Evaluation of Phenotypic and Genotypic Characteristics of Carbapnemases-producing Enterobacteriaceae and Its Prevalence in a Referral Hospital in Tehran City

Jalalvand, Kosar; Shayanfar, Nasrin; Shahcheraghi, Fereshteh; Amini, Elahe; Mohammadpour, Mahsa; Babaheidarian, Pegah

doi:10.30699/ijp.2020.111181.2188

Cited by 17 publications

(23 citation statements)

References 48 publications

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“…The uppermost number of clinical isolates was collected from urine and sputum from the urinary tract infections and respiratory tract infections, respectively ( Table 1 ). These results are in agreement with those obtained by Jalalvand et al and Rimrang et al [ 7 , 28 ] who demonstrated that the most predominant Gram-negative bacilli were E . coli and K .…”

Section: Discussionsupporting

confidence: 93%

“…with those obtained by Jalalvand et al and Rimrang et al [7,28] who demonstrated that the most predominant Gram-negative bacilli were E. coli and K. pneumoniae.…”

Section: Plos Onesupporting

confidence: 81%

“…Similar to data from Iran and Lebanon, the most common isolated species is E . coli and the second is Klebsiella pneumoniae [ 7 , 24 ]. Urinary tract infections were found to be the dominant type of infection, 38 out of 65 isolates (58%) were from urine cultures, followed by respiratory tract infections (23%), wound infections (12%) and blood infections associated with systemic disease (6%).…”

Section: Discussionmentioning

confidence: 99%

“…This finding is consistent with studies on invasive urinary tract infections documenting E . coli as a major pathogen among Gram-negative isolates [ 7 , 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…53 isolates screened as carbapenemase-positive by the phenotype-based method were further investigated for the detection of carbapenemase genes using PCR-based methods. Singleplex and multiplex PCR were carried out to examine for the presence of five predominant carbapenemase genes namely KPC ( bla KPC gene), MBLs ( bla IMP , bla VIM, and bla NDM genes) and OXA-48 ( bla OXA-48 gene) using a panel of primers as previously described [ 7 , 24 , 25 ]. Multiplex PCR for bla IMP and bla VIM detection was planned.…”

Section: Methodsmentioning

confidence: 99%

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Prevalence and characterisation of carbapenemase encoding genes in multidrug-resistant Gram-negative bacilli

2021

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Background Emerging worldwide in the past decade, there has been a significant increase in multidrug-resistant bacteria from serious nosocomial infections, especially carbapenemase-producing Gram-negative bacilli that have emerged worldwide. The objective of this study is to investigate carbapenem resistance in Gram-negative bacilli bacteria using phenotypic detection, antimicrobial resistance profiles and genotypic characterisation methods. Methods 200 Gram-negative bacilli isolates were collected from different clinical specimens. All clinical samples were exposed to isolation and identification of significant pathogens applying bacteriological examination and an automated Vitek-2 system. The isolates were subjected to susceptibility tests by the Vitek-2 automated system and those isolates that were resistant to beta-lactam drugs, including carbapenems, third-generation cephalosporines or cefoxitin, were selected for phenotyping using Carba plus disc system assay for detection of carbapenemase-producing isolates. These isolates were further confirmed by molecular detection. PCR was used for the detection carbapenem-resistant genes (OXA-48, IMP, NDM, VIM, and KPC). Results 110 (55%) of 200 Gram-negative bacilli were identified as beta-lactam-resistant isolates. The frequency of carbapenem-resistant isolates was calculated to be 30.9% (n = 34/110). A collection totalling 65/110 (59%) isolates were identified as carbapenemase producers by phenotypic method. Moreover, among the 65 carbapenemase-producing Gram-negative isolates with a positive phenotype-based result, 30 (46%), 20 (30%) and 18 (27%) isolates were positive for OXA-48, KPC and MBL enzymes, respectively, as well as the production of 27% of AmpC with porin loss. Tigecycline was the most effective antibiotic that affected 70% of MDR isolates, but high rates of resistance were detected to other tested antimicrobials. Of interest, a high incidence of MDR, XDR and PDR profiles were observed among all carbapenemase-producing isolates. 36% (24/65) of the tested isolates were MDR to 3 to 5 antimicrobial classes. 29% (17/65) of the recovered isolates were XDR to 6 to 7 antimicrobial classes. Alarmingly, 24% (16/65) of isolates displayed PDR to all the tested 8 antimicrobial classes. Genotype assay, including 53 phenotypically confirmed carbapenemase-producing isolates of Gram-negative bacilli, found 51(96%) isolates were harbouring one or more genes. The most common carbapenemase gene was bla NDM 83% (44/53) followed by bla OXA-48 75% (40/53), bla VIM 49% (26/53) and bla IMP 43% (23/53), while the gene bla KPC was least frequent 7% (4/53). 92% (46/51) of isolates were involved in the production of more than one carbapenemase gene. Conclusion This study demonstrated the emergence of carbapenemase-producing Gram-negative pathogens implicated in healthcare-related infections. Accurate identification of carbapenem-resistant bacterial pathogens is essential for patient treatment, as well as the development of appropriate contamination control measures to limit the rapid spread of pathogens. Tigecycline exhibited potent antimicrobial activity against MDR, XDR and PDR-producing strains that establish a threatening alert which indicates the complex therapy of infections caused by these pathogens.

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Section: Discussionsupporting

confidence: 93%

“…with those obtained by Jalalvand et al and Rimrang et al [7,28] who demonstrated that the most predominant Gram-negative bacilli were E. coli and K. pneumoniae.…”

Section: Plos Onesupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

“…This finding is consistent with studies on invasive urinary tract infections documenting E . coli as a major pathogen among Gram-negative isolates [ 7 , 14 ].…”

Section: Discussionmentioning

confidence: 99%