Background and aim: A multicentre nationwide surveillance study was
conducted in Greek hospitals to evaluate epidemiology of
carbapenemase-producing Klebsiella pneumoniae clinical isolates, and
their susceptibilities to last-line antibiotics. Methods: Minimum
inhibitory concentrations (MICs) were evaluated by Etest, colistin MICs
were also evaluated by broth microdilution SensiTest (now known as
ComASP) Colistin. Carbapenemase genes were detected by PCR. Clonal
relatedness was assessed by PFGE. Isolates were prospectively collected
between November 2014 and April 2016, from 15 hospitals. Results: Among
394 isolates, K. pneumoniae carbepenemase (KPC) remained the most
prevalent carbapenemase (66.5%). NDM was the second most prevalent
(13.7%), identified in 12 hospitals, followed by VIM (8.6%). OXA-48-
and double carbapenemase-producers remained rare (3.6%, 6.3%,
respectively). Carbapenemase-producing K. pneumoniae isolates showed
high resistance to last-line antibiotics. Gentamicin and colistin were
the most active in vitro with 61.9% and 59.6% of the isolates to be
inhibited at <= 2mg/L, followed by fosfomycin (susceptibility (S):
58.4%) and tigecycline (S:51.5%). Ceftazidime/avibactam inhibited
99.6% of KPC and 100% of OXA-48-like-producing isolates, while
temocillin was active against 58% of KPC isolates at urinary breakpoint
of <= 2mg/L and only 2.7% at systemic breakpoint of <= 8mg/L.
NDM-producing isolates belonged mainly to one clone, whereas KPC, VIM,
OXA-48 and double carbapenemase-producers were mainly polyclonal.
Conclusions: KPC remains the predominant carbapenemase among K.
pneumoniae in Greece, followed by NDM, whereas changing trends of
resistance rates to last-line antimicrobials against
carbapenemase-producing K. pneumoniae with the exception of
ceftazidime/avibactam mandates continuing surveillance to support
clinical practice
