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Antimicrobial Resistance & Infection Control

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Open Access 01-12-2017 | Research

The emergence of carbapenem resistant Klebsiella pneumoniae in Malaysia: correlation between microbiological trends with host characteristics and clinical factors

Authors: Ye-Mun Low, Polly Soo-Xi Yap, Kartini Abdul Jabar, Sasheela Ponnampalavanar, Rina Karunakaran, Rukumani Velayuthan, Chun-Wie Chong, Sazaly Abu Bakar, Mohd Yasim Md Yusof, Cindy Shuan-Ju Teh

Published in: Antimicrobial Resistance & Infection Control | Issue 1/2017

Abstract

Background

Carbapenem resistant Enterobacteriaceae is a growing concern worldwide including Malaysia. The emergence of this pathogen is worrying because carbapenem is one of the 'last-line' antibiotics. The main objective of this study was to determine the prevalence of genetic mechanisms and clinical risk factors of carbapenem resistant Klebsiella pneumoniae (K. pneumoniae) in Malaysia.

Methods

In this study, seventeen carbapenem resistant K. pneumoniae strains isolated from a tertiary teaching hospital in 2013 were studied. Minimal inhibitory concentration (MIC) of the bacterial strains was determined and genes associated with carbapenemases and extended-spectrum-beta-lactamases (ESBLs) were sequenced and compared with the closest representatives published in public domains. All strains were also sub-typed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). Statistical analyses were performed to determine the correlation between risk factors for acquiring carbapenem resistant K. pneumoniae and in-hospital mortality.

Results

The predominant carbapenemase was bla _OXA-48, detected in 12 strains (70.59%). Other carbapenemases detected in this study were bla _KPC-2, bla _IMP-8, bla _NMC-A and bla _NDM-1. Nine different pulsotypes were identified and nine strains which were affiliated with ST101, the predominant sequence type had similar PFGE patterns (similarity index of 85%). Based on univariate statistical analysis, resistance to imipenem and usage of mechanical ventilation showed a statistically significant effect separately to in-hospital mortality.

Conclusion

The diverse genetic mechanisms harbored by these carbapenem resistant K. pneumoniae facilitates its spread and complicates its detection. Thus, correlation between microbiological trends with host characteristics and clinical factors will provide a better insight of rational treatment strategies and pathogen control.

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Title: The emergence of carbapenem resistant Klebsiella pneumoniae in Malaysia: correlation between microbiological trends with host characteristics and clinical factors
Authors: Ye-Mun Low
Polly Soo-Xi Yap
Kartini Abdul Jabar
Sasheela Ponnampalavanar
Rina Karunakaran
Rukumani Velayuthan
Chun-Wie Chong
Sazaly Abu Bakar
Mohd Yasim Md Yusof
Cindy Shuan-Ju Teh
Publication date: 01-12-2017
Publisher: BioMed Central
Published in: Antimicrobial Resistance & Infection Control / Issue 1/2017
Electronic ISSN: 2047-2994
DOI: https://doi.org/10.1186/s13756-016-0164-x

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Abstract

Background

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