The Antimicrobial Susceptibility of Klebsiella pneumoniae from Community Settings in Taiwan, a Trend Analysis.
Drug-resistant Klebsiella pneumoniae, especially extended-spectrum β-lactamase (ESBL)- and/or AmpC β-lactamase-producing strains, is an emerging problem worldwide. However, few data focusing on drug susceptibility of K. pneumoniae from community is available. In this study, we analyzed 1016 K. pneumoniae isolates from outpatients or those visiting emergency rooms collected during 2002-2012 from Taiwan Surveillance of Antimicrobial Resistance program. Significantly decreased susceptibilities to 3rdgeneration cephalosporins and ciprofloxacin were found during the study period. By 2012, susceptibility to cefotaxime and ciprofloxacin was 83.6% and 81.6%, respectively. The prevalence of ESBL-producers increased from 4.8% in 2002 to 11.9% in 2012 (P = 0.012), while that of AmpC β-lactamase-producers increased from 0% to 9.5% in the same period (P < 0.001). Phylogenic analysis of the ESBL and AmpC-β-lactamase-producers by pulsed-field gel electrophoresis and multi-locus sequence typing revealed wide genetic diversity even among the most common sequence type 11 isolates (33.0%). By multivariate analysis, later study year, elderly, and urine isolates were associated with carriage of ESBL genes, while only urine isolates were associated with carriage of AmpC β-lactamase genes. Further studies are needed to determine which antibiotics are reasonable empirical therapy options for patients presenting with severe sepsis that might be caused by K. pneumoniae.
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Wu-Pu
WP
Lin
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
Jann-Tay
JT
Wang
Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.|Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Shan-Chwen
SC
Chang
Division of Infectious Diseases and Tropical Medicine, Tri-Service General Hospital, Taipei, Taiwan.|Department of Internal Medicine, National Defense Medical Center, Taipei, Taiwan.
Feng-Yee
FY
Chang
Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Chang-Phone
CP
Fung
Department of Internal Medicine, Chi-Mei Medical Center, Tainan, Taiwan.
Yin-Ching
YC
Chuang
Department of Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan.|School of Medicine, National Yang Ming University, Taipei, Taiwan.
Yao-Shen
YS
Chen
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
Yih-Ru
YR
Shiau
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
Mei-Chen
MC
Tan
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
Hui-Ying
HY
Wang
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
Jui-Fen
JF
Lai
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
I-Wen
IW
Huang
National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Zhunan, Taiwan.
Tsai-Ling
TL
Lauderdale
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002439:Cefotaxime / Q000494:pharmacology; D002511:Cephalosporins / Q000494:pharmacology; D002939:Ciprofloxacin / Q000494:pharmacology; D014644:Genetic Variation; D006801:Humans; D007710:Klebsiella Infections / Q000097:blood / Q000382:microbiology* / Q000652:urine; D007711:Klebsiella pneumoniae / Q000145:classification / Q000187:drug effects* / Q000302:isolation & purification; D008826:Microbial Sensitivity Tests / Q000379:methods*; D008875:Middle Aged; D058885:Multilocus Sequence Typing; D010802:Phylogeny; D011159:Population Surveillance; D013624:Taiwan; D014556:Urine / Q000382:microbiology; D055815:Young Adult
D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D002439:Cefotaxime