Ana Beatriz Gonçalves , Valquíria Alves , Isabel Neves , Antónia Read , Luísa Peixe , Ângela Novais
{"title":"肺炎克雷伯菌对头孢他啶-阿维巴坦的耐药性:2019-2024年不同亚系中日益增长的公共卫生问题","authors":"Ana Beatriz Gonçalves , Valquíria Alves , Isabel Neves , Antónia Read , Luísa Peixe , Ângela Novais","doi":"10.1016/j.jgar.2025.06.016","DOIUrl":null,"url":null,"abstract":"<div><h3>Objectives</h3><div>Strains resistant to last-line β-lactam antibiotics pose a global public health threat, requiring close monitoring and action. This study investigated ceftazidime-avibactam (CAZ-AVI) resistance rates among <em>Klebsiella pneumoniae</em> infection isolates from northern Portugal in a 6-year period.</div></div><div><h3>Methods</h3><div>A total of 539 carbapenem-resistant or KPC-positive <em>K. pneumoniae</em> isolates identified between May 2019 and February 2024 were screened for CAZ-AVI resistance by gradient diffusion. Species identification and antimicrobial susceptibility testing were performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and VITEK 2 automated systems, respectively. CAZ-AVI resistance and extended susceptibility profiles were confirmed by disk diffusion. Isolates exhibiting resistance or reduced susceptibility to CAZ-AVI were further characterized by Fourier-transform infrared spectroscopy and whole genome sequencing or polymerase chain reaction and sequencing.</div></div><div><h3>Results</h3><div>We observed an average CAZ-AVI resistance rate of 1.7%, which increased post-COVID19 (1.1% in 2021 to 2.7% in 2022) alongside rising CAZ-AVI usage. Notably, CAZ-AVI-resistant isolates also exhibited resistance to last-line β-lactams not yet introduced in routine clinical practice (89% cefiderocol, 33% imipenem-relebactam and 22% meropenem-vaborbactam). Resistance to CAZ-AVI was associated with production of diverse KPC-3 variants (KPC-31, KPC-46, KPC-66), IMP-22 or DHA-1 often in combination with porin deficiencies. A multiclonal population was identified, including high-risk sublineages commonly linked to KPC-3 production (ST147-KL64 and ST323-KL21). All patients had prior exposure to different β-lactams, including CAZ-AVI in five cases.</div></div><div><h3>Conclusions</h3><div>Our findings highlight a concerning scenario for managing carbapenem-resistant <em>K. pneumoniae</em> and underscore the need for routine laboratory testing of last-line antibiotics and the implementation of effective antimicrobial stewardship guidelines.</div></div>","PeriodicalId":15936,"journal":{"name":"Journal of global antimicrobial resistance","volume":"44 ","pages":"Pages 211-216"},"PeriodicalIF":3.2000,"publicationDate":"2025-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Ceftazidime-avibactam resistance in Klebsiella pneumoniae: A growing public health concern across diverse sublineages, 2019–2024\",\"authors\":\"Ana Beatriz Gonçalves , Valquíria Alves , Isabel Neves , Antónia Read , Luísa Peixe , Ângela Novais\",\"doi\":\"10.1016/j.jgar.2025.06.016\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Objectives</h3><div>Strains resistant to last-line β-lactam antibiotics pose a global public health threat, requiring close monitoring and action. This study investigated ceftazidime-avibactam (CAZ-AVI) resistance rates among <em>Klebsiella pneumoniae</em> infection isolates from northern Portugal in a 6-year period.</div></div><div><h3>Methods</h3><div>A total of 539 carbapenem-resistant or KPC-positive <em>K. pneumoniae</em> isolates identified between May 2019 and February 2024 were screened for CAZ-AVI resistance by gradient diffusion. Species identification and antimicrobial susceptibility testing were performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and VITEK 2 automated systems, respectively. CAZ-AVI resistance and extended susceptibility profiles were confirmed by disk diffusion. Isolates exhibiting resistance or reduced susceptibility to CAZ-AVI were further characterized by Fourier-transform infrared spectroscopy and whole genome sequencing or polymerase chain reaction and sequencing.