Ann Lab Med.  2016 Nov;36(6):529-535. 10.3343/alm.2016.36.6.529.

Prevalence and Molecular Characteristics of Carbapenemase-Producing Enterobacteriaceae From Five Hospitals in Korea

• Jeong SH
• Kim HS
• Kim JS
• Shin DH
• Kim HS
• Park MJ
• Shin S
• Hong JS
• Lee SS
• Song W

• KMID: 2373590
• DOI: http://doi.org/10.3343/alm.2016.36.6.529

Abstract

BACKGROUND
The emergence of carbapenemase-producing Enterobacteriaceae (CPE) represents a major clinical problem because these bacteria are resistant to most antibiotics. CPE remain relatively uncommon in Korea. We report the prevalence, clinical characteristics, and molecular epidemiology of CPE isolates collected from five university hospitals in Korea.
METHODS
Between January and December 2015, 393 non-duplicated isolates that were nonsusceptible to ertapenem were analyzed. Production of carbapenemase, extended-spectrum β-lactamase, and AmpC β-lactamase was determined by genotypic tests. Antimicrobial susceptibility profiles were determined by using an Etest. Clonality of Klebsiella pneumoniae carbapenemase (KPC)-2-producing and oxacillinase (OXA)-232-producing Klebsiella pneumoniae isolates was determined by pulsed-field gel electrophoresis (PFGE).
RESULTS
Of the 393 isolates tested, 79 (20.1%) were CPE. Of these 79 isolates, 47 (59.5%) harbored the bla(OXA-232) gene while the remaining isolates carried genes bla(KPC-2) (n=27), bla(IMP-1) (n=4), and bla(NDM-1) (n=1). Among the 24 KPC-2 K. pneumoniae isolates from hospital B, 100% were resistant to carbapenems, 8% to colistin, and 0% to tigecycline. Among the 45 OXA-232 K. pneumoniae at hospital C, 95% were resistant to ertapenem, 68% to imipenem, 95% to meropenem, 10% to colistin, and 24% to tigecycline. PFGE analysis revealed a unique pattern for KPC-2 K. pneumoniae and identified 30 isolates belonging to the dominant pulsotypes (PT)1 and PT2 among 41 OXA-232 K. pneumoniae isolates.
CONCLUSIONS
CPE strains are present in Korea, with the majority of K. pneumoniae isolates producing OXA-232 and KPC-2. The prevalence and predominant genotypes of CPE show hospital-specific differences.

Keyword

Enterobacteriaceae; Klebsiella pneumoniae; KPC-2; OXA-232; Korea

MeSH Terms

Aged
Anti-Bacterial Agents/pharmacology
Bacterial Proteins/*genetics/metabolism
Drug Resistance, Bacterial
Electrophoresis, Gel, Pulsed-Field
Enterobacteriaceae/drug effects/*enzymology/isolation & purification
Enterobacteriaceae Infections/diagnosis/epidemiology/*microbiology
Female
Genotype
Hospitals
Humans
Male
Microbial Sensitivity Tests
Middle Aged
Prevalence
Republic of Korea/epidemiology
beta-Lactamases/*genetics/metabolism
Anti-Bacterial Agents
Bacterial Proteins
beta-Lactamases

Figure

• 

  Fig. 1 Pulsed-field gel electrophoresis (PFGE) patterns of KPC-2-producing K. pneumoniae isolated in hospital B (n=20). Isolates that exhibited PFGE dendrograms with more than 90% similarity were considered as one pulsotype (PT).

• 

  Fig. 2 Pulsed-field gel electrophoresis (PFGE) patterns of OXA-232-producing K. pneumoniae isolated in hospital C (n=41). Isolates that exhibited PFGE dendrograms with more than 90% similarity were considered as one pulsotype (PT). Black line in dendrogram represents percentage similarity cut-off.

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