Carbapenem Resistance and Carbapenemases in Bloodstream Enterobacterales,  Busan,  2018-2024

Sohyun Park

doi:10.4167/jbv.2026.56.1.024

All Issue

2026 Vol.56, Issue 1 Preview Page Next Page

Original Article

Carbapenem Resistance and Carbapenemases in Bloodstream Enterobacterales, Busan, 2018-2024

31 March 2026. pp. 24-34

PDF XML

Abstract

Background: Carbapenem-resistant Enterobacterales(CRE) have emerged as a majorglobal health concern because of limited therapeutic options and high mortality in bloodstream infections.Regional epidemiologic data on bloodstream CRE infections are essential for guidinginfection-control strategies and antimicrobial stewardship. Methods: A total of 609 non-duplicate CRE isolates recovered from blood cultures at healthcare institutions in Busan, South Korea, between 2018 and 2024 were analyzed. Species identification was performed using the Vitek 2 Compact system(bioMérieux, France). Antimicrobial susceptibility testing for four carbapenems was determined by broth microdilution, and ten carbapenemase genes were detected by PCR. Results: Klebsiella pneumoniae predominated (81.8%), followed by Escherichia coli (11.7%) and Enterobacter spp. (4.6%). Ertapenem resistance (MIC ≥ 2 µg/mL) was observed in 99.3% of isolates, and elevated MIC values (≥ 8 µg/mL) were frequently observed across all carbapenems. Carbapenemase-producing Enterobacterales (CPE) accounted for 98.2% of isolates. KPC-type carbapenemases were most frequent (88.2%), predominantly KPC-2 (84.9%), whereas NDM- and OXA-type carbapenemases were detected sporadically. Conclusion: KPC-2-producing K. pneumoniae remains the principal cause of CRE bloodstream infections in Busan. The presence of diverse carbapenemase genotypes across healthcare institutions indicates ongoing regional disseminationof resistance determinants, underscoring the need for sustained molecular surveillance and coordinated infection-control efforts.

Keywords

Enterobacterales

Carbapenem resistance

Carbapenemase

KPC-2

Bloodstream infection

References

Vasoo S, Barreto JN, Tosh PK. Emerging issues in gram-negative bacterial resistance: an update for the practicing clinician. Mayo Clin Proc. 2015;90(3):395-403.

10.1016/j.mayocp.2014.12.002

Logan LK, Weinstein RA. The epidemiology of carbapenem-resistant Enterobacteriaceae: the impact and evolution of a global menace. J Infect Dis. 2017;215(Suppl 1):S28-S36.

10.1093/infdis/jiw28228375512PMC5853342

Nordmann P, Naas T, Poirel L. Global spread of carbapenemase-producing Enterobacteriaceae. Emerg Infect Dis. 2011;17(10):1791-1798.

10.3201/eid1710.11065522000347PMC3310682

Joo SJ, Kim MK, Shin EK, Kim JY, Yoo J. Molecular characteristic analysis and antimicrobial resistance of carbapenem-resistant Enterobacteriaceae (CRE) isolates in the Republic of Korea, 2017-2020. Public Health Wkly Rep. 2021;14(53):3790-3804.

Lee ES, Lee SJ, Yun SJ, Lee YK. Number of Carbapenem-resistant Enterobacteriaceae infections in Republic of Korea (2018-2020). Public Health Wkly Rep. 2021;14(39):2765-2772.

Jung HS, Hyun JH, Lee YK. Characteristics of Carbapenem-resistant Enterobacteriaceae (CRE) in the Republic of Korea, 2021. Public Health Wkly Rep. 2022;15(33):2354-2363.

Kang JS, Yi JY, Ko MK, LEE SO, Lee JE, Kim KH. Prevalence and Risk Factors of Carbapenem-resistant Enterobacteriaceae Acquisition in an Emergency Intensive Care Unit in a Tertiary Hospital in Korea: a Case-Control Study. J Korea Med Sci. 2019;34(18):e140.

10.3346/jkms.2019.34.e14031074254PMC6509365

Iovleva A, Doi Y. Carbapenem-resistant Enterobacteriaceae. Clin Lab Med. 2017;37(2):303-315.

10.1016/j.cll.2017.01.00528457352PMC5412586

Queenan AM, Bush K. Carbapenemases: the versatile β-lactamases. Clin Microbiol Rev. 2007;20(3):440-458.

10.1128/CMR.00001-0717630334PMC1932750

Codjoe FS, Donkor ES. Carbapenem resistance: a review. Med Sci (Basel). 2017;6(1):1.

10.3390/medsci601000129267233PMC5872158

Doi Y, Paterson DL. Carbapenemase-producing Enterobacteriaceae. Semin Respir Crit Care Med. 2015;36(1):74-84.