</div></div><div><h3>Results</h3><div>We observed an average CAZ-AVI resistance rate of 1.7%, which increased post-COVID19 (1.1% in 2021 to 2.7% in 2022) alongside rising CAZ-AVI usage. Notably, CAZ-AVI-resistant isolates also exhibited resistance to last-line β-lactams not yet introduced in routine clinical practice (89% cefiderocol, 33% imipenem-relebactam and 22% meropenem-vaborbactam). Resistance to CAZ-AVI was associated with production of diverse KPC-3 variants (KPC-31, KPC-46, KPC-66), IMP-22 or DHA-1 often in combination with porin deficiencies. A multiclonal population was identified, including high-risk sublineages commonly linked to KPC-3 production (ST147-KL64 and ST323-KL21). All patients had prior exposure to different β-lactams, including CAZ-AVI in five cases.</div></div><div><h3>Conclusions</h3><div>Our findings highlight a concerning scenario for managing carbapenem-resistant <em>K. pneumoniae</em> and underscore the need for routine laboratory testing of last-line antibiotics and the implementation of effective antimicrobial stewardship guidelines.</div></div>\",\"PeriodicalId\":15936,\"journal\":{\"name\":\"Journal of global antimicrobial resistance\",\"volume\":\"44 \",\"pages\":\"Pages 211-216\"},\"PeriodicalIF\":3.2000,\"publicationDate\":\"2025-06-27\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of global antimicrobial resistance\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://www.sciencedirect.com/science/article/pii/S2213716525001511\",\"RegionNum\":3,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q2\",\"JCRName\":\"INFECTIOUS DISEASES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of global antimicrobial resistance","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S2213716525001511","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"INFECTIOUS DISEASES","Score":null,"Total":0}
Ceftazidime-avibactam resistance in Klebsiella pneumoniae: A growing public health concern across diverse sublineages, 2019–2024
Objectives
Strains resistant to last-line β-lactam antibiotics pose a global public health threat, requiring close monitoring and action. This study investigated ceftazidime-avibactam (CAZ-AVI) resistance rates among Klebsiella pneumoniae infection isolates from northern Portugal in a 6-year period.
Methods
A total of 539 carbapenem-resistant or KPC-positive K. pneumoniae isolates identified between May 2019 and February 2024 were screened for CAZ-AVI resistance by gradient diffusion. Species identification and antimicrobial susceptibility testing were performed using matrix-assisted laser desorption/ionization time-of-flight mass spectrometry and VITEK 2 automated systems, respectively. CAZ-AVI resistance and extended susceptibility profiles were confirmed by disk diffusion. Isolates exhibiting resistance or reduced susceptibility to CAZ-AVI were further characterized by Fourier-transform infrared spectroscopy and whole genome sequencing or polymerase chain reaction and sequencing.
Results
We observed an average CAZ-AVI resistance rate of 1.7%, which increased post-COVID19 (1.1% in 2021 to 2.7% in 2022) alongside rising CAZ-AVI usage. Notably, CAZ-AVI-resistant isolates also exhibited resistance to last-line β-lactams not yet introduced in routine clinical practice (89% cefiderocol, 33% imipenem-relebactam and 22% meropenem-vaborbactam). Resistance to CAZ-AVI was associated with production of diverse KPC-3 variants (KPC-31, KPC-46, KPC-66), IMP-22 or DHA-1 often in combination with porin deficiencies. A multiclonal population was identified, including high-risk sublineages commonly linked to KPC-3 production (ST147-KL64 and ST323-KL21). All patients had prior exposure to different β-lactams, including CAZ-AVI in five cases.
Conclusions
Our findings highlight a concerning scenario for managing carbapenem-resistant K. pneumoniae and underscore the need for routine laboratory testing of last-line antibiotics and the implementation of effective antimicrobial stewardship guidelines.
期刊介绍:
The Journal of Global Antimicrobial Resistance (JGAR) is a quarterly online journal run by an international Editorial Board that focuses on the global spread of antibiotic-resistant microbes.
JGAR is a dedicated journal for all professionals working in research, health care, the environment and animal infection control, aiming to track the resistance threat worldwide and provides a single voice devoted to antimicrobial resistance (AMR).
Featuring peer-reviewed and up to date research articles, reviews, short notes and hot topics JGAR covers the key topics related to antibacterial, antiviral, antifungal and antiparasitic resistance.