title: National surveillance study on carbapenem non-susceptible Klebsiella pneumoniae in Taiwan: the emergence and rapid dissemination of KPC-2 carbapenemase.
abstract: OBJECTIVE
  The global spread and increasing incidence of carbapenem non-susceptible Klebsiella pneumoniae (CnSKP) has made its treatment difficult, increasing the mortality. To establish nationwide data on CnSKP spread and carbapenem-resistance mechanisms, we conducted a national surveillance study in Taiwanese hospitals.
  
  
  METHODS
  We collected 100 and 247 CnSKP isolates in 2010 and 2012, respectively. The tests performed included antibiotic susceptibility tests; detection of carbapenemase, extended-spectrum β-lactamases (ESBL), and AmpC β-lactamases genes; outer membrane porin profiles; and genetic relationship with pulsed-field gel electrophoresis and multilocus sequence type.
  
  
  RESULTS
  The resistance rate of CnSKP isolates to cefazolin, cefotaxime, cefoxitin, ceftazidime, and ciprofloxacin was over 90%. Susceptibility rate to tigecycline and colistin in 2010 was 91.0% and 83.0%, respectively; in 2012, it was 91.9% and 87.9%, respectively. In 2010, carbapenemase genes were detected in only 6.0% of isolates (4 bla IMP-8 and 2 bla VIM-1). In 2012, carbapenemase genes were detected in 22.3% of isolates (41 bla KPC-2, 7 bla VIM-1, 6 bla IMP-8, and 1 bla NDM-1). More than 95% of isolates exhibited either OmpK35 or OmpK36 porin loss or both. Impermeability due to porin mutation coupled with AmpC β-lactamases or ESBLs were major carbapenem-resistance mechanisms. Among 41 KPC-2-producing K. pneumoniae isolates, all were ST11 with 1 major pulsotype.
  
  
  CONCLUSIONS
  In 2010 and 2012, the major mechanisms of CnSKP in Taiwan were the concomitance of AmpC with OmpK35/36 loss. KPC-2-KP dissemination with the same ST11 were observed in 2012. The emergence and rapid spread of KPC-2-KP is becoming an endemic problem in Taiwan. The identification of NDM-1 K. pneumoniae case is alarming.
authors.affiliation: Division of Infectious Diseases and Tropical Medicine, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
authors.forename: Sheng-Kang
authors.initials: SK
authors.lastname: Chiu
authors.forename: Tsu-Lan
authors.initials: TL
authors.lastname: Wu
authors.forename: Yin-Ching
authors.initials: YC
authors.lastname: Chuang
authors.forename: Jung-Chung
authors.initials: JC
authors.lastname: Lin
authors.forename: Chang-Phone
authors.initials: CP
authors.lastname: Fung
authors.forename: Po-Liang
authors.initials: PL
authors.lastname: Lu
authors.forename: Jann-Tay
authors.initials: JT
authors.lastname: Wang
authors.forename: Lih-Shinn
authors.initials: LS
authors.lastname: Wang
authors.forename: L Kristopher
authors.initials: LK
authors.lastname: Siu
authors.forename: Kuo-Ming
authors.initials: KM
authors.lastname: Yeh
mesh_terms: D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001426:Bacterial Proteins / Q000235:genetics / Q000378:metabolism*; D015780:Carbapenems / Q000494:pharmacology*; D002437:Cefazolin / Q000494:pharmacology; D002439:Cefotaxime / Q000494:pharmacology; D002440:Cefoxitin / Q000494:pharmacology; D002442:Ceftazidime / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000201:enzymology*; D008826:Microbial Sensitivity Tests; D013624:Taiwan; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001426:Bacterial Proteins; D015780:Carbapenems; D002939:Ciprofloxacin; D002440:Cefoxitin; D002442:Ceftazidime; D001618:beta-Lactamases; C063912:carbapenemase; D002437:Cefazolin; D002439:Cefotaxime
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