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Carbapenem-resistant  Enterobacteriaceae  (CRE) has increasingly spread worldwide in the past decade. The prevalence and characteristics of CRE in Thailand are unknown. In this study, we conducted a 2-year surveillance of CRE among 12,741 clinical isolates of  Enterobacteriaceae  at the largest university hospital in Thailand with molecular characterization of beta-lactamase ( bla ) genes, including carbapenemase genes. The CRE prevalence was 1.4%.  bla   KPC-13  and  bla   IMP-14a  were the only carbapenemase genes detected among these CRE isolates.  bla   KPC-13  gene was found in a single isolate of  Escherichia coli ,  Enterobacter cloacae  and  Citrobacter freundii , and  bla   IMP-14a  was found in four isolates of  Klebsiella pneumoniae . Carbapenem-resistant  K .  pneumoniae  (CRKP) isolates were resistant to multiple carbapenems at a higher ratio than other CRE species, and thus were further characterized for resistance phenotypes,  bla  genotypes and molecular epidemiology. Most CRKP isolates harboured multiple  bla  genes, especially those related to extended-spectrum beta-lactamases. Seven CRKP isolates were resistant to all tested carbapenems, and showed decreased  ompK35  and/or  ompK36  porin gene expression. Molecular typing of CRKP based on pulsed-field gel electrophoresis (PFGE) demonstrated several unrelated clones. Multilocus sequence typing (MLST) was partially concordant with PFGE results and revealed that ST340, a member of drug-resistant  K .  pneumoniae  clonal complex 258, was the most predominant clone, followed by ST48, ST11 and ST273. The novel ST1645 was identified from this study. ST340 has neither been shown to be predominated among CRKP from other studies, nor been reported in Thailand. Therefore, it emphases a critical concern to monitor and control the spread of CRKP.

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Genetic Characterization of Carbapenem-Resistant Enterobacteriaceae and the Spread of Carbapenem-Resistant Klebsiella pneumonia ST340 at a University Hospital in Thailand