Molecular epidemiology of carbapenem-resistant Klebsiella pneumoniae at a Turkish centre: Is the increase of resistance a threat for Europe?

OBJECTIVES

In recent years, carbapenem-resistant Klebsiella pneumoniae (CRKP) have become an important threat to hospitalised patients. This study aimed to identify the genetic mechanisms of carbapenem resistance in CRKP isolated from patients in a Turkish centre.

METHODS

During 2013-2014, a total of 98 K. pneumoniae isolated from patients at Çukurova University Balcalı Hospital (Adana, Turkey) determined phenotypically as resistant to carbapenems were screened genotypically for the presence of carbapenemase enzymes by multiplex PCR.

RESULTS

Of the 98 patients for whom genetic investigation was made, 93 (94.9%) were adults, 56 (57.1%) were male and 81 (82.7%) were diagnosed as infected. The mean and median age were 51.8±20.5years and 55 years (range 1-89 years), respectively. The nosocomial infection rate was 87.8% (86/98). The mortality rate was 41.8% (41/98). Fifty-eight patients (59.2%) were admitted to intensive care units. Of the 12 non-nosocomial infections, 5 (41.7%) originated from the inpatient clinic of the urology department. The mean and median hospital length of stay (LOS) were 20.7±20.8days and 17days (range 0-90 days), respectively. The most common carbapenemase gene detected was bla (74.5%), followed by bla (45.9%) and bla (37.8%). The bla gene was detected in 20 isolates (20.4%). The most effective antibiotics were tigecycline and colistin, with susceptibility rates of 87.5% and 74.3%, respectively.

CONCLUSIONS

Multiple resistance mechanisms were present in CRKP isolates in Turkey. Most of the isolates harboured bla, bla and bla genes; meanwhile, the rate of 20.4% for bla is alarming.