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. 2022 Jan;132(1):237-243.
doi: 10.1111/jam.15166. Epub 2021 Jul 22.

Epidemiology of resistance of carbapenemase-producing Klebsiella pneumoniae to ceftazidime-avibactam in a Chinese hospital

D Chen  1   2 , L Xiao  3 , D Hong  1   4 , Y Zhao  1 , X Hu  1   2 , S Shi  1   4 , F Chen  1   2
Affiliations

Epidemiology of resistance of carbapenemase-producing Klebsiella pneumoniae to ceftazidime-avibactam in a Chinese hospital

D Chen et al. J Appl Microbiol. 2022 Jan.

Abstract

Aims: Klebsiella pneumoniae has been reported to develop increased antibiotic resistance. Ceftazidime-avibactam (CZA) is a novel antibiotic with activity against serine-lactamase. Here, we investigated the sensitivity of carbapenem-resistant K. pneumoniae (CRKP) to CZA and the mechanisms of drug resistance in our hospital.

Methods and results: Patient characteristics were obtained from medical records. K. pneumoniae and its antibiotic susceptibility were determined using the Vitek-2 Compact instrument. The antibiotic resistance genes KPC, NDM, OXA-48, VIM, IMP, CIM, SPM, TMB, SMB, SIM, AIM and DIM were detected using real-time PCR. Multilocus sequence typing was used for genetic RELATEDNESS analysis. In total, 121 CRKP strains were isolated from patients in the intensive care unit (51·2%), senior ward (12·4%) and neurosurgery department (10%). With an average age of 72·5 years, most patients were in care for respiratory (34·7%), brain (20·7%), digestive tract (13·2%) and cardiovascular (8·3%) diseases. Specimens were predominantly obtained from sputum (39·67%), urine (29·75%) and blood (6·61%).

Conclusion: Of 23 CZA-resistant CRKP strains (19·01%), ST11 being the most common at 56·52%, 11 NDM-1-positive (47·83%) and four NDM-5-positive (17·39%) strains were detected.

Significance and impact of the study: Our study indicates that CZA resistance occurs in ~19·01% CRKP strains and that blaNDM-1 and blaNDM-5 might be critical for resistance.

Keywords: Klebsiella pneumoniae; NDM-1; NDM-5; carbapenem resistance; ceftazidime-avibactam; epidemiology.

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Conflict of interest statement

No competing financial interest exists.

Figures

FIGURE 1
FIGURE 1
Minimum inhibitory concentrations (MICs) of ceftazidime‐avibactam. Concentrations of ceftazidime‐avibactam ranging between 0·25/4 and 128/4 μg ml−1 were used to determine the MICs of this combination of antimicrobials using 121 isolated carbapenem‐resistant Klebsiella pneumoniae strains.
FIGURE 2
FIGURE 2
Multilocus sequence typing and phylogenetic analysis of carbapenem and ceftazidime‐avibactam‐resistant Klebsiella pneumoniae. Phylogenetic tree indicating the evolutionary relationships among the 23 strains of carbapenem and ceftazidime‐avibactam‐resistant K. pneumoniae strains isolated in this study. The frequency by which each sequence type was detected is indicated at each branch; ST, sequence type.
FIGURE 3
FIGURE 3
Antibiotic‐resistant genes of carbapenem and ceftazidime‐avibactam‐resistant Klebsiella pneumoniae. Quantitative polymerase chain reaction was used to determine the frequency of 13 antibiotic‐resistant genes in the strains of carbapenem and ceftazidime‐avibactam‐resistant K. pneumoniae. Bar plots indicate the frequency of each gene.
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