Epidemiological Study of an Outbreak of KPC-2 Producing Klebsiella pneumoniae in a Tertiary Hospital in Korea

Jun Sung Hong; Byeol Yi Park; Dokyun Kim; Kunhan Kim; Kyoung Hwa Lee; Nan Hyoung Cho; Seok Hoon Jeong

doi:10.5145/ACM.2020.23.2.5

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Hong, Park, Kim, Kim, Lee, Cho, and Jeong: Epidemiological Study of an Outbreak of KPC-2 Producing Klebsiella pneumoniae in a Tertiary Hospital in Korea

Original Article

Ann Clin Microbiol 2020;23(2):81-92.

Published online: 19 June 2020

DOI: https://doi.org/10.5145/ACM.2020.23.2.5

Epidemiological Study of an Outbreak of KPC-2 Producing Klebsiella pneumoniae in a Tertiary Hospital in Korea

Jun Sung Hong¹, Byeol Yi Park¹, Dokyun Kim², Kunhan Kim¹, Kyoung Hwa Lee², Nan Hyoung Cho³, Seok Hoon Jeong¹

^¹Department of Laboratory Medicine and Research Institute of Bacterial Resistance, Yonsei University College of Medicine, Seoul,Korea

^²Division of Infectious Disease, Department of Internal Medicine, Yonsei University College of Medicine, Seoul,Korea

^³Department of Infection Control, Gangnam Severance Hospital, Seoul,Korea

Corresponding author: Dokyun Kim E-mail: kyunsky@yuhs.ac

Received 23 October 2019 Revised 6 January 2020 Accepted 6 ` 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: The prevalence of carbapenemase-producing Enterobacteriaceae (CPE), especially the KPC-2-producing Klebisella pneumoniae, is rapidly increasing and becoming a menace to global public health. This study aims to present the molecular epidemiology of the KPC-2-producing K. pneumoniae isolates emerged in a tertiary hospital in South Korea and describe its clinical significance. Methods: This study included carbapenem-resistant K. pneumoniae isolates collected from a tertiary hospital from April to December in 2018. Antimicrobial susceptibility of K. pneumoniae isolates was tested using disk diffusion method. PCR and DNA sequence analyses were performed to identify the resistance genotype. In addition, the molecular epidemiology was investigated using pulsed-field gel electrophoresis (PFGE) and multilocus sequencing typing (MLST). Results: Total 100 KPC-2-producing K. pneumoniae isolates were collected, which were mainly classified into two pulsotypes according to the XbaI restriction digestion pattern by PGFE analysis (pulsotype A, n = 31; pulsotype B, n = 63). The isolates exhibiting pulsotype A belonged to ST395 and the remaining isolates exhibiting pulsotype B were attributed to ST307 by MLST analysis. Conclusion: This study investigated clinical information and molecular bacterial profiles for KPC-2-producing K. pneumoniae isolates. These findings indicate that the proper infection control activities are needed to prevent the spread of multidrug-resistant organisms such as CPE, which could cause high mortality in clinical field.

Keywords: Carbapenemase, KPC, Klebsiella pneumoniae, PFGE

CONFLICTS OF INTEREST

No potential conflicts of interest relevant to this article were reported.

FUNDING

본 논문은 2018년도 정부(교육부)의 재원으로 한국연구재단의 지원을 받아 수행된 기초연구사업임(2018R1A6A3A01011394).

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Table 1

Oligonucleotide sequence of the primers used in this study

Fig. 1.

Monthly isolation of KPC-2 producing K. pneumoniae isolates stratified by PFGE banding patterns. Bar graphs indicate the numbers of KPC-2 producing K. pneumoniae isolates collected in each nine month in 2018 and arrows indicate the activity performed for eradicating a KPC-type carbapenemase producing K. pneumoniae isolates outbreak. Yellow bar, pulsotype A; Blue bar, pulsotype B; Gray bar, other pulsotypes.

Table 2

Patient characteristics

*P-value was calculated comparing two groups including pulsotype A and pulsotype B by Fisher’s exact test and Mann Whitney U test in categorical variables and continuous variables, respectively.†Mean [interquartile range].

Fig. 2.

Dendrogram of KPC-2-producing K. pneumoniae isolates according to the PFGE band pattern.

Table 3

Antimicrobial susceptibility results of KPC-producing K. pneumoniae isolates obtained by Phoenix system

Fig. 3.

Representative results of disk diffusion method for antimicrobial susceptibility testing in KPC-2 producing K. pneumoniae isolates exhibiting pulsotype A (ST395). (A) shows results of zone diameter for 12 antibiotics on MH 150 Ø agar, (B) shows results of zone diameter for remaining 6 antibiotics on MH 90 Ø agar, and (C) is results of antimicrobial susceptibility. R, resistant; I, intermediate; S, susceptible.

Fig. 4.

Representative results of disk diffusion method for antimicrobial susceptibility testing in KPC-2 producing K. pneumoniae isolates exhibiting pulsotype B (ST307). (A) shows results of zone diameter for 12 antibiotics on MH 150 Ø agar, (B) shows results of zone diameter for remaining 6 antibiotics on MH 90 Ø agar, and (C) is results of antimicrobial susceptibility. R, resistant; I, intermediate; S, susceptible.

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