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. 2020 Dec;9(1):1771-1779.
doi: 10.1080/22221751.2020.1799721.

Prevalence, risk factors and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in patients from Zhejiang, China, 2008-2018

Yanyan Hu  1 , Congcong Liu  1 , Zhangqi Shen  2   3 , Hongwei Zhou  1 , Junmin Cao  4 , Shi Chen  5 , Huoyang Lv  6 , Mingming Zhou  7 , Qiang Wang  1 , Long Sun  8 , Qiaoling Sun  1 , Fupin Hu  9 , Yang Wang  2   3 , Rong Zhang  1
Affiliations

Prevalence, risk factors and molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae in patients from Zhejiang, China, 2008-2018

Yanyan Hu et al. Emerg Microbes Infect. 2020 Dec.

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP) is emerging as a worldwide public health concern; however, the long-term molecular epidemiological surveillance of clinical CRKP in China is limited. We conducted a retrospective observational study (2008-2018) to assess the prevalence, susceptibility, risk factors and molecular epidemiology of clinical CRKP isolates. We found the prevalence of CRKP increased from 2.5%, 2008 to 15.8%, 2018. CRKP were significantly more frequent among hospitalized patients from ICU, and it was significantly more likely to be isolated from the capital city (Hangzhou) and the patients aged ≥60 years. Additionally, seasons and specimen types were associated with CRKP infections. The main CRKP sequence type (ST) was ST11, and bla KPC-2 was the most prevalent gene variant. Together these data reveal an increasing incidence and resistance trends among CRKP, especially the ST11-bla KPC-2-CRKP, in Zhejiang, during 2008-2018. Our findings are important for hospitals to limit its dissemination and optimize antibiotic administration.

Keywords: Carbapenem-resistant; Klebsiella pneumoniae; molecular epidemiology; risk factor; surveillance.

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Conflict of interest statement

No potential conflict of interest was reported by the author(s).

Figures

Figure 1.
Figure 1.
A. Trends in the resistance of Klebsiella pneumoniae to extended-spectrum β-lactam (ESBL) and carbapenem from 2008 to 2018. B. Antimicrobial resistance patterns of carbapenem-resistant Klebsiella pneumoniae (CRKP) and carbapenem-sensitive K. pneumoniae CSKP isolates in 2018. CFZ, cefazolin; CXM, cefuroxime; CAZ, ceftazidime; CTX, cefotaxime; FEP, cefepime; FOX, cefoxitin; ATM, aztreonam; CIP, ciprofloxacin; LEV, levofloxacin; SCF, cefoperazone/sulbactam; TZP, piperacillin/tazobactam; SXT, sulfamethoxazole/trimethoprim; AK, amikacin; GM, gentamicin; TG, tigecycline. C. Comparison of trends in carbapenem resistance in intensive care unit (ICU) and non-ICU wards from 2008–2018.
Figure 2.
Figure 2.
Heatmap of imipenem-resistant Klebsiella pneumoniae among the administrative districts of Zhejiang Province. A. Data combined from 2014 to 2018. B. Annual imipenem resistance rates from 2008–2018. The legend shows the corresponding imipenem resistance rates (%). Missing data are marked in grey.
Figure 3.
Figure 3.
Flow chart diagram of samples in this study. All the strains were collected from clinical samples in Zhejiang. Isolates with missing data were excluded for risk factor analysis. ZJSH, Second Affiliated Hospital of Zhejiang University.
Figure 4.
Figure 4.
Distribution of carbapenemase genes and sequence types (STs).
See this image and copyright information in PMC

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