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Bloodstream infection caused by KPC-producing Klebsiella pneumoniae resistant to ceftazidime/avibactam: epidemiology and genomic characterization
- Source :
- Clinical Microbiology and Infection. 26:516.e1-516.e4
- Publication Year :
- 2020
- Publisher :
- Elsevier BV, 2020.
-
Abstract
- Objectives The aim of this study was to evaluate the incidence of ceftazidime/avibactam resistance among Klebsiella pneumoniae carbapenemase (KPC)-producing K. pneumoniae (KPC-Kp) strains isolated from patients with bloodstream infection. Methods We collected 120 carbapenemase producing Enterobacteriaceae (CPE) strains from unique patients hospitalized in two Italian hospitals between January 2018 to February 2019. Strains were phenotypically characterized for the type of carbapenemase production and susceptibility to ceftazidime/avibactam. Ceftazidime/avibactam-resistant strains were characterized by whole-genome sequencing. Results During the study period, we characterized 105 (87.5%) KPC producers among a total of 120 CPE strains. Ceftazidime/avibactam resistance was found in three KPC-Kp strains isolated from patients with no history of previous ceftazidime/avibactam-based treatment. Of note, two out of three ceftazidime–avibactam-resistant KPC-Kp were also resistant to meropenem/vaborbactam. Genomic characterization showed that a ceftazidime/avibactam-resistant KPC-Kp harboured a mixed population with D179Y mutated KPC-2, while the other two ceftazidime–avibactam-resistant KPC-Kp possessed non-functional ompK35-ompK37 and mutated ompK36 porins associated with higher copy number of blaKPC gene. Conclusions Our results showed that incidence of ceftazidime/avibactam resistance emerged in KCP-Kp strains independently from previous antimicrobial exposure. Resistance to ceftazidime/avibactam was associated with mutations within the blaKPC gene or porin deficiency associated with higher blaKPC copy number and is also related to the meropenem/vaborbactam resistance.
- Subjects :
- Microbiology (medical)
Klebsiella pneumoniae
Avibactam
Population
Ceftazidime
Bacteremia
Microbial Sensitivity Tests
bla
Meropenem/vaborbactam resistance
Meropenem
Microbiology
Tertiary Care Centers
chemistry.chemical_compound
Ceftazidime/avibactam resistance
Drug Resistance, Multiple, Bacterial
copy number
polycyclic compounds
medicine
Humans
education
Vaborbactam
education.field_of_study
Porin deficiency
Whole Genome Sequencing
biology
Incidence
Genomics
General Medicine
biochemical phenomena, metabolism, and nutrition
bacterial infections and mycoses
biology.organism_classification
Antimicrobial
Ceftazidime/avibactam
Anti-Bacterial Agents
Klebsiella Infections
Drug Combinations
KPC
Carbapenem-Resistant Enterobacteriaceae
Infectious Diseases
Italy
chemistry
Mutation
D179Y mutation
Azabicyclo Compounds
Genome, Bacterial
medicine.drug
Subjects
Details
- ISSN :
- 1198743X
- Volume :
- 26
- Database :
- OpenAIRE
- Journal :
- Clinical Microbiology and Infection
- Accession number :
- edsair.doi.dedup.....264573c1078e4980736d2110b795c2c8