Klebsiella pneumoniae Harboring Carbapenemase Genes in Taiwan: Its Evolution over 20 Years, 1998–2019

•Carbapenemase-producing Klebsiella pneumoniae (CPKP) has become a global threat, by causing substantial mortality due to limited therapeutic options•The emergence of Klebsiella pneumoniae carbapenemases (KPC)-2 in K. pneumoniae has led to substantial global spread and public health implications•The evolution of CPKP has changed endemicity from IMP-8, NDM-1 to the most wide-spreading KPC-2 and rapidly emerging OXA-48 in the last two decades in Taiwan•CPKP is potentially evolving into hypervirulence in epidemic success•Ceftazidime-avibactam is active vs. KPC-2- and OXA-48-producing isolates Klebsiella pneumoniae (K. pneumoniae) is an important pathogen causing various types of human infections in Taiwan. Carbapenemases have increasingly been reported in Enterobacterales in the past two decades. Carbapenemase-producing K. pneumoniae (CPKP), a major resistance concern that has emerged during the last decade, has become a global threat, with its related infections associated with high morbidity and mortality; however, therapeutic options for CPKP-associated infections are limited. Carbapenemases – including K. pneumoniae carbapenemases (KPC)-2, New Delhi metallo-β-lactamase (NDM)-1, Verona integron-encoded metallo-β-lactamase (VIM)-1, imipenemase (IMP)-1, and oxacillinase (OXA)-48 – have been reported worldwide, with a marked prevalence in different countries or areas of the world. Understanding the epidemiology of carbapenemase producers is important for the prevention of their expansion. This review examined the evolution of CPKP in the last two decades to better understand the role of CPKP in Taiwan. It discovered that the endemicity has changed from IMP-8, NDM-1 and VIM-1 to the most common KPC-2 and rapidly emerging OXA-48. Resistance epidemiology, genetic background, virulence factors, therapy, and outcomes are discussed in this paper.