Ceftazidime/Avibactam-Resistant Carbapenem-Resistant Klebsiella pneumoniae in China: A Nationwide Multicenter Study - PubMed
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- #genomic analysis
- #antimicrobial resistance
- #Klebsiella pneumoniae
- Study on ceftazidime/avibactam-resistant carbapenem-resistant Klebsiella pneumoniae (CRKP) in China.
- Multicenter surveillance across 26 hospitals in 19 provinces from 2021-2024.
- 101 out of 4739 isolates (2.1%) were CZA-resistant CRKP, mainly affecting older male inpatients with lower-respiratory infections.
- NDM was the predominant resistance mechanism (55.4%); dual NDM+KPC producers showed the broadest resistance.
- Tigecycline remained the most active agent (3% resistance), while resistance to other agents was ≥37%.
- Genomic analysis revealed high resistance burdens (mean 15.4 ARGs; 4.1 plasmids per isolate), with ST11 being the dominant sequence type (42.6%).
- Hypervirulence markers were absent in the studied isolates.
- In KPC-2-only CZA-resistant isolates, high-MIC strains showed increased blaKPC-2 expression and copy number.
- Susceptibility was restored in 8/9 isolates with 8 mg/L avibactam.
- Efflux inhibition reduced MICs by ≥4-fold in 6/9 isolates.
- CZA-resistant CRKP in China is uncommon but widely distributed, driven by epidemic ST11-KL64/KL47 lineages with extensive multidrug resistance.