Situation Analysis of Carbapenem-Resistant Klebsiella pneumoniae in Uttaradit Hospital Between 2015 and 2017
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Abstract
Carbapenem-Resistant Klebsiella pneumoniae (CR-KP) is one of major global health problems of hospital acquired infection. There was a retrospective study of the CR-KP isolates collected from Uttaradit Hospital between 2015 and 2017. The CR-KP isolates were presented at 8.2% (114 out of 1,393 K. pneumoniae isolates) and most isolates were found in urine sample (41.2%) of patient at the medicine ward (58.8%). Most isolates (95.6%) resisted to all 4 carbapenems (ertapenem, imipenem, meropenem and doripenem) with high minimum inhibitory concentration (MIC) levels. Levels of MIC50 and MIC90 were similar at ≥ 8 mg/L for ertapenem and doripenem and at ≥ 16 mg/L for imipenem and meropenem, respectively. Approximately 20% CR-KP isolates were susceptible to fluoroquinolones with the high MIC90 levels at ≥ 4 mg/L and ≥ 8 mg/L for ciprofloxacin and levofloxacin,respectively. Amikacin was the most active drug against CR-KP isolates (87.8%) with the MIC50 and MIC90 levels at ≤ 2 mg/L and ≥ 64 mg/L, respectively.
Thirty-nine out of 41 random sampling CR-KP isolates (95.1%) harboured carbapenemase genes and all isolates carried the New Delhi Metalo-β-lactamase (NDM) gene. Furthermore, the OXA-48 like carbapenemase gene and the mobile colistin resistant gene (mcr-1) were also presented in 2 isolates and 1 isolate, respectively. These target genes are mainly mediated via plasmid that make them easily to transfer to other strains and species. Thus, it is necessary to monitor and identify the carbapenemase and mcr-1 genes in CR-KP isolates for setting up the policy of rational drug use, prevention control and surveillance program in the hospital.
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References
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