engleski

Diffusion of OXA-48 carbapenemase among urinary isolates of Klebsiella pneumoniae in non-hospitalized elderly patients

Abstract Background: Recently, a dramatic increase of Klebsiella pneumoniae positive for OXA-48 β- lactamase was observed first in the hospital setting and later in the long-term care facilities (LTCFs) and community in the Zagreb County, particulary, in urinary isolates. The aim of the study was to analyse the epidemiology and the mechanisms of antibiotic resistance of OXA-48 carbapenemase producing K. pneumoniae strains isolated from urine of non- hospitalized elderly patients. Results: The isolates were classified into two groups: one originated from the LTCFs and the other from the community. Extended- spectrum β- lactamases (ESBLs) were detected by double disk- synergy (DDST) and combined disk test in 55% isolates (51/92). The ESBL positive isolates exhibited resistance to expanded-spectrum cephalosporins (ESC) and in majority of cases to gentamicin. ESBL production was associated with group 1 of CTX-M or SHV-12 β-lactamases. Two new sequence types were reported: ST4870 and ST4781. LTCFs isolates showed significantly lower rate of additional ESBL and consequential resistance to ESC and lower gentamicin resistance rate compared to the community isolates, similarly to hospital isolates in Zagreb, pointing out to the possible transmission from hospitals. Conclusions: The rapid spread of OXA- 48 producing K. pneumoniae points out to the shortcomings in the infection control measures in LTCFs. Keywords: Klebsiella pneumoniae, OXA-48, resistance, long-term care facility, urinary tract infection

Klebsiella pneumoniae ; OXA-48 ; resistance ; long-term care facility ; urinary tract infection

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