Characterization of KPC, NDM and VIM Type Carbapenem Resistance <i>Enterobacteriaceae</i> from North Eastern, Nigeria

Abstract

Introduction and Aim: Carbapenem resistance among species of Enterobacteriaceae has emerged as a global public health problem that adds to the high cost of care, severity and high mortality of otherwise straightforward infections. Governments around the world are devoting efforts to combat this important threat. The present study was undertaken in our setting to detect and characterize carbapenem resistance among Enterobacteriaceae. Methodology: Confirmed species of Enterobacteriaceae isolated from 225 patients that were admitted in various units of University of Maiduguri Teaching Hospital (UMTH) Maiduguri were screened for carbapenem resistance with meropenem and ertapenem disc (10 µg, Oxoid, England) using clinical and laboratory standards institute (CLSI) breakpoints. Suspected carbapenemase producers were subjected to confirmation using Modified Hodge Test method. Detection of the carbapenemase genes was done by multiplex PCR using KPC, NDM-1 and VIM primers. Results: A total of 225 clinical isolates of Enterobacteriaceae comprising 73 (32.4%) of Klebsiella pneumoniae, 61 (27.1%) of Escherichia coli, 21 (9.3%) of Proteus mirabilis, 18 (8.0%) of Klebsiella oxytoca, 13 (5.8%) of Morganella morganii, 12 (5.3%) of Citrobacter freundii, 12 (5.3%) of Serratia marcescens, 7 (3.1) of Enterobacter aerogenes, 3 (1.4%) of Klebsiella ozaenae, 3 (1.4%) of Hafnia alvei and 2 (0.9%) of Citrobcter sedlakii were isolated. A total of 28 (12.4%) of the isolates screened positive as carbapenemase producers. All the 28 screened isolates were further subjected to confirmation using the Modified Hodge Test for which 23 (10.2%) were confirmed resistant. Therefore a prevalence of 10.2% for carbapenem resistance was recorded in this study. Based on multiplex polymerase chain reaction, the various percentage genotypes of the carbapenemase producers were: 11 (47.8%) for KPC, 2 (8.7%) for VIM while 5 (21.7%) isolates have co-existence of the NDM-1 and VIM genes. However, 5 (21.7%) of the iso- 101lates have none of the genes screened for in them. The occurrence of carbapenemase genes among species of Enterobacteriaceae was as follows: 6 (33.3%) for Klebsiella pneumoniae, 4 (22.2%) for Escherichia coli, 4 (22.2%) for Proteus mirabilis, 3 (16.7%) for Serratia marcescens and then 1 (5.6%) for Klebsiella oxytoca. Conclusion: Despite the low use of carbapenem agents in the study area, carbapenem resistance was documented. This calls for an ongoing surveillance and infection control practices of this and other emerging resistance threat in all health centers of Nigeria. Irrational use of antibiotics must be discouraged so as to reduce this resistance threat. Antibiotic stewardship program should be established in all tertiary health centers of Nigeria.

Detection of the carbapenemase gene blaVIM-5 in members of the Pseudomonas putida group isolated from polluted Nigerian wetlands

“…Reports of carbapenemase genes in bacteria from environmental sources in Nigeria are not available for a comparative assessment of our results. However, the frequency of carbapenemase genes detection in this study is slightly higher than the prevalence rates of 5.5% and 10.2% reported in two of the hospital-based studies carried out in Nigeria 22 , 23 . Further, while we detected only bla VIM , these two Nigerian studies detected other carbapenemase genes in addition to bla VIM and the carriage of multiple carbapenemase genes among the investigated CRB.…”

Multicenter Study of the Burden of Multidrug-Resistant Bacteria in the Etiology of Infected Diabetic Foot Ulcers

“…Carbapenems are drugs of last resort in the treatment of resistant Gram-negative bacilli infections and with variable and increasing rates of resistance being reported. 26,27 Independent risk factors for acquisition of MDR bacteria found in our study are peripheral sensory neuropathy and foot infection duration > 1 month. This is similar to reports among IDFU cases from India.…”

Detection of Carbapenemase-producing Klebsiella pneumoniae isolated from Environmental Sources in a Tertiary Health Institution in Nigeria.

“…Although this was similar to ndings observed in previous Nigerian studies which dealt with clinical isolates of Klebsiella pneumoniae, [10] [25] contrasting observations were seen in Maiduguri, Nigeria (6.5%). [11] A signi cantly different nding was also observed in a Brazilian study that revealed that 100% of the Klebsiella pneumoniae isolates carried the bla KPC gene. [23] The contrasting rates may be due to long term high use of carbapenems in Brazil, but the still recent introduction of these drugs in Nigeria.…”

“…Following incubation of the plates for 16-18 hours at 35-37 0 C, zones of growth inhibition around each antibiotic were read off. Klebsiella pneumoniae isolates that showed a zone of inhibition ≤ 22mm in diameter for meropenem or ≤ 21mm for ertapenem were considered as suspected carbapenemase producers and were subjected to phenotypic con rmation by the Modi ed Hodges Test (MHT) [11] [14].…”

“…[8] Furthermore, the KPCs have been documented as major causes of nosocomial outbreaks. [9][10] [11] Several studies done previously on carbapenemase detection focused more on isolates from clinical specimens of patients, but limited information is found in the literature on the prevalence of carbapenemase-producing Klebsiella pneumoniae in the hospital environment. One environmental study worthy of note was that in which the prevalence of carbapenemase-producing Klebsiella pneumoniae was determined in environmental sites of Intensive Care Units (ICUs) in Cairo, Egypt.…”