10.1055/s-0035-154420825643272PMC4470611

Kim KA, Heo HS, Kim HJ, Shin SJ, Na YR. Study on the distribution of carbapenem-resistant Enterobacteriaceae(CRE) in Busan, 2022. J Bacteriol Virol. 2023;53(2):119-130.

10.4167/jbv.2023.53.2.119

Lee HJ, Lee S, Jung YH, Choi J, Park SK. Characteristics of notified Carbapenem-resistant Enterobacterales cases in the Republic of Korea, 2023. Public Health Wkly Rep. 2025;18(2):75-89.

Kim EJ, Kang JH, Hyun JH, Park SK. Review of International Literature for the Prevention and Control of Carbapenem-resistant Enterobacterales Infection. Public Health Wkly Rep. 2024;17(5):e2.

Park JW, Lee H, Park SY, Kim TH. Epidemiological, clinical, and microbiological characteristics of carbapenemase- producing Enterobacteriaceae bloodstream infection in the Republic of Korea. Antimicrob Resist Infect Control. 2019;8:48

10.1186/s13756-019-0497-330873279PMC6402157

Tamma PD, Goodman KE, Harris AD, Tekle T, Roberts A, Taiwo A, et al. Comparing the outcomes of patients with carbapenemase-producing and non-carbapenemase-producing carbapenem-resistant Enterobacteriaceae bacteremia. Clin Infect Dis. 2017;64(3):257-264.

10.1093/cid/ciw74128013264PMC5241781

Korea Disease Control and Prevention Agency. Compendium of Standard Laboratory Procedures for Infectious Disease Testing. Cheongju: KDCA; 2025.

Clinical and Laboratory Standards Institute. Performance standards for antimicrobial susceptibility testing. CLSI supplement M100. Wayne, PA: CLSI; 2016.

Korea Disease Control and Prevention Agency. Guidelines for the management of healthcare-associated infections. Cheongju: KDCA; 2022.

On Y, Kim JW, Lee J, Yoo JS. Genomic analysis of carbapenem-resistant Klebsiella pneumoniae blood isolates from nationwide surveillance in South Korea. Front Microbiol. 2025;16:1562222.

10.3389/fmicb.2025.156222240396185PMC12089144

Hassoun-Kheir N, Hussein K, Karram M, Saffuri M, Badaan S, Peleg S, et al. Risk factors for acquisition of carbapenemase-producing versus non-carbapenemase-producing Enterobacterales: a case-control study. Clin Microbiol Infect. 2023;29(5):629-634.

10.1016/j.cmi.2023.01.005

Bouganim R, Dykman L, Fakeh O, Motro Y, Oren R, Daniel C, et al. The clinical and molecular epidemiology of noncarbapenemase-producing carbapenem-resistant Enterobacteriaceae: A Case-Case-Control Matched Analysis. Open Forum Infect Dis. 2020;7(8):ofaa299.

10.1093/ofid/ofaa29932855986PMC7443108

Shropshire WC, Konovalova A, McDaneld P, Gohel M, Strope B, Sahasrabhojane P, et al. Systematic analysis of mobile genetic elements mediating β-lactamase gene amplification in noncarbapenemase-producing Carbapenem- Resistant Enterobacterales bloodstream infections. mSystems. 2022;7(5):e00476-22.

10.1128/msystems.00476-2236036505PMC9601100

Sabour S, Harrington KRV, Martinson E, Bhatnagar AS, Huang JY, Duffy D, et al. Characterization of Carbapenem- resistant Enterobacterales and Pseudomonas aeruginosa carrying multiple carbapenemase genes-Antimicrobial Resistance Laboratory Network, 2018- 2022. J Clin Microbiol. 2024;62(12):e0122024.

10.1128/jcm.01220-2439565121PMC11633150

Lee YQ, Sri La Sri Ponnampalavanar S, Chong CW, Karunakaran R, Vellasamy KM, Abdul Jabar K, et al. Characterisation of non-carbapenemase-producing carbapenem-resistant Klebsiella pneumoniae Based on Their Clinical and Molecular Profile in Malaysia. Antibiotics (Basel). 2022;11(11):1670.

10.3390/antibiotics1111167036421313PMC9686620

Information

Publisher :The Korean Society for Microbiology and The Korean Society of Virology
Publisher(Ko) :대한미생물학회‧대한바이러스학회
Journal Title :JOURNAL OF BACTERIOLOGY AND VIROLOGY
Volume : 56
No :1
Pages :24-34
Received Date : 2026-01-02
Revised Date : 2026-02-27
Accepted Date : 2026-03-20
DOI :https://doi.org/10.4167/jbv.2026.56.1.024

JOURNAL OF BACTERIOLOGY AND VIROLOGY ISSN:1598-2467(Print) 2093-0429(Online)

All Issue