Aim: The types of carbapenemases and clonal relatedness among community isolates of carbapenemase-producing Klebsiella pneumoniae in Belgrade, Serbia, were determined. Materials & methods: During the period 2016–2020, K. pneumoniae community isolates were screened for carbapenemases, and carbapenemase production was confirmed by multiplex PCR. Clonality was determined based on genetic profiles obtained by enterobacterial repetitive intergenic consensus PCR. Results: Carbapenemase genes were detected in 114 of 4800 isolates (2.4%). The most frequent gene was bla_OXA-48-like. Most isolates (70.5%) were grouped in ten clusters. Cluster 11 contained 16.4% of all bla_OXA-48-like-positive isolates, and all bla_KPC-positive isolates were grouped in one cluster. Conclusion: Laboratory-based detection and surveillance are highly recommended in order to control the spread of resistance in community settings.

Plain language summary

The main threat of antimicrobial resistance is the ability of bacteria to exchange the genetic material on mobile genetic elements. Carbapenemases are a group of proteins that confer resistance to carbapenem antibiotics and their genes are commonly carried on mobile genetic elements. Five of these proteins have the greatest clinical importance: KPC, VIM, IMP, NDM and OXA-48. Serbia has one of the highest levels of carbapenemase-producing Klebsiella pneumoniae among hospital isolates in Europe, but there are no available data for community isolates. Thus, we analyzed K. pneumoniae isolates from community patients in Belgrade, Serbia. There was no difference between the number of isolates with carbapenemases in comparison with other European regions where similar studies have been conducted. The predominant carbapenemase among community isolates of K. pneumoniae in our study was OXA-48. In previous studies in our country, NDM carbapenemase was the most prevalent among both community and hospital isolates. This is in accordance with the endemicity of NDM enzymes in Balkan countries, but our results suggest that there could be changes in the molecular epidemiology of carbapenemases in Serbia, which should be confirmed by future research.

Tweetable abstract

Predominance of OXA-48 carbapenemase in Klebsiella pneumoniae community isolates in Belgrade, Serbia, is an emerging public health issue, requiring immediate action to control the spread of antimicrobial resistance.

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Papers of special note have been highlighted as: • of interest; •• of considerable interest

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Vol. 18, No. 7

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History

Received 4 September 2022

Accepted 24 February 2023

Published online 22 May 2023

Published in print May 2023

Information

Keywords

Author contributions

All authors made significant contributions to this work. Conceptualization: I Ćirković and S Brkić. Methodology: I Ćirković, S Brkić, DD Božić, D Bulbuk and M Jovanović. Formal analysis: S Brkić and DD Božić. Data curation: DD Božić, N Stojanović, D Bulbuk and M Jovanović. Original draft preparation: S Brkić. Review and editing: I Ćirković, S Brkić and DD Božić. All authors have read and agreed to the final version of the manuscript.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Ethical conduct of research

The study was approved by the institutional review boards of the City Institute of Public Health of Belgrade and Institute for Laboratory Diagnostics ‘Konzilijum’, Belgrade, Serbia.

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