title: Carbapenem-nonsusceptible Enterobacteriaceae in Taiwan.
abstract: A total of 1135 carbapenem-resistant (nonsusceptible) Enterobacteriaceae (CRE) isolates were recovered between November 2010 and July 2012 (517 from 2010-2011 and 618 from 2012) from 4 hospitals in Taiwan. Carbapenemase-producing Enterobacteriaceae (CPE) comprised 5.0% (57 isolates), including 17 KPC-2 (16 Klebsiella pneumoniae and 1 Escherichia coli), 1 NDM-1 (K. oxytoca), 37 IMP-8 (26 Enterobacter cloacae, 4 Citrobacter freundii, 4 Raoultella planticola, 1 K. pneumoniae, 1 E. coli and 1 K. oxytoca), and 2 VIM-1 (1 E. cloacae, 1 E. coli). The KPC-2-positive K. pneumoniae were highly clonal even in isolates from different hospitals, and all were ST11. IMP-8 positive E. cloacae from the same hospitals showed higher similarity in PFGE pattern than those from different hospitals. A total of 518 CRE isolates (45.6%) were positive for blaESBL, while 704 (62.0%) isolates were blaAmpC-positive, 382 (33.6% overall) of which carried both blaESBL and blaAmpC. CTX-M (414, 80.0%) was the most common blaESBL, while DHA (497, 70.6%) and CMY (157, 22.3%) were the most common blaAmpC. Co-carriage of blaESBL and blaAmpC was detected in 31 (54.4%) and 15 (26.3%) of the 57 CPE, respectively. KPC-2 was the most common carbapenemase detected in K. pneumoniae (2.8%), while IMP-8 was the most common in E. cloacae (9.7%). All KPC-2-positive CRE were resistant to all three tested carbapenems. However, fourteen of the 37 IMP-8-positive CRE were susceptible to both imipenem and meropenem in vitro. Intra- and inter-hospital spread of KPC-2-producing K. pneumoniae and IMP-8-producing E. cloacae likely occurred. Although the prevalence of CPE is still low, careful monitoring is urgently needed. Non-susceptibility to ertapenem might need to be considered as one criterion of definition for CRE in areas where IMP type carbapenemase is prevalent.
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors: Jann-Tay
authors: JT
authors: Wang
authors: Department of Medical Research, National Taiwan University Hospital, Taipei, Taiwan.
authors: Un-In
authors: UI
authors: Wu
authors: National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
authors: Tsai-Ling Yang
authors: TL
authors: Lauderdale
authors: National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
authors: Mei-Chen
authors: MC
authors: Chen
authors: Centers for Disease Control, Taipei, Taiwan.
authors: Shu-Ying
authors: SY
authors: Li
authors: Graduate Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan.
authors: Le-Yin
authors: LY
authors: Hsu
authors: Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan; Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Shan-Chwen
authors: SC
authors: Chang
mesh_terms: D000890:Anti-Infective Agents / Q000494:pharmacology; D015780:Carbapenems / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004755:Enterobacteriaceae / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D004756:Enterobacteriaceae Infections / Q000453:epidemiology / Q000382:microbiology; D005798:Genes, Bacterial; D006761:Hospitals; D006801:Humans; D008826:Microbial Sensitivity Tests; D010802:Phylogeny; D015995:Prevalence; D013045:Species Specificity; D013624:Taiwan; D001618:beta-Lactamases / Q000235:genetics / Q000378:metabolism
chemical_list: D000890:Anti-Infective Agents; D015780:Carbapenems; D001618:beta-Lactamases