Carbapenem-nonsusceptible Enterobacteriaceae in Taiwan

• Published in: PloS one Vol. 10; no. 3; p. e0121668
• Main Authors: Wang, Jann-Tay, Wu, Un-In, Lauderdale, Tsai-Ling Yang, Chen, Mei-Chen, Li, Shu-Ying, Hsu, Le-Yin, Chang, Shan-Chwen
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 20.03.2015; Public Library of Science (PLoS)
• Subjects: Anti-Infective Agents - pharmacology; Antibacterial agents; Antibiotics; Beta lactam antibiotics; beta-Lactamases - genetics; beta-Lactamases - metabolism; Carbapenemase; Carbapenems; Carbapenems - pharmacology; Citrobacter; CRE bacteria; Disease control; Drug Resistance, Bacterial - drug effects; E coli; Enterobacter; Enterobacter cloacae; Enterobacteriaceae; Enterobacteriaceae - drug effects; Enterobacteriaceae - genetics; Enterobacteriaceae - isolation & purification; Enterobacteriaceae Infections - epidemiology; Enterobacteriaceae Infections - microbiology; Enzymes; Epidemiology; Ertapenem; Escherichia coli; Genes, Bacterial; Health care; Hospitals; Humans; Imipenem; Infections; Infectious diseases; Internal medicine; Klebsiella; Klebsiella pneumoniae; Laboratories; Medical research; Meropenem; Microbial Sensitivity Tests; Phylogeny; Pneumonia; Prevalence; Preventive medicine; Species Specificity; Taiwan; Urogenital system; Taiwan
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0121668

A total of 1135 carbapenem-resistant (nonsusceptible) Enterobacteriaceae (CRE) isolates were recovered between November 2010 and July 2012 (517 from 2010-2011 and 618 from 2012) from 4 hospitals in Taiwan. Carbapenemase-producing Enterobacteriaceae (CPE) comprised 5.0% (57 isolates), including 17 KPC-2 (16 Klebsiella pneumoniae and 1 Escherichia coli), 1 NDM-1 (K. oxytoca), 37 IMP-8 (26 Enterobacter cloacae, 4 Citrobacter freundii, 4 Raoultella planticola, 1 K. pneumoniae, 1 E. coli and 1 K. oxytoca), and 2 VIM-1 (1 E. cloacae, 1 E. coli). The KPC-2-positive K. pneumoniae were highly clonal even in isolates from different hospitals, and all were ST11. IMP-8 positive E. cloacae from the same hospitals showed higher similarity in PFGE pattern than those from different hospitals. A total of 518 CRE isolates (45.6%) were positive for blaESBL, while 704 (62.0%) isolates were blaAmpC-positive, 382 (33.6% overall) of which carried both blaESBL and blaAmpC. CTX-M (414, 80.0%) was the most common blaESBL, while DHA (497, 70.6%) and CMY (157, 22.3%) were the most common blaAmpC. Co-carriage of blaESBL and blaAmpC was detected in 31 (54.4%) and 15 (26.3%) of the 57 CPE, respectively. KPC-2 was the most common carbapenemase detected in K. pneumoniae (2.8%), while IMP-8 was the most common in E. cloacae (9.7%). All KPC-2-positive CRE were resistant to all three tested carbapenems. However, fourteen of the 37 IMP-8-positive CRE were susceptible to both imipenem and meropenem in vitro. Intra- and inter-hospital spread of KPC-2-producing K. pneumoniae and IMP-8-producing E. cloacae likely occurred. Although the prevalence of CPE is still low, careful monitoring is urgently needed. Non-susceptibility to ertapenem might need to be considered as one criterion of definition for CRE in areas where IMP type carbapenemase is prevalent.