title: National sentinel site surveillance for antimicrobial resistance in Klebsiella pneumoniae isolates in South Africa, 2010 - 2012.
abstract: BACKGROUND
  The increasing rates of antimicrobial resistance observed in the nosocomial pathogen Klebsiella pneumoniae are of major public health concern worldwide.
  
  
  OBJECTIVE
  To describe the antibiotic susceptibility profiles of K. pneumoniae isolates from bacteraemic patients submitted by sentinel laboratories in five regions of South Africa from mid-2010 to mid-2012. Molecular methods were used to detect the most commonly found extended-spectrum beta-lactamase (ESBL) and carbapenemase resistance genes.
  
  
  METHODS
  Thirteen academic centres serving the public healthcare sector in Gauteng, KwaZulu-Natal, Free State, Limpopo and Western Cape provinces submitted K. pneumoniae isolates from patients with bloodstream infections. Vitek 2 and MicroScan instruments were used for organism identification and susceptibility testing. Multiplex polymerase chain reactions (PCRs) were used to detect blaCTX-M, blaSHV and blaTEM genes in a proportion of the ESBL isolates. All isolates exhibiting reduced susceptibility to carbapenems were PCR tested for blaKPC and blaNDM-1 resistance genes.
  
  
  RESULTS
  Overall, 68.3% of the 2,774 isolates were ESBL-positive, showing resistance to cefotaxime, ceftazidime and cefepime. Furthermore, 46.5% of all isolates were resistant to ciprofloxacin and 33.1% to piperacillin-tazobactam. The major ESBL genes were abundantly present in the sample analysed. Most isolates (95.5%) were susceptible to the carbapenems tested, and no isolates were positive for blaKPC or blaNDM-1. There was a trend towards a decrease in susceptibility to most antibiotics.
  
  
  CONCLUSIONS
  The high proportion of ESBL-producing K. pneumoniae isolates observed, and the prevalence of ESBL genes, are of great concern. Our findings represent a baseline for further surveillance in SA, and can be used for policy and treatment decisions.
authors.affiliation: Centre for Opportunistic, Tropical and Hospital Infections, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa; Department of Clinical Microbiology and Infectious Diseases, School of Pathology of the University of the Witwatersrand and National Health Laboratory Service, Johannesburg. olgap@nicd.ac.za.
authors.forename: Olga
authors.initials: O
authors.lastname: Perovic
authors.forename: Ashika
authors.initials: A
authors.lastname: Singh-Moodley
authors.forename: Adriano
authors.initials: A
authors.lastname: Dusé
authors.forename: Colleen
authors.initials: C
authors.lastname: Bamford
authors.forename: G
authors.initials: G
authors.lastname: Elliott
authors.forename: Khine Swe
authors.initials: KS
authors.lastname: Swe-Han
authors.forename: Ranmini
authors.initials: R
authors.lastname: Kularatne
authors.forename: Warren
authors.initials: W
authors.lastname: Lowman
authors.forename: Andrew
authors.initials: A
authors.lastname: Whitelaw
authors.forename: Trusha
authors.initials: T
authors.lastname: Nana
authors.forename: Jeanette
authors.initials: J
authors.lastname: Wadula
authors.forename: Ruth
authors.initials: R
authors.lastname: Lekalakala
authors.forename: Adrienne
authors.initials: A
authors.lastname: Saif
authors.forename: Melony
authors.initials: M
authors.lastname: Fortuin De-Smit
authors.forename: Else
authors.initials: E
authors.lastname: Marais
mesh_terms: D024881:Drug Resistance, Bacterial; D006801:Humans; D007711:Klebsiella pneumoniae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests; D018571:Sentinel Surveillance; D013019:South Africa; D001618:beta-Lactamases / Q000235:genetics
chemical_list: D001618:beta-Lactamases