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Bloodstream infection caused by KPC-producing Klebsiella pneumoniae resistant to ceftazidime/avibactam: epidemiology and genomic characterization.
Clin Microbiol Infect. 2020 Apr; 26(4):516.e1-516.e4.CM

Abstract

OBJECTIVES

The aim of this study was to evaluate the incidence of ceftazidime/avibactam resistance among Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) strains isolated from patients with bloodstream infection.

METHODS

We collected 120 carbapenemase producing Enterobacteriaceae (CPE) strains from unique patients hospitalized in two Italian hospitals between January 2018 to February 2019. Strains were phenotypically characterized for the type of carbapenemase production and susceptibility to ceftazidime/avibactam. Ceftazidime/avibactam-resistant strains were characterized by whole-genome sequencing.

RESULTS

During the study period, we characterized 105 (87.5%) KPC producers among a total of 120 CPE strains. Ceftazidime/avibactam resistance was found in three KPC-Kp strains isolated from patients with no history of previous ceftazidime/avibactam-based treatment. Of note, two out of three ceftazidime-avibactam-resistant KPC-Kp were also resistant to meropenem/vaborbactam. Genomic characterization showed that a ceftazidime/avibactam-resistant KPC-Kp harboured a mixed population with D179Y mutated KPC-2, while the other two ceftazidime-avibactam-resistant KPC-Kp possessed non-functional ompK35-ompK37 and mutated ompK36 porins associated with higher copy number of blaKPC gene.

CONCLUSIONS

Our results showed that incidence of ceftazidime/avibactam resistance emerged in KCP-Kp strains independently from previous antimicrobial exposure. Resistance to ceftazidime/avibactam was associated with mutations within the blaKPC gene or porin deficiency associated with higher blaKPC copy number and is also related to the meropenem/vaborbactam resistance.

Authors+Show Affiliations

Operative Unit of Clinical Microbiology, S. Orsola-Malpighi University Hospital, Bologna, Italy. Electronic address: paolo.gaibani@unibo.it.Operative Unit of Clinical Microbiology, S. Orsola-Malpighi University Hospital, Bologna, Italy; University of Bologna, Italy.Operative Unit of Infectious Diseases, S. Orsola-Malpighi University Hospital, Italy.Operative Unit of Infectious Diseases, S. Orsola-Malpighi University Hospital, Italy.Operative Unit of Clinical Microbiology, S. Orsola-Malpighi University Hospital, Bologna, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31740422

Citation

Gaibani, P, et al. "Bloodstream Infection Caused By KPC-producing Klebsiella Pneumoniae Resistant to Ceftazidime/avibactam: Epidemiology and Genomic Characterization." Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, vol. 26, no. 4, 2020, pp. 516.e1-516.e4.
Gaibani P, Re MC, Campoli C, et al. Bloodstream infection caused by KPC-producing Klebsiella pneumoniae resistant to ceftazidime/avibactam: epidemiology and genomic characterization. Clin Microbiol Infect. 2020;26(4):516.e1-516.e4.
Gaibani, P., Re, M. C., Campoli, C., Viale, P. L., & Ambretti, S. (2020). Bloodstream infection caused by KPC-producing Klebsiella pneumoniae resistant to ceftazidime/avibactam: epidemiology and genomic characterization. Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases, 26(4), e1-e4. https://doi.org/10.1016/j.cmi.2019.11.011
Gaibani P, et al. Bloodstream Infection Caused By KPC-producing Klebsiella Pneumoniae Resistant to Ceftazidime/avibactam: Epidemiology and Genomic Characterization. Clin Microbiol Infect. 2020;26(4):516.e1-516.e4. PubMed PMID: 31740422.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Bloodstream infection caused by KPC-producing Klebsiella pneumoniae resistant to ceftazidime/avibactam: epidemiology and genomic characterization. AU - Gaibani,P, AU - Re,M C, AU - Campoli,C, AU - Viale,P L, AU - Ambretti,S, Y1 - 2019/11/16/ PY - 2019/07/01/received PY - 2019/09/19/revised PY - 2019/11/05/accepted PY - 2019/11/20/pubmed PY - 2020/11/11/medline PY - 2019/11/20/entrez KW - Ceftazidime/avibactam resistance KW - D179Y mutation KW - Meropenem/vaborbactam resistance KW - Porin deficiency KW - bla(KPC)copy number SP - 516.e1 EP - 516.e4 JF - Clinical microbiology and infection : the official publication of the European Society of Clinical Microbiology and Infectious Diseases JO - Clin Microbiol Infect VL - 26 IS - 4 N2 - OBJECTIVES: The aim of this study was to evaluate the incidence of ceftazidime/avibactam resistance among Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) strains isolated from patients with bloodstream infection. METHODS: We collected 120 carbapenemase producing Enterobacteriaceae (CPE) strains from unique patients hospitalized in two Italian hospitals between January 2018 to February 2019. Strains were phenotypically characterized for the type of carbapenemase production and susceptibility to ceftazidime/avibactam. Ceftazidime/avibactam-resistant strains were characterized by whole-genome sequencing. RESULTS: During the study period, we characterized 105 (87.5%) KPC producers among a total of 120 CPE strains. Ceftazidime/avibactam resistance was found in three KPC-Kp strains isolated from patients with no history of previous ceftazidime/avibactam-based treatment. Of note, two out of three ceftazidime-avibactam-resistant KPC-Kp were also resistant to meropenem/vaborbactam. Genomic characterization showed that a ceftazidime/avibactam-resistant KPC-Kp harboured a mixed population with D179Y mutated KPC-2, while the other two ceftazidime-avibactam-resistant KPC-Kp possessed non-functional ompK35-ompK37 and mutated ompK36 porins associated with higher copy number of blaKPC gene. CONCLUSIONS: Our results showed that incidence of ceftazidime/avibactam resistance emerged in KCP-Kp strains independently from previous antimicrobial exposure. Resistance to ceftazidime/avibactam was associated with mutations within the blaKPC gene or porin deficiency associated with higher blaKPC copy number and is also related to the meropenem/vaborbactam resistance. SN - 1469-0691 UR - https://www.unboundmedicine.com/medline/citation/31740422/Bloodstream_infection_caused_by_KPC_producing_Klebsiella_pneumoniae_resistant_to_ceftazidime/avibactam:_epidemiology_and_genomic_characterization_ DB - PRIME DP - Unbound Medicine ER -