Short communicationHigh prevalence of CTX-M-15-producing Klebsiella pneumoniae isolates in Asian countries: diverse clones and clonal dissemination
Introduction
Extended-spectrum β-lactamases (ESBLs) in Enterobacteriaceae are of great concern in clinical settings and public health. Recently, the distribution and prevalence of ESBLs have changed. TEM- and SHV-type ESBLs have been prevalent in the past, but the CTX-M-type ESBL has disseminated worldwide and has become pandemic [1]. The global spread of CTX-M-producing Enterobacteriaceae is a major concern in most continents, including Asia. In particular, a rapid increase of CTX-M-15 has been widely reported, and CTX-M-15 is now the most common ESBL in much of the world [1]. The spread of CTX-M-15 has been mainly associated with global dissemination of a particular clone of Escherichia coli of sequence type 131 (ST131) that harbours blaCTX-M-15 [2].
In contrast to E. coli, CTX-M-15 has not been the main ESBL in Klebsiella pneumoniae until recently. However, CTX-M-15-producing K. pneumoniae isolates are also disseminating worldwide [3], [4], [5]. It has been proposed that horizontal transfer of blaCTX-M-15 from E. coli to K. pneumoniae has occurred by conjugation of IncFII plasmids [6]. The increase in CTX-M-15-producing K. pneumoniae isolates may be due to frequent incorporation of plasmids containing blaCTX-M-15 or to the dissemination of a limited number of clones. Coelho et al. [3] reported that CTX-M-15-producing K. pneumoniae isolates from Barcelona (Spain) were composed of three main clones that harboured diverse plasmids containing blaCTX-M-15. On the other hand, another study reported diverse clones of CTX-M-15-producing K. pneumoniae isolates from Spain based on multilocus sequence typing (MLST) [7]. However, only limited data on CTX-M-15-producing K. pneumoniae isolates in Asian countries are available.
In this study, we report the high prevalence of CTX-M-15 amongst 218 K. pneumoniae isolates from nine Asian countries. CTX-M-15-producing K. pneumoniae isolates belonged to diverse clones as determined by MLST. However, spread of some K. pneumoniae clones producing CTX-M-15 in several Asian countries was also identified.
Section snippets
Klebsiella pneumoniae isolates
As part of a multinational Asian Network for Surveillance of Resistant Pathogens (ANSORP) surveillance study, a total of 218 K. pneumoniae isolates were obtained from patients with hospital-acquired pneumonia (HAP) in nine Asian countries during 2008 and 2009, including Hong Kong (n = 26), India (n = 7), Indonesia (n = 4), South Korea (n = 18), Malaysia (n = 24), the Philippines (n = 30), Singapore (n = 12), Taiwan (n = 12) and Thailand (n = 85). These represented 16.3% of the total number of isolates causing
Antimicrobial resistance, extended-spectrum β-lactamases and CTX-M-15
Whilst all K. pneumoniae isolates were resistant to ampicillin, only one isolate from Thailand was resistant to imipenem and none were resistant to meropenem. In addition, only one colistin-resistant K. pneumoniae isolate from South Korea was identified. For the other antimicrobial agents (gentamicin, ceftazidime, cefotaxime, cefepime, aztreonam, ciprofloxacin, SXT and TZP), 21.1–46.3% of the K. pneumoniae isolates showed resistance (Table 1). Of note, 92 K. pneumoniae isolates (42.2%) were
Discussion
In this study, we report a high percentage of ESBL-producers amongst K. pneumoniae isolates causing HAP in Asian countries, particularly in South Korea and Thailand. Although only a few K. pneumoniae isolates could be included from some countries and the distribution of isolates was unbalanced amongst the different Asian countries, CTX-M-15-producing K. pneumoniae isolates were prevalent in the surveyed Asian countries. Although a high prevalence of CTX-M-15-producing E. coli isolates
Acknowledgments
The authors thank members of the Asian Network for Surveillance of Resistant Pathogens (ANSORP) for their collaboration. Klebsiella pneumoniae isolates used in this study were obtained from the Asian Bacterial Bank (ABB) of the Asia Pacific Foundation for Infectious Diseases (APFID) (Seoul, South Korea).
Funding: This research was supported by the Basic Science Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2010-0004848
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