Molecular analysis and ceftazidime-avibactam susceptibilities of carbapenem-resistant Klebsiella pneumoniae: Seven year experience from blood cultures of liver transplant recipients in a university hospital
Abstract
BACKGROUND: Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection is a major cause of mortality in liver transplantation (LT) recipients.
METHODS: We aimed to elucidate the molecular mechanisms of carbapenem resistance among CRKP strains and determine ceftazidime-avibactam (CZA) in vitro susceptibility in high-risk patient populations, such as LT recipients.
RESULTS: Of the 127 LT recipients between January 2016 and 2022, no statistically significant difference was found in the in vitro sensitivity of amikacin, gentamicin, ciprofloxacin, levofloxacin, imipenem, meropenem, piperacillin-tazobactam, trimethoprim-sulfamethoxazole, tigecycline, and colistin in patients with CRKP sepsis who survived and died at 30 days, except for amikacin and meropenem, which was statistically significant at 90 days (p ≤ 0.05). Of the isolates, 120 (94.4 %) were positive for the modified carbapenem inactivation test. When the carbapenemase genes of 127 CRKP isolates were analyzed, the most common carbapenemase gene was OXA-48 (59.1 %). The presence of OXA-48, OXA-48 + NDM, NDM, IMP, and VIM genes in CRKP isolates showed a statistically significant difference with the CZA susceptibility result (p ˂ 0.05).
CONCLUSIONS: The presence of the OXA-48 resistance gene in CRKP isolates was closely associated with in vitro susceptibility to CZA, regardless of the diversity of the patient population.
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