Risk of infection and carriage rates of klebsiella spp. Klebsiella pneumoniae carbapenemase carbapenems disease outbreaks infection control. Klebsiella pneumoniae, a common gut bacteria, causes problems when it moves outside the gut and causes infection. The investigation found extensive spread of kpcproducing enterobacteriaceae throughout 4 adjacent counties in indiana and illinois over a 1yr period. Carbapenemase producing klebsiella pneumoniae in hospital, singapore, 2011. 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. 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. Given their multidrug resistance, therapeutic options are limited and, as discussed here. Management of kpcproducing klebsiella pneumoniae infections. People are at risk of developing klebsiella pneumonia if they are diabetic, chronic alcoholics or have an underlying lung disease. Potential antibiotic combination therapy algorithm for the treatment of carbapenemresistant klebsiella pneumoniae infections stratified to site of infection and antibiogram results. 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.
Klebsiella pneumoniae is a gramnegative, nonmotile, encapsulated, lactose fermenting, facultative anaerobic, rodshaped bacterium. Drug resistance among gramnegative bacteria is a worldwide challenge. Klebsiella pneumoniae an overview sciencedirect topics. 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. Escherichia coli, carbapenemaseproducing klebsiella pneumoniae ckp, and multidrug. 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. Increasing antimicrobial drug resistance, including carbapenemresistant k. They are resistant because they produce an enzyme called a carbapenemase that disables the drug molecule. Klebsiella species are examples of enterobacteriaceae, a. Treatment of klebsiella pneumoniae carbapenemaseproducing. 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. In patients with klebsiella spp infections, bacteria can be transmitted usually via.
An outbreak of colistinresistant klebsiella pneumoniae. 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. Clinical and epidemiological characterization of an. Carbapenems, such as imipenem and meropenem, are often used to treat infections caused by extendedspectrum betalactamase esblproducing. Ceftazidimeavibactam is a novel combination antimicrobial agent consisting of a broadspectrum cephalosporin, ceftazidime, and a non. Markogiannakis2 1 first department of propaedeutic medicine, university of athens and 2 department of. Although found in the normal flora of the mouth, skin, and intestines, it can cause destructive changes to human and animal lungs if aspirated. We summarize the wide resistome of this pathogen, which encompasses plentiful chromosomal and plasmidencoded antibiotic. Bacteria producing klebsiella pneumoniae carbapenemases kpcs are rapidly emerging as a cause of multidrugresistant infections worldwide. Oct 28, 2019 germany has reported an outbreak of carbapenemase producing ndm1 and oxa48 and colistinresistant klebsiella pneumoniae sequence type st 307. Klebsiella pneumoniae is a gramnegative, nonmotile, encapsulated, lactosefermenting, facultative anaerobic, rodshaped bacterium.
Epidemiology of carbapenemase producing klebsiella. Germany has reported an outbreak of carbapenemase producing ndm1 and oxa48 and colistinresistant klebsiella pneumoniae sequence type st 307. Original article the rate of acquisition of carbapenemase. In particular, the increasing prevalence of carbapenemresistant klebsiella pneumoniae is a major source of concern. Attributable mortality of carbapenemresistant klebsiella pneumoniae infections in a.
Edelstein, ebbing lautenbach, marie synnestvedt, neil o. We collected 120 carbapenemase producing enterobacteriaceae. This agent has demonstrated activity against resistant gramnegative bacteria, including klebsiella pneumoniae carbapenemase producing organisms. Risk factors and clinical impact of klebsiella pneumoniae. Jul 19, 2017 klebsiella pneumoniae carbapenemase kpcproducing k. Therefore, the aim of our study was to provide updated epidemiologic data on contemporary carbapenemase producing k. As of 21 october 2019, 17 patients in three hospitals and one rehabilitation clinic in mecklenburgwest pomerania in northeast germany have been affected. Some klebsiella bacteria have become highly resistant to antibiotics. Before 2011, the prevalence rates of carbapenemase producing klebsiella pneumoniae cpkp among carbapenem nonsusceptible k.
