Volume 10,Issue 1
Fall 2025
Epidemiological Study of an Outbreak of KPC-2- Producing Klebsiella pneumoniae in a Tertiary Hospital in Korea
Background: The prevalence of carbapenemase-producing Enterobacteriaceae (CPE), especially the KPC-2-producing Klebsiella pneumoniae, is rapidly increasing and becoming a menace to global public health. This study aims to present the molecular epidemiology of the KPC-2-producing K. pneumoniae isolates that emerged in a tertiary hospital in South Korea and describe its clinical significance. Methods: This study included carbapenem-resistant K. pneumoniae isolates collected from a tertiary hospital from April to December 2018. The antimicrobial susceptibility of pneumoniae isolates was tested using the disk diffusion method. PCR and DNA sequence analyses were performed to identify the resistance genotype. In addition,the molecular epidemiology was investigated using pulsed-field gel electrophoresis (PFGE) and multi-locus sequencing typing (MLST). Results: A total of 100 KPC-2-producing K. pneumoniae isolates were collected, which were mainly classified into two pulsotypes according to the XbaI restriction digestion pattern by PFGE analysis (pulsotype A, n = 31; pulsotype B, n = 63). The isolates exhibiting pulsotype A belonged to ST395 and the remaining isolates exhibiting pulsotype B were attributed to ST307 by MLST analysis. Conclusion: This study investigated clinical information and molecular bacterial profiles for KPC-2-producing K. pneumoniae isolates. These findings indicate that proper infection control activities are needed to prevent the spread of multidrug-resistant organisms such as CPE, which could cause high mortality in the clinical field.
1. Potter RF, D'Souza AW, Dantas G. The Rapid Spread of Carbapenem-Resistant Enterobacteriaceae. Drug Resist Updat. 2016;29:30–46.
2. Nordmann P, Naas T, Poirel L. Global Spread of Carbapenemase-Producing Enterobacteriaceae. Emerg Infect Dis. 2011;17:1791–1798.
3. Papp-Wallace KM, Endimiani A, Taracila MA, et al. Carbapenems: Past, Present, and Future. Antimicrob Agents Chemother. 2011;55:4943–4960.
4. Korea Centers for Disease Control and Prevention. Monitoring of Antimicrobial Resistance on General Hospitals in Korea 2010. Public Health Weekly Report. 2010;34:565–569.
5. Yoon EJ, Yang JW, Kim JO, et al. Carbapenemase-Producing Enterobacteriaceae in South Korea: A Report from the National Laboratory Surveillance System. Future Microbiol. 2018;13:771–783.
6. Iovleva A, Doi Y. Carbapenem-resistant Enterobacteriaceae. Clin Lab Med. 2017;37:303-15.
7. Park YJ, Yu JK, Park KG, et al. Prevalence and Contributing Factors of Nonsusceptibility to Imipenem or Meropenem in Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae and Escherichia coli. Diagn Microbiol Infect Dis. 2011;71:87–89.
8. Lee EJ, Lee SJ, Bahk HJ, et al. Analysis of Carbapenemase-Producing Enterobacteriaceae (CPE) Surveillance Results for 2017 in Korea: Comparison with the Surveillance Results of the Previous 5 Years (2012-2016). Division of Healthcare Associated Infection Control, Center for Infectious Disease Surveillance & Response, Korea Centers for Disease Control and Prevention. Viewed 15 May 2020, https://www.cdc.go.kr/board/board.es?mid=a20602010000&bid=0034&list_no=141909&act=view#
9. Hong SK, Yong D, Kim K, et al. First Outbreak of KPC-2-Producing Klebsiella pneumoniae Sequence Type 258 in a Hospital in South Korea. J Clin Microbiol. 2013;51:3877–3879.
10. Yoo JS, Kim HM, Yoo JI, et al. Detection of Clonal KPC-2-Producing Klebsiella pneumoniae ST258 in Korea During Nationwide Surveillance in 2011. J Med Microbiol. 2013;62:1338–1342.
11. Jeong S, Kim JO, Yoon EJ, et al. Extensively Drug-Resistant Escherichia coli Sequence Type 1642 Carrying an IncX3 Plasmid Containing the blaKPC-2 Gene Associated with Transposon Tn4401a. Ann Lab Med. 2018;38:17–22.
12. M100-S28. 28th Informational Supplement. Performance Standards for Antimicrobial Susceptibility Testing. Clinical and Laboratory Standards Institute, 2018, Wayne.
13. Maida CM, Bonura C, Geraci DM, et al. Outbreak of ST395 KPC-Producing Klebsiella pneumoniae in a Neonatal Intensive Care Unit in Palermo, Italy. Infect Control Hosp Epidemiol. 2018;39:496–498.
14. Zheng B, Dai Y, Liu Y, et al. Molecular Epidemiology and Risk Factors of Carbapenem-Resistant Klebsiella pneumoniae Infections in Eastern China. Front Microbiol. 2017;8:1061.
15. Chang YY, Chuang YC, Siu LK, et al. Clinical Features of Patients with Carbapenem Nonsusceptible Klebsiella pneumoniae and Escherichia coli in Intensive Care Units: A Nationwide Multicenter Study in Taiwan. J Microbiol Immunol Infect. 2015;48:219–225.
16. American Thoracic Society. Hospital-Acquired Pneumonia in Adults: Diagnosis, Assessment of Severity, Initial Antimicrobial Therapy, and Preventive Strategies. A Consensus Statement, American Thoracic Society, November 1995. Am J Respir Crit Care Med. 1996;153:1711–1725.
17. Craven DE, Chroneou A. Nosocomial Pneumonia. In: Mandell GL, Douglas RG, Bennett JE, eds. Mandell, Douglas, and Bennett’s Principles and Practice of Infectious Diseases, 7th ed. 2010, Churchill Livingstone, Philadelphia, 3717–3725.
18. Tumbarello M, Trecarichi EM, De Rosa FG, et al. Infections Caused by KPC-producing Klebsiella pneumoniae: Differences in Therapy and Mortality in a Multicentre Study. J Antimicrob Chemother. 2015;70:2133–2143.
19. Tenover FC, Arbeit RD, Goering RV, et al. Interpreting Chromosomal DNA Restriction Patterns Produced by Pulsed-Field Gel Electrophoresis: Criteria for Bacterial Strain Typing. J Clin Microbiol. 1995;33:2233–2239.