Distribution of β-Lactamase Genes Among Carbapenem-ResistantKlebsiella pneumoniaeStrains Isolated From Patients in Turkey

Abstract

BackgroundThe emergence of carbapenem-resistant Klebsiella pneumoniae poses a serious problem to antibiotic management. We investigated the β-lactamases in a group of carbapenem-resistant K. pneumoniae clinical isolates from Turkey.MethodsThirty-seven strains of K. pneumoniae isolated from various clinical specimens were analyzed by antimicrobial susceptibility testing, PCR for the detection of β-lactamase genes, DNA sequencing, and repetitive extragenic palindronic (REP)-PCR analysis.ResultsAll 37 isolates were resistant to ampicillin, ampicillin/sulbactam, piperacillin, piperacillin/tazobactam, ceftazidime, cefoperazone/sulbactam, cefepime, imipenem, and meropenem. The lowest resistance rates were observed for colistin (2.7%), tigecycline (11%), and amikacin (19%). According to PCR and sequencing results, 98% (36/37) of strains carried at least one carbapenemase gene, with 32 (86%) carrying OXA-48 and 7 (19%) carrying NDM-1. No other carbapenemase genes were identified. All strains carried a CTX-M-2-like β-lactamase, and some carried SHV- (97%), TEM- (9%), and CTX-M-1-like (62%) β-lactamases. Sequence analysis of blaTEM genes identified a blaTEM-166 with an amino acid change at position 53 (Arg53Gly) from blaTEM-1b, the first report of a mutation in this region. REP-PCR analysis revealed that there were seven different clonal groups, and temporo-spatial links were identified within these groups.ConclusionsCombinations of β-lactamases were found in all strains, with the most common being OXA-48, SHV, TEM, and CTX-M-type (76% of strains). We have reported, for the first time, a high prevalence of the NDM-1 (19%) carbapenemase in carbapenem-resistant K. pneumoniae from Turkey. These enzymes often co-exist with other β-lactamases, such as TEM, SHV, and CTX-M β-lactamases.

Molecular Characterization of Carbapenem-Resistant Klebsiella pneumoniae Species Isolated From a Tertiary Hospital, Ankara, Turkey

“…In the present study, KPC, IMP, and VIM were not determined from any of the isolates. Similar to the current study data, 2 recent studies performed on carbapenem-resistant K. pneumoniae clinical isolates from different hospitals of Turkey, no positive results for KPC, IMP, and VIM enzymes were reported (40,41). In a multicentral surveillance study, the prevalence of VIM, IMP, and KPC among 136 carbapenemresistant E. coli and K. pneumoniae isolates was reported as 2.8%, 1.4%, and 0%, respectively (33).…”

Molecular detection of β-lactamase and integron genes in clinical strains of Klebsiella pneumoniae by multiplex polymerase chain reaction

“…Udomsantisuk et al 53 reported that the frequency of the bla VEB gene was 30% among β-lactamase-positive K. pneumoniae strains; however, in the current study, the frequncy of bla VEB gene was 12%. Iraz et al 54 reported that 86% of the carbapenem-resistant K. pneumoniae strains carried the bla OXA gene; however, Charrouf et al 55 found that only 6% of their isolates carried this gene. Our results did not match either of these studies; in our study, the prevalence of this gene was 28%.…”

Extended spectrum beta-lactamase production and antibiotic resistance of Escherichia coli and Klebsiella spp. isolated from hospitalized patients: data of 2011-2015

“…Yunanistan'da 2007 yılında yapılan bir çalışmada, çoklu ilaç direnci bulunan patojenlerle enfeksiyon nedeniyle kolistin kullanılan yoğun bakım hastalarında, kolistine dirençli K. pneumoniae ile bronşiyal ve bağırsak kolonizasyon oranı %37 olarak saptanmıştır (20). Karbapenem dirençli K. pneumonia suşlarında da İtalya'da %43, Türkiye'de %2,7 kolistin direnci bildirilmiştir (21,22). Yine İtalya'dan bildirilen bir çalışmada, karbapenemaz üreten K. pneumonia suşlarında kolistin direncinin 2010-2013 yılları arasında %11'den %27'ye yükseldiği belirtilmiştir (23).…”