Increasing Frequency of New Delhi Metallo-beta-Lactamase and Klebsiella pneumoniae Carbapenemase Resistant Genes in a Set of Population of Karachi

Afridi, Faisal Iqbal; Sani, Aliya Irshad; Khan, Rizma; Baig, Saeeda; Zaidi, Syed Aqib Ali; Jamal, Qamar

doi:10.29271/jcpsp.2023.01.59

Cited by 2 publications

(7 citation statements)

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“…The key contributing carbapenemases involved in the expansion of CPE in the study population are bla NDM-1 and bla OXA-48 , confirming the existing data from Pakistan [ 14 , 15 , 17 , 40 , 45 , 57 , 90 , 91 , 92 ]. We observed a considerable increase in the prevalence of KPC-producing K. pneumoniae (15.4%).…”

Section: Discussionsupporting

confidence: 87%

“…While the global data suggested the higher prevalence of K. pneumoniae , P. aeruginosa , E. coli and A. baumannii from Tanzania, Algeria, Nepal and Saudi Arabia [ 46 , 47 , 48 , 49 ], our study demonstrated 42.1% CR among Enterobacterales . This is higher than prevalences previously reported from Pakistan such as 21.84% [ 50 ], 25.5% [ 51 ], 9.6% [ 52 ] and 6.5% [ 45 ]. However, our results are in agreement with the global reports that CRE prevalence is at alarming rates, such as 65.0% from the USA [ 53 ], 42.6% from Cuba [ 54 ] and 34.3% from China [ 55 ].…”

Section: Discussioncontrasting

confidence: 62%

“…Our results showed that the patients were infected mostly with K. pneumoniae and E. coli strains while infrequently detected genera were Pseudomonas, Proteus , Acinetobacter , Citrobacter , Morganella , Providencia and Burkholderia . Previous studies from Pakistan showed that K. pneumoniae and E. coli were the most commonly detected pathogens responsible for nosocomial infections [ 43 , 44 , 45 ]. While the global data suggested the higher prevalence of K. pneumoniae , P. aeruginosa , E. coli and A. baumannii from Tanzania, Algeria, Nepal and Saudi Arabia [ 46 , 47 , 48 , 49 ], our study demonstrated 42.1% CR among Enterobacterales .…”

Section: Discussionmentioning

confidence: 99%

“…(18.5%). E. coli and K. pneumoniae were considered the prime reason for CRE as evidenced by a number of other studies; E. coli (86.0–38.24%) [ 17 , 45 , 51 , 56 ] and K. pneumoniae (60.0–31.62%) [ 15 , 45 , 56 , 57 ]). We observed that CR is significantly associated with K. pneumoniae ( p = 0.008) and Proteus spp.…”

Section: Discussionmentioning

confidence: 99%

“…In our study, wound (32.0%) and pus (22.6%) were the predominant specimens for CRE isolation, while clinical wards with higher proportions of CRE were general surgery (28.7%), general medicine (19.7%) and ICU (17.2%). However, tracheal aspirate (25.0%), urine (24.26%), pus (25.53%), and surgical units (51.4%), ICU (65.3%), medical units (43.5%), pediatric wards (71.4%) were the previously reported causes of CRE infections in Pakistan [ 45 , 52 ]. Worldwide reports established that ICU-related colonization of CRE is higher, with results such as 86.15%, 35.5%, 31.0%, 24.0% and 12.3%, thus favoring the resistance selection process [ 54 , 83 , 84 , 85 , 86 ].…”

Section: Discussionmentioning

confidence: 99%

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Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

