Antimicrobial resistance among imipenem-non-susceptible Escherichia coli and Klebsiella pneumoniae isolates, with an emphasis on novel β-lactam/β-lactamase inhibitor combinations and tetracycline derivatives: The Taiwan surveillance of antimicrobial resistance program, 2020-2022

  • J Microbiol Immunol Infect. 2025 Apr;58(2):219-225. doi: 10.1016/j.jmii.2025.01.006.
Yu-Lin Lee  1 ,  Chun-Eng Liu  2 ,  Wei-Yao Wang  3 ,  Mei-Chen Tan  4 ,  Pei-Jing Chen  4 ,  Yih-Ru Shiau  4 ,  Hui-Ying Wang  4 ,  Jui-Fen Lai  4 ,  I-Wen Huang  4 ,  Ya-Sung Yang  5 ,  Shu-Chen Kuo  6
Affiliations
  • 1. Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; PhD Program in Medical Biotechnology, Institute of Genomics and Bioinformatics, National Chung-Hsing University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
  • 2. Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan.
  • 3. Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan.
  • 4. National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan.
  • 5. Division of Infectious Diseases and Tropical Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan; Institute of Preventive Medicine, National Defense Medical Center, Taipei, Taiwan. Electronic address: [email protected].
  • 6. National Institute of Infectious Diseases and Vaccinology, National Health Research Institutes, Miaoli County, Taiwan. Electronic address: [email protected].
PMID: 39934015 DOI: 10.1016/j.jmii.2025.01.006
Abstract

Background: To determine susceptibility of imipenem-non-susceptible Escherichia coli (INS-EC) and Klebsiella pneumoniae (INS-KP) isolates collected during 2020-2022 through a national surveillance program in Taiwan to novel Antibiotics, and to compare the results with those obtained during 2012-2018.

Methods: Minimum inhibitory concentrations were determined by broth microdilution methods. Genes encoding carbapenemases including blaKPC, Metallo-β-lactamase (MBL) genes, and blaOXA-48 were detected via multiplex PCR. Data retrieved from our 2012-2018 study were used for comparison.

Results: Of 3260 E. coli and 1457 K. pneumoniae isolates collected during 2020-2022, 0.9 % and 9.5 %, were INS-EC and INS-KP, respectively. Cefepime-zidebactam, ceftazidime-avibactam, imipenem-relebactam, and meropenem-vaborbactam were active against 100 %, 75.9 %, 65.5 %, and 79.3 % of 29 INS-EC isolates respectively; and against 100 %, 90.6 %, 64.5 %, and 67.4 % of 138 INS- KP isolates, respectively. Susceptibility was contingent upon carbapenemase types. Susceptibility rates of cefepime-zidebactam and ceftazidime-avibactam remained constant from 2012 to 2018 through 2020-2022 but those of imipenem-relebactam and meropenem-vaborbactam decreased significantly, which may be partially attributable to the increasing prevalence of blaOXA-48. Eighteen MBL-gene-positive isolates and two blaKPC-positive isolates were resistant to ceftazidime-avibactam, whereas all were susceptible to cefepime-zidebactam. Tigecycline had a higher susceptibility rate than eravacycline and omadacycline for K. pneumoniae isolates. Lascufloxacin and delafloxacin were effective against fewer than 10 % of INS isolates. Susceptibilities to novel tetracyclines and fluoroquinolones remained similar from 2012 to 2018 through 2020-2022.

Conclusions: This study highlights significant resistance patterns of INS-EC and INS-KP isolates in Taiwan. The declining susceptibility rates and the rising prevalence of genetic resistance determinants highlight the importance of ongoing surveillance and antimicrobial stewardship.

Keywords
Carbapenem-resistant enterobacterales; Carbapenemase; Multidrug resistance; β-lactam; β-lactamase inhibitor.
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