Klebsiella pneumoniae, which commonly acquires resistance encoded. The carbapenemases commonly encountered in cpkps are the kpc variants and the zincdependent metallo. Multiplex realtime pcr detection of klebsiella pneumoniae. Prevalence of virulence plasmids in bloodstream isolates of klebsiella pneumoniae and crkp obtained from patients at two hospitals in hong kong published. We report the development of a consistent sampling framework and the results of the. Pdf the emergence of klebsiella pneumoniae carbapenemases kpcs producing bacteria has become a significant global public health challenge while the. Carbapenemase producing organisms cpo refers to bacteria in the family of enterobacteriaceae e. Ndm1 producers have not been described in south africa, and this is the first instance that kpc producers have been identified in africa. Carbapenemresistant klebsiella pneumoniae is emerging rapidly worldwide. Outbreak of carbapenemaseproducing ndm1 and oxa48 and. Antimicrobial resistance in bacterial pathogens and. Carbapenemase producing klebsiella pneumoniae strains cpkps have become a major public health problem worldwide.
Characteristics of 46 carbapenemaseproducing klebsiella pneumoniae isolates collected in a hospital in portugal, 202018 pfge type st isolation year no. Treatment of klebsiella pneumoniae carbapenemaseproducing k. It appears as a mucoid lactose fermenter on macconkey agar. Kpc is an enzyme that degrades penicillin, cephalosporin, and broadspectrum. Epidemiology and resistance phenotypes of carbapenemase. 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. 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. The diagnosis was made between july and december of 2014. Genomic epidemiology of global klebsiella pneumoniae. 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. Introduction to klebsiella pneumoniae carbapenemases.
Klebsiella pneumoniae carbapenemase kpcproducing klebsiella pneumoniae. The first outbreak of kpcproducing k pneumoniae outside the usa was from israel. The occurrence of carbapenemase genes among species of enterobacteriaceae was as follows. Once confined to outbreaks in the northeastern united states us, they have spread throughout the us and most of the world. Treatment of klebsiella pneumoniae carbapenemase kpc infections. Carbapenemaseproducing klebsiella pneumoniae bloodstream. Klebsiella pneumoniae is a superbug that causes a range of diseases, depending on which part of the body it infects. 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. The real threat of klebsiella pneumoniae carbapenemase. Clinical impact of endemic ndmproducing klebsiella. Detection and treatment options for klebsiella pneumoniae. May 31, 2018 before 2011, the prevalence rates of carbapenemase producing klebsiella pneumoniae cpkp among carbapenem nonsusceptible k. Full text outbreak of klebsiella pneumoniae carbapenemase.
As of 21 october 2019, 17 patients in three hospitals and one. Emergence of klebsiella pneumoniae carbapenemase kpc. The spread of enterobacteriaceae, primarily klebsiella pneumoniae, producing kpc, vim, imp, and ndm carbapenemases, is causing an unprecedented public health crisis. Pdf klebsiella pneumoniae carbapenemase kpcproducing. This organism is also surrounded by a capsule, which increases its virulence by acting as a physical barrier to evade the hosts immune response. Carbapenem resistant klebsiella pneumoniae organism 446870005, snomedct extended spectrum betalactamase producing klebsiella pneumoniae organism 409801009, snomedct klebsiella pneumoniae carbapenemase 2 producing klebsiella pneumoniae organism 7171002, snomedct klebsiella pneumoniae ss. Outbreak of klebsiella pneumoniae carbapenemaseproducing k. 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. In total, six patients were found to be positive for kpckp. Klebsiella is a superbug that causes a range of diseases, depending on which part of the body it infects. Neutrophilic and necrotizing with an exudate and fibrin filling the airspaces. Risk factors and clinical impact of klebsiella pneumoniae carbapenemase producing k. Detection of klebsiella pneumoniae carbapenemase kpc production in nonklebsiella pneumoniae enterobacteriaceae isolates by use.
All isolates were resistant to colistin and exhibited reduced susceptibility to gentamicin and. Pitout,14 patrice nordmann,5,6 and laurent poirel6 division of microbiology, calgary laboratory services1, departments of pathology and laboratory medicine2. Emergence of new delhi metallobetalactamase ndm1 and. The enzyme may confer lowlevel carbapenem resistance, and the failure of susceptibility methods to identify this resistance has been reported. A gramnegative pneumonia that can cause both nosocomial and communityacquired pneumonia. Pdf treatment of klebsiella pneumoniae carbapenemase kpc. In vitro and in vivo bactericidal activity of ceftazidime. 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. Infection with klebsiella pneumoniae carbapenemase kpc producing klebsiella pneumoniae in cancer patients. Six of the 17 cases presented with clinical symptoms.
