Carbapenemase producing Enterobacterales clinical isolates from a tertiary care hospital in Egypt

Abstract

Background Carbapenem resistant Enterobacterales (CRE) is on the rise globally, triggering a significant health threat and a substantial concern for infection control management. We aimed to detect and characterize carbapenemases producing Enterobacterales (CPE) clinical isolates over a period of nearly one-year duration in Theodor Bilharz Research Institute, a tertiary care hospital in Egypt through molecular and phenotypic methods using carbapenemase detection combination inhibitor disk set (Enterobacterales) MASTDISCS ID (MDI) (MAST, UK), with the addition of temocillin disk. Results CRE represented 6.5% of Enterobacterales. Healthcare-associated infections were frequently high representing 87% of the CRE isolated from hospitalized patients. Most of the CRE isolates were Klebsiella pneumonia (68%) followed by Escherichia coli (22%), Enterobacter cloacae (4%), Serratia marcescens (4%) and Citrobacter freundii (2%). Phenotypic detection revealed metallo-β lactamases in 84% of isolates, followed by oxacillinase-48 {(OXA-48) 6%} and Klebsiella pneumoniae carbapenemase in 2% of the isolates. The most prevalent gene detected by conventional PCR was blaNDM (84%) followed by blaOXA-48 (6%) and blaKPC (2%). Excellent agreement was found between PCR and MDI for detection of carbapenemase production. Conclusions NDM carbapenemase is prevalent in our hospital. Carbapenemase detection combination inhibitor disk set (Enterobacterales) MASTDISCS ID is a useful tool for rapid and precise confirmation of the detection of CPE.

Dissemination of NDM-1 and OXA-48 Co-producing Carbapenem-resistant Enterobacterales at Two Tertiary Hospitals in Egypt

“…Similar findings were reported in recent studies from different institutions in Egypt, where Shawky et al found that 75% of their isolates carried blaNDM, followed by blaOXA-48 (59%) 27 . Additionally, El Defrawy et al reported that blaNDM was prevalent (84%), followed by blaOXA-48 (6%), with only 2% of isolates carrying blaKPC 6 . Moreover, within cancer institutions in Egypt, blaNDM emerged as the dominant genotype (68.88%), succeeded by blaOXA-48 (32.59%) 28 .…”

“…Carbapenemaseproducing Enterobacterales (CPE) are of special concern among CRE because their genes can easily spread, and they are often concurrently resistant to several non-ß-lactam antibiotics 5 . Carbapenemases are categorized into three out of four classes of ßlactamases, Ambler classes A, B, and D. Class A predominantly consists of KPC enzymes, class B comprises NDM, IMP, and VIM enzymes, and OXA-48-like enzymes make up class D carbapenemases 6 .…”