Emergence of extended-spectrum β-lactamase (ESBL) and/or carbapenemase producing Enterobacteriaceae (CPE) and their antimicrobial resistance

Abstract

OBJECTIVES: We focused on detecting the most frequent resistance mechanisms in selected multidrugresistant (MDR) strains and determining their antimicrobial resistance. BACKGROUND: MDR pathogens pose urgent public health threat due to limited treatment options, rigorous control measures and signifi cant mortality. METHODS: We confi rmed extended-spectrum β-lactamase (ESBL) and carbapenemase producing Enterobacteriaceae through guidelines, as well following β-lactamases: AmpC by cloxacillin, class A carbapenemase with phenylboronic acid, class B metallo-β-lactamase with ethylenediaminetetraacetic acid. Multilocus sequence typing was used to investigate 20 Escherichia coli strains. RESULTS: Overall 205 mostly ESBL Escherichia coli demonstrated resistance against amikacin (4.7 %), tigecycline (1.2 %), and no resistance to ceftazidime/avibactam, meropenem, nitrofurantoin and fosfomycin. Out of 41 Klebsiella species (spp.), 37 (90.2 %) showed carbapenemase activity, 13 (35.1 %) of class A and 24 (64.9 %) of class B. Resistance was following: meropenem 66.7 %, tigecyclin 10.2 % and colistin 0 %. From Enterobacter spp. 21 strains, 14 (66.7 %) were ESBL, 5 produced ESBL and/or AmpC and 2 were MDR. We ascertained 14 (70 %) E. coli sequence type-ST131. CONCLUSIONS: The study revealed various resistance mechanisms in concert with different agents and association of specifi c ST131 within E. coli. These characteristics considerably contribute to emergence of antimicrobial resistance (Tab. 4, Ref. 30).

Systematic review: Mechanisms used by Klebsiella pneumoniae and Enterobacter spp to acquire their antibiotic multiresistant and what treatment alternatives exist.

“…For example, the mechanism with the highest prevalence (38.1%) is once again the β-lactamase enzymes, which also provide special resistance to beta-lactam antibiotics (penicillins, cephalosporins, monobactams, and carbapenems). 21,22 Likewise, with a prevalence of (9.5%), mechanisms very similar to those described above were found. 23 Among them are: Alteration of porins (Omp35 and Omp36), efflux pumps, LPS modification system, PMQR determinants, and finally with a lower prevalence (4.8%) were found: DNA gyrase mutations, mutation of antibiotic targets, QRDR determinants, gyrB mutation and mutation in the AmpR repressor .24,25 It is important to clarify that due to the similarity of intrinsic resistance mechanisms between Klebsiella pneumoniae and Enterobacter spp.…”

“…Similar figures were reported by Bartoloni et al 14,19,20 The sensitivity of the strains to amikacin in the present work coincides with authors from Bolivia and Venezuela, who published sensitivity figures above 90 %. 14,21 In Cuba, in a national study, resistance values were observed for trimethoprim-sulfamethoxazole (49 %), gentamicin (43 %), and nalidixic acid (38 %). 22. Another relevant finding was the high percentages of resistance to the three thirdgeneration cephalosporins.…”

Carbapenem-Resistant Klebsiella pneumoniae in COVID-19 Era—Challenges and Solutions

“…Also, the colistin-MIC distribution was less favourable for NDM-strains, with values far from the breakpoint, which may be a disadvantage when a combination treatment is considered. Growing numbers of colistin-resistant CRKP isolates were also reported from University Hospital facilities in the Slovak Republic, even if not so alarming—from 0% published in 2019 to 2.5% in 2022 [ 3 , 4 ]. When analysing this extremely high colistin-resistance rate in the CMH among the NDM CRKP strains, the most probable reason is the epidemic spread of the same colistin-resistant NDM Klebsiella pneumoniae strain during the COVID-19 period (as discussed above).…”

“…The emergence and spread of carbapenem-resistant Klebsiella pneumoniae (CRKP) in hospitals worldwide [ 1 , 2 ], including the Slovak Republic [ 3 , 4 ], represent an urgent global public health issue, posing an enormous burden on hospital settings caring for high-risk patients [ 5 ]. Infections caused by these bacterial agents represent a significant therapeutic problem, primarily in patients in intensive care units, where bacterial superinfections increase the morbidity and mortality rates of critically ill and debilitated patients, with an overwhelming impact on hospitalisation costs [ 6 , 7 ].…”

Excellent antibacterial activity of Slovak honeys on bacteria mostly infecting chronic wounds

“…Nowadays, in the era of increasing antimicrobial resistance among microorganisms, extensive research on new and more effective antibiotics is facilitated (9). On the other hand, alternative non-antibiotic treatments are applied, and the old and forgotten antimicrobial therapeutic options are being rediscovered.…”