[Source: Eurosurveillance, full page: (LINK). Abstract, edited.]
Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016
Irene Galani1, Ilias Karaiskos2, Irene Karantani3, Vassiliki Papoutsaki3, Sofia Maraki4, Vassiliki Papaioannou5,Polyzo Kazila6, Helen Tsorlini7, Nikoletta Charalampaki8, Marina Toutouza9, Helen Vagiakou10, Konstantinos Pappas11, Anna Kyratsa12,Konstantina Kontopoulou13, Olga Legga14, Efthymia Petinaki15, Helen Papadogeorgaki3, Efrosini Chinou16, Maria Souli1, Helen Giamarellou2,on behalf of the study collaborators17
Affiliations: 1 Infectious Diseases Laboratory, 4th Department of Internal Medicine, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece; 2 6th Department of Internal Medicine, Hygeia General Hospital, Athens, Greece; 3 Microbiology Laboratory, Hygeia General Hospital, Athens, Greece; 4 Department of Clinical Bacteriology, Parasitology, Zoonoses and Geographical Medicine, University Hospital of Heraklion, Heraklion, Greece; 5 Microbiology Department, KAT Hospital, Athens, Greece; 6 Cancer Hospital of Thessaloniki ‘THEAGENEIO’, Thessaloniki, Greece; 7 Microbiological Laboratories, Bacteriology Department ‘G. Papanikolaou’ General Hospital of Thessaloniki, Thessaloniki, Greece; 8 Department of Clinical Μicrobiology, Thriassio General Hospital, Elefsina, Athens, Greece; 9 Department of Microbiology, Hippokration Athens General Hospital, Athens, Greece; 10 Microbiology Laboratory, General Hospital of Athens ‘G. Gennimatas’, Athens, Greece; 11 Athens Naval Hospital, Athens, Greece; 12 Microbiology Laboratory, General Hospital of Corfu, Corfu, Greece; 13 Department of Microbiology, General Hospital of Thessaloniki ‘G. Gennimatas’, Thessaloniki, Greece; 14 Department of Microbiology, General Hospital of Lamia, Lamia, Greece; 15 Department of Microbiology, University Hospital of Larissa, Larissa, Greece; 16 Department of Microbiology, St Savvas Cancer Hospital, Athens, Greece; 17 The study collaborators are acknowledged at the end of the article
Citation style for this article: Galani Irene, Karaiskos Ilias, Karantani Irene, Papoutsaki Vassiliki, Maraki Sofia, Papaioannou Vassiliki, Kazila Polyzo, Tsorlini Helen,Charalampaki Nikoletta, Toutouza Marina, Vagiakou Helen, Pappas Konstantinos, Kyratsa Anna, Kontopoulou Konstantina, Legga Olga, Petinaki Efthymia,Papadogeorgaki Helen, Chinou Efrosini, Souli Maria, Giamarellou Helen, on behalf of the study collaborators. Epidemiology and resistance phenotypes of carbapenemase-producing Klebsiella pneumoniae in Greece, 2014 to 2016. Euro Surveill. 2018;23(31):pii=1700775. https://doi.org/10.2807/1560-7917.ES.2018.23.30.1700775
Received: 17 Nov 2017; Accepted: 29 Mar 2018
Background and aim
A multicentre nationwide surveillance study was conducted in Greek hospitals to evaluate epidemiology of carbapenemase-producing Klebsiella pneumoniae clinical isolates, and their susceptibilities to last-line antibiotics.
Minimum inhibitory concentrations (MICs) were evaluated by Etest, colistin MICs were also evaluated by broth microdilution SensiTest (now known as ComASP) Colistin. Carbapenemase genes were detected by PCR. Clonal relatedness was assessed by PFGE. Isolates were prospectively collected between November 2014 and April 2016, from 15 hospitals.
Among 394 isolates, K. pneumoniae carbepenemase (KPC) remained the most prevalent carbapenemase (66.5%). NDM was the second most prevalent (13.7%), identified in 12 hospitals, followed by VIM (8.6%). OXA-48- and double carbapenemase-producers remained rare (3.6%, 6.3%, respectively). Carbapenemase-producing K. pneumoniae isolates showed high resistance to last-line antibiotics. Gentamicin and colistin were the most active in vitro with 61.9% and 59.6% of the isolates to be inhibited at ≤ 2mg/L, followed by fosfomycin (susceptibility (S): 58.4%) and tigecycline (S: 51.5%). Ceftazidime/avibactam inhibited 99.6% of KPC and 100% of OXA-48-like-producing isolates, while temocillin was active against 58% of KPC isolates at urinary breakpoint of ≤ 2mg/L and only 2.7% at systemic breakpoint of ≤ 8mg/L. NDM-producing isolates belonged mainly to one clone, whereas KPC, VIM, OXA-48 and double carbapenemase-producers were mainly polyclonal.
KPC remains the predominant carbapenemase among K. pneumoniae in Greece, followed by NDM, whereas changing trends of resistance rates to last-line antimicrobials against carbapenemase-producing K. pneumoniae with the exception of ceftazidime/avibactam mandates continuing surveillance to support clinical practice.
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Keywords: Klebsiella pneumoniae; Antibiotics; Drugs Resistance; Greece; Carbapenem.