4.5 Article

Molecular Characterization of Carbapenem Resistant Klebsiella pneumoniae in Malaysia Hospital

Journal

PATHOGENS
Volume 10, Issue 3, Pages -

Publisher

MDPI
DOI: 10.3390/pathogens10030279

Keywords

carbapenem-resistant Klebsiella pneumoniae; Enterobacteriaceae; OXA-48; NDM; carbapenemase; PFGE

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Funding

  1. International Society for Infectious Diseases (ISID) [IF2016-2015]

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The study reported the epidemiology of carbapenem-resistant Klebsiella pneumoniae (CRKP) in a Malaysian teaching hospital, with bla(OXA-48) identified as the predominant carbapenemase gene. Infection or colonization by CRKP, especially NDM-producers, central venous catheter usage, and stoma were associated with higher in-hospital mortality. Early detection of CRKP isolates was crucial due to the potential high mortality rate associated with infection.
The emergence of carbapenem-resistant Klebsiella pneumoniae (CRKP) is a great concern, as carbapenems are the last-line therapy for multidrug-resistant Gram-negative bacteria infections. This study aims to report the epidemiology of CRKP in a teaching hospital in Malaysia based on the molecular genotypic and clinical characteristics of the isolates. Sixty-three CRKP strains were isolated from a tertiary teaching hospital from January 2016 until August 2017. Carbapenemase genes were detected in 55 isolates, with bla(OXA-48) (63.5%) as the predominant carbapenemase gene, followed by bla(NDM) (36.5%). At least one porin loss was detected in nine isolates. Overall, 63 isolates were divided into 30 clusters at similarity of 80% with PFGE analysis. Statistical analysis showed that in-hospital mortality was significantly associated with the usage of central venous catheter, infection or colonization by CRKP, particularly NDM-producers. In comparison, survival analysis using Cox proportional hazards regression identified a higher hazard ratio for patients with a stoma and patients treated with imipenem but a lower hazard ratio for patients with NDM-producing CRKP. OXA-48 carbapenemase gene was the predominant carbapenemase gene in this study. As CRKP infection could lead to a high rate of in-hospital mortality, early detection of the isolates was important to reduce their dissemination.

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