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Longitudinal Study of the Drug Resistance in Klebsiella pneumoniae of a Tertiary Hospital, China: Phenotypic Epidemiology Analysis (2013–2018)

Authors Pei N, Liu Q, Cheng X, Liang T, Jian Z, Wang S, Zhong Y, He J, Zhou M, Kristiansen K, Chen W, Liu W, Li J

Received 2 December 2020

Accepted for publication 14 January 2021

Published 17 February 2021 Volume 2021:14 Pages 613—626


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Professor Suresh Antony

Na Pei,1– 3,* Qingxia Liu,4,* Xinyi Cheng,1,5,6,* Tianzhu Liang,1,3 Zijuan Jian,4 Siyi Wang,4 Yiming Zhong,4 Jingxuan He,4 Mao Zhou,4 Karsten Kristiansen,1,2 Weijun Chen,1,6,7 Wenen Liu,4 Junhua Li1,3

1BGI-Shenzhen, Shenzhen, 518083, People’s Republic of China; 2Laboratory of Genomics and Molecular Biomedicine, Department of Biology, University of Copenhagen, Copenhagen, Denmark; 3Shenzhen Key Laboratory of Unknown Pathogen Identification, Shenzhen, 518083, People’s Republic of China; 4Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China; 5School of Biology and Biological Engineering, South China University of Technology, Guangzhou, People’s Republic of China; 6BGI Education Center, University of Chinese Academy of Sciences, Shenzhen, 518083, People’s Republic of China; 7BGI PathoGenesis Pharmaceutical Technology, Shenzhen, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Junhua Li
BGI-Shenzhen, Shenzhen, 518083, People’s Republic of China
Tel +86 13929566296
Wenen Liu
Department of Clinical Laboratory, Xiangya Hospital, Central South University, Changsha, Hunan, 410008, People’s Republic of China
Tel +86 13973128689

Purpose: Multi-drug resistant Klebsiella pneumoniae (MDR KP) is spreading worldwide and has posed a huge medical burden to public health. However, studies on drug resistance surveillance of KP, especially MDR KP, with a large longitudinal sample size in a tertiary hospital are rare. This study aims to investigate phenotypic epidemiology characteristics of 4128 KP isolates in a Chinese tertiary hospital covering a period of 5 years.
Methods: All the KP clinical isolates were retrospectively collected from a tertiary hospital in Hunan province of China from Jan 5, 2013 to Jul 24, 2018. All the isolates were identified by MALDI-TOF MS analysis. Twenty-four antimicrobial agents were tested by antimicrobial susceptibility testing. Fisher exact test and logistic regression were used to analyze the association between clinical factors and antimicrobial non-susceptibility for seven second-choice antimicrobials.
Results: A total of 4128 KP isolates were collected in our study. The non-susceptible rates (NSRs) to ertapenem, imipenem and tigecycline increased considerably from 2013 to 2018 (13.6% to 28.6%, 10.1% to 28.9%, 10.8% to 46.5%, respectively). Amikacin presents the lowest NSR among 3 aminoglycosides (3.8– 22.8%). The multi-drug NSRs among KP isolates to second-choice antimicrobials (88.6– 100%) were higher than to all drugs (68.0%). The NSRs varied significantly among departments and sample sources. Higher ETP/IPM/AK NSRs (39.8/39.7/30.6%) were observed in Intensive Care Unit, and ETP/IPM non-susceptible isolates tended to distribute in cerebrospinal fluid. From 2015 to 2017, the NSRs of ETP, IPM, and AK showed an opposite trend of seasonal fluctuations to SXT.
Conclusion: Higher multi-drug resistance (MDR) rates were observed in KP isolates to second-choice antimicrobials than to others, among which MDR rates to carbapenems or AK are the highest. A unique pattern of MIC and time distributions of MDR were observed. Clinical factors including gender were correlated with MDR rates of KP. Isolates in ICU and CSF showed higher NSRs in carbapenems which should be paid more attention to, and temporal distribution of NSRs was observed.

Keywords: Klebsiella pneumoniae, drug resistance, NSR, phenotypic epidemiology

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