to those reported in the usa, suggesting strain exchange by. The increasing incidence of carbapenemresistant klebsiella pneumoniae crkp fundamentally alters the management of patients at risk to be colonized or infected by such microorganisms. Carbapenemresistant enterobacteriaceae cre or carbapenemase producing enterobacteriaceae cpe are gramnegative bacteria that are resistant to the carbapenem class of antibiotics, considered the drugs of last resort for such infections. Outbreak of carbapenemaseproducing ndm1 and oxa48 and. Full text outbreak of klebsiella pneumoniae carbapenemase. Six of the 17 cases presented with clinical symptoms. All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and. Pdf the emergence of klebsiella pneumoniae carbapenemases kpcs producing bacteria has become a significant global public health challenge while the. Original article the rate of acquisition of carbapenemase. In particular, the increasing prevalence of carbapenemresistant klebsiella pneumoniae is a major source of concern. May 31, 2018 before 2011, the prevalence rates of carbapenemase producing klebsiella pneumoniae cpkp among carbapenem nonsusceptible k. Klebsiella pneumoniae is a gramnegative, nonmotile, lactose fermenting, rodshape organism. Occurrence of oxa48 and ndm1 carbapenemase producing klebsiella pneumoniae in a moroccan university hospital in casablanca.
The carbapenemases commonly encountered in cpkps are the kpc variants and the zincdependent metallo. Once confined to outbreaks in the northeastern united states us, they have spread throughout the us and most of the world. Clinical isolates producing kpc2 and oxa48 do not coproduce other extendedspectrum. Jun 10, 2019 an investigation of klebsiella pneumoniae carbapenemase kpcproducing enterobacteriaceae among patients of acute and longterm acute care hospitals was conducted in 2011.
Carbapenems are commonly used to treat infections caused by multidrugresistant enterobacteriaceae. May 10, 2019 klebsiella pneumoniae are normally harmless bacteria that live in your intestines and feces, but they can be dangerous in other parts of your body. Attributable mortality of carbapenemresistant klebsiella pneumoniae infections in a. Risk factors and clinical impact of klebsiella pneumoniae. Therefore, the aim of our study was to provide updated epidemiologic data on contemporary carbapenemase producing k.
Infection with klebsiella pneumoniae carbapenemase kpc producing klebsiella pneumoniae in cancer patients. Detection of klebsiella pneumoniae carbapenemase kpc production in nonklebsiella pneumoniae enterobacteriaceae isolates by use. Ceftazidimeavibactam is a novel combination antimicrobial agent consisting of a broadspectrum cephalosporin, ceftazidime, and a non. Evaluation of methods to identify the klebsiella pneumoniae. Klebsiella pneumoniae is a superbug that causes a range of diseases, depending on which part of the body it infects. In the last 5 years, the spread of isolates producing klebsiella pneumoniae carbapenemases kpcs has become a significant problem.
Klebsiella pneumoniae is a member of the klebsiella genus of enterobacteriaceae and belongs to the normal flora of the human mouth and intestine. The investigation found extensive spread of kpcproducing enterobacteriaceae throughout 4 adjacent counties in indiana and illinois over a 1yr period. Escherichia coli, carbapenemaseproducing klebsiella pneumoniae ckp, and multidrug. Jul 19, 2017 klebsiella pneumoniae carbapenemase kpcproducing k. This agent has demonstrated activity against resistant gramnegative bacteria, including klebsiella pneumoniae carbapenemase producing organisms. Ndm coupled with kpc carbapenemase producing klebsiella pneumoniae, only 7 strains appeared the susceptibility to ceftazidimeavibactam treatment, mic 50 and mic 90 were 64mgl and 256mgl, respectively. Klebsiella is a superbug that causes a range of diseases, depending on which part of the body it infects. Klebsiella pneumoniae carbapenemase kpcproducing bacteria are a group of emerging highly drugresistant gramnegative bacilli causing infections associated with significant morbidity and mortality. Hoxha a, karki t, giambi c, montano c, sisto a, bella a, et al.
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