et al. 2023

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Carbapenem resistance has become major concern in healthcare settings globally; therefore, its monitoring is crucial for intervention efforts to halt resistance spread. During May 2019–April 2022, 2170 clinical strains were characterized for antimicrobial susceptibility, resistance genes, replicon and sequence types. Overall, 42.1% isolates were carbapenem-resistant, and significantly associated with Klebsiella pneumoniae (K. pneumoniae) (p = 0.008) and Proteus species (p = 0.043). Carbapenemases were detected in 82.2% of isolates, with blaNDM-1 (41.1%) associated with the ICU (p < 0.001), cardiology (p = 0.042), pediatric medicine (p = 0.013) and wound samples (p = 0.041); blaOXA-48 (32.6%) was associated with the ICU (p < 0.001), cardiology (p = 0.008), pediatric medicine (p < 0.001), general surgery (p = 0.001), general medicine (p = 0.005) and nephrology (p = 0.020); blaKPC-2 (5.5%) was associated with general surgery (p = 0.029); blaNDM-1/blaOXA-48 (11.4%) was associated with general surgery (p < 0.001), and wound (p = 0.002), urine (p = 0.003) and blood (p = 0.012) samples; blaOXA-48/blaVIM (3.1%) was associated with nephrology (p < 0.001) and urine samples (p < 0.001). Other detected carbapenemases were blaVIM (3.0%), blaIMP (2.7%), blaOXA-48/blaIMP (0.1%) and blaVIM/blaIMP (0.3%). Sequence type (ST)147 (39.7%) represented the most common sequence type identified among K. pneumoniae, along with ST11 (23.0%), ST14 (15.4%), ST258 (10.9%) and ST340 (9.6%) while ST405 comprised 34.5% of Escherichia coli (E. coli) isolates followed by ST131 (21.2%), ST101 (19.7%), ST10 (16.0%) and ST69 (7.4%). Plasmid replicon types IncFII, IncA/C, IncN, IncL/M, IncFIIA and IncFIIK were observed. This is first report describing the carbapenem-resistance burden and emergence of blaKPC-2-ST147, blaNDM-1-ST340 and blaNDM-1-ST14 in K. pneumoniae isolates and blaNDM-1-ST69 and blaNDM-1/blaOXA-48-ST69 in E. coli isolates coharboring extended-spectrum beta-lactamases (ESBLs) from Pakistan.

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Section: Discussionsupporting

confidence: 87%

Section: Discussioncontrasting

confidence: 62%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

et al. 2023

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Outcome, risk factors and therapeutic strategies in carbapenem-resistant Gram-negative bacteraemia from Pakistan

Fatima

Dodani

Babar

et al. 2023

JAC-Antimicrobial Resistance

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Background Carbapenem-resistant Gram-negative (CRGN) bacteraemia has high mortality and limited therapeutic options. We assessed the risk factors and outcome of CRGN bacteraemia treated with limited options. Methods A prospective cohort study done at a tertiary care hospital in Pakistan, from October 2021 to August 2022. All patients >18 years with CRGN bacteraemia were assessed for demographics, source, risk factors and treatment received. Outcome was assessed as bacterial clearance and all-cause mortality at Day 14 of bacteraemia. Results We included 175 patients. Median age was 45 years (IQR 30–58) and the majority of our patients were on haemodialysis (75%). We found 14 day mortality in 26.8% of our patients; in addition, microbiological clearance was achieved in 95%. The central line (49.7%) was the most common source and Klebsiella spp. (47%) the most common organism. On multivariate analysis, risk factors for mortality were Foley’s catheter [aOR 2.7 (95% CI 1.1–6.5)], mechanical ventilation [aOR 5.1 (95% CI 1.6–15.8)] and Pitt bacteraemia score >4 [aOR 3.48 (95% CI 1.1–10.5)]. Source control was a significant protective factor [aOR 0.251 (95% CI 0.09–0.6)]. The majority received a colistin-based regimen with no difference in mortality between monotherapy and combination therapy. Conclusions Our cohort of CRGN bacteraemia is unique, comprising younger patients mostly on haemodialysis with a central line as the source of bacteraemia and we have found 14 day mortality of 27%. Colistin with various combinations can be an effective option in patients with renal failure having prompt source control.

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Increasing Frequency of New Delhi Metallo-beta-Lactamase and Klebsiella pneumoniae Carbapenemase Resistant Genes in a Set of Population of Karachi

Abstract: Objective: To determine the frequency of Klebsiella pneumoniae Carbapenemase (bla KPC ) and New Delhi Metallo-Beta-Lactamase (bla NDM ) resistant genes among clinical isolates of Enterobacterales in a set of Karachi population.

Cited by 2 publications

References 1 publication

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

Estimation, Evaluation and Characterization of Carbapenem Resistance Burden from a Tertiary Care Hospital, Pakistan

Outcome, risk factors and therapeutic strategies in carbapenem-resistant Gram-negative bacteraemia from Pakistan

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