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Characterization of carbapenem-nonsusceptible Klebsiella pneumoniae bloodstream isolates at a Taiwanese hospital: clinical impacts of lowered breakpoints for carbapenems

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Abstract

This study was conducted in order to characterize carbapenem-nonsusceptible Klebsiella pneumoniae isolates and to evaluate the impacts of recently lowered interpretative breakpoints for carbapenems for Enterobacteriaceae. Among 152 K. pneumoniae bloodstream isolates suspected as AmpC or extended-spectrum β-lactamase (ESBL) producers, 58 (38.2%) isolates were currently interpreted as nonsusceptible to ertapenem, imipenem, or meropenem, and 42 (72.4%) of them were categorized as carbapenem-susceptible by the previous criteria. The high revision rate was associated with the predominance (79.3%) of DHA-1 among the carbapenem-nonsusceptible isolates due to both polyclonal and clonal spread. ESBLs were common (~57%) in both ertapenem-susceptible and -nonsusceptible isolates; however, 84.8% of the carbapenem-nonsusceptible isolates were also AmpC producers. The IMP-8 metallo-β-lactamase was detected in three isolates. Polyacrylamide gel electrophoresis suggested decreased OmpK35 expression in all but one ertapenem-nonsusceptible isolate, and genetic disruptions of ompK35 and ompK36 were detected in 30 and six ertapenem-nonsusceptible isolates, respectively. A comparison between patients infected by AmpC- or ESBL-producing ertapenem-susceptible (n = 62) isolates and those with isolates revised as ertapenem-nonsusceptible (n = 41) revealed more cases of malignancies (36.6% versus 14.5%; p = 0.01) and higher Charlson score (p = 0.033) among the patients with ertapenem-nonsusceptible isolates; however, the acquisition of an isolate revised as carbapenem-nonsusceptible was not identified as an independent mortality risk factor.

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Acknowledgments

The authors are grateful to the Research Center of Clinical Medicine, National Cheng Kung University Hospital, Tainan, Taiwan, for providing the statistical consulting services. This work was partially supported by grants DOH100-TD-B-111-002 (Multidisciplinary Center of Excellence for Clinical Trial and Research, Department of Health, Executive Yuan, Taiwan) and NSC 99-3112-B-006-015 and 100-2320-B-006-015 (National Science Council, Taiwan).

Competing interests

None declared.

Ethical approval

The study protocol was reviewed and approved by the Institutional Review Board at National Cheng Kung University Hospital.

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Authors and Affiliations

  1. Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan

    N. Y. Lee & W. C. Ko

  2. Department of Medical Laboratory Science and Biotechnology, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 70101, Taiwan

    J. J. Wu & L. H. Tsai

  3. Research Center of Clinical Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan

    S. H. Lin

  4. Department of Pathology, National Cheng Kung University Hospital, 138 Sheng-Li Road, Tainan, 70428, Taiwan

    J. J. Yan

  5. Department of Pathology, College of Medicine, National Cheng Kung University, No. 1 University Road, Tainan, 70101, Taiwan

    J. J. Yan

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  1. N. Y. Lee
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Correspondence to J. J. Yan.

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Lee, N.Y., Wu, J.J., Lin, S.H. et al. Characterization of carbapenem-nonsusceptible Klebsiella pneumoniae bloodstream isolates at a Taiwanese hospital: clinical impacts of lowered breakpoints for carbapenems. Eur J Clin Microbiol Infect Dis 31, 1941–1950 (2012). https://doi.org/10.1007/s10096-011-1525-2

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  • DOI: https://doi.org/10.1007/s10096-011-1525-2

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