Klebsiella pneumoniae carbapenemase2 kpc2, b new delhi metallo. Klebsiella pneumoniae is a member of the klebsiella genus of enterobacteriaceae and belongs to the normal flora of the human mouth and intestine. Occurrence of oxa48 and ndm1 carbapenemase producing klebsiella pneumoniae in a moroccan university hospital in casablanca. The emergence of carbapenemresistant gramnegative pathogens poses a serious threat to public health worldwide. Klebsiella pneumoniae antimicrobial drug resistance, united. Carbapenemaseproducing klebsiella pneumoniae ncbi nih. Antimicrobial susceptibility testing of ceftazidimeavibactam combined with aztreonam disclosed the synergism of two drugs in 90% 2730. E nterobacteriaceae are inhabitants of the intestinal. Pdf carbapenemaseproducing klebsiella pneumoniae in.
From early this decade, enterobacteriaceae that produce klebsiella pneumoniae carbapenemases kpc were reported in the usa and. Klebsiella pneumoniae carbapenemase kpcproducing klebsiella. Carbapenemase production was detected in the majority 85% of cre. Treatment of carbapenemresistant klebsiella pneumoniae. Klebsiella is a gramnegative, anaerobic bacterium, which under the microscope is shaped like a rod.
Outbreak of klebsiella pneumoniae carbapenemaseproducing. Klebsiella pneumoniae carbapenemase kpcproducing enterobacteriaceae have been reported in many countries, and outbreaks due to kpcproducing organisms have been reported worldwide 1,2,3. Carbapenem nonsusceptible klebsiella pneumoniae in taiwan. Emergence of carbapenemresistant hypervirulent klebsiella. The kpc3producing strain from israel is genetically linked to those reported in the usa, suggesting strain exchange by. Klebsiella pneumoniae carbapenemase kpcproducing bacteria are a group of emerging highly drugresistant gramnegative bacilli causing infections associated with significant morbidity and mortality.
Minimum inhibitory concentrations mics were evaluated by etest, colistin mics were also evaluated by broth. We summarize the wide resistome of this pathogen, which encompasses plentiful chromosomal and plasmidencoded antibiotic resistance. 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. This report documents emergence of new delhi metallobetalactamase ndm1 and klebsiella pneumoniae carbapenemase kpc2 in k.
This procedure provides instructions for taqmanbased realtime pcr detection of. Automated and nonautomated methods for carbapenem susceptibility were evaluated for. 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. Clinical isolates producing kpc2 and oxa48 do not coproduce other extendedspectrum. Eurosurveillance epidemic diffusion of kpc carbapenemase. Pdf infection with klebsiella pneumoniae carbapenemase. 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. 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. Pdf treatment of klebsiella pneumoniae carbapenemase. A tenyear surveillance study of carbapenemase producing klebsiella pneumoniae in a tertiary care greek university hospital. Klebsiella pneumoniae in healthcare settings hai cdc. Klebsiella pneumoniae is a gramnegative, nonmotile, lactose fermenting, rodshape organism. Klebsiella pneumoniae is a bacterium that normally lives inside human intestines, where. Phenotypic and genotypic characterization of esbl, ampc.
Global dissemination of carbapenemaseproducing klebsiella. Klebsiella pneumoniae carbapenemase kpcproducing k. Six of the 17 cases presented with clinical symptoms of infection, while 11 were identified. Global spread of carbapenemase producing enterobacteriaceae. Detection of carbapenemresistant klebsiella pneumoniae. Hoxha a, karki t, giambi c, montano c, sisto a, bella a, et al. Jun 10, 2019 an investigation of klebsiella pneumoniae carbapenemase kpcproducing enterobacteriaceae among patients of acute and longterm acute care hospitals was conducted in 2011. The increasing incidence of carbapenemresistant klebsiella pneumoniae crkp fundamentally alters the management of patients at risk to be colonized or infected by such microorganisms. Aims to provide practical suggestion for physicians dealing with the management of kpckp infections in critically ill patients, based on expert opinions. In the last 5 years, the spread of isolates producing klebsiella pneumoniae carbapenemases kpcs has become a significant problem. Evaluation of methods to identify the klebsiella pneumoniae. Klebsiella is a genus of enterobacteriaceae that has emerged as a significant nosocomial pathogen in neonates.
It belongs to the family enterobacteriaceae and is a normal commensal living in the mouth and gut. 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. 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. Carbapenemase producing enterobacteria cpe infect mainly hospitalized patients but also have been spreading in longterm care facilities. Bloodstream infection caused by kpcproducing klebsiella. The two patients infected with these carbapenemase producing bacteria demised.