<p>Carbapenemase Producers Among Extensive Drug-Resistant Gram-Negative Pathogens Recovered from Febrile Neutrophilic Patients in Egypt</p>

Abstract

Purpose This study aimed to detect the prevalence of carbapenemase producers (CPs) among extensive drug-resistant (XDR)-carbapenemase producing Gram-negative bacteria (GNB) recovered from various clinical specimens of hospitalized neutrophilic febrile patients in two major tertiary care hospitals in Egypt. Methods Standard methods were used to evaluate the antimicrobial susceptibility of clinical isolates according to the guidelines of the Clinical and Laboratory Standards Institute (CLSI). Phenotypic and genotypic analysis of CPs were carried out and statistically analyzed using standard methods. Results Three hundred and forty-two GNB were obtained from 342 clinical specimens during the period of the study, where 162 (47%) were enterobacterial isolates, including, 63 (18.4%) Escherichia coli , 87 (25.4%) Klebsiella spp., 5 (1.46%) Enterobacter cloacae , 5 (1.46%) Salmonella spp. and 2 (0.6%) Proteus and 180 (53%) were non-fermentative bacilli including, 129 (37.7%), Acinetobacter baumannii , and 51 (14.9%), Pseudomonas spp. Out of the 342 GNB, 188 (54.9%) isolates were multi-drug resistant (MDR). Of these, 52 (27.6%) were XDR as well as CPs as confirmed phenotypically. The MIC of imipenem against the XDR GNB against showed either low (11 isolates; 21.1%; MIC range =4–32 µg/mL) or high levels of resistance (41 isolates; 78.8%; MIC range = 64-≥1024). The most prevalent carbapenem resistance (CR) genes were blaKPC (63.5%) followed by blaOXA -48 (55.7%) and blaVIM (28.8%). No significant association could be observed between the MIC level and the presence of CR genes ( P value >0.05). Conclusion High prevalence of MDR (54.9%) and XDR (27.6%) GNB pathogens associated with high levels of resistance to carbapenems were observed. All XDR GNB were CPs and tested positive for at least one of the CR genes. However, most of them (78.8%) showed a high level of CR (MIC range = 64-≥1024) with no significant association with the CR genes.

OXA-48 Carbapenemase-Encoding Transferable Plasmids of Klebsiella pneumoniae Recovered from Egyptian Patients Suffering from Complicated Urinary Tract Infections

“…Both bla KPC and bla NDM genes were co-present in one isolate. The bla IMP gene was not carried in the plasmids of any of the tested isolates, which agreed with the results of other studies from Egypt reporting the absence of bla IMP gene from the tested CR-GNB isolates [ 48 , 52 ]. However, this does not negate the presence of IMP carbapenemase in Egypt, as it was reported to be harbored by P. aeruginosa isolates in Egypt in 2017 [ 53 ].…”

“…Contrary to our results, a study on the epidemiology of CRE in Egyptian intensive care units reported that 117/236 (49.6%) Enterobacterales isolates from urine specimens were CRE, suggesting the presence of healthcare transmission [ 45 ]. Antimicrobial susceptibility testing showed that 64 out of 65 CR-GNB isolates were MDR, which was in accordance to previously published studies that underscore the considerable resistance of many CPs [ 46 , 47 , 48 ].…”

Evaluation of the BioFire FilmArray Pneumonia Panel Plus to the Conventional Diagnostic Methods in Determining the Microbiological Etiology of Hospital-Acquired Pneumonia

“…In terms of its accuracy in detecting antimicrobial resistance genes, BFPP showed relatively high agreement when compared to VITEK-2 breakpoints, with PPA [100%, 93%, not applicable], NPA [97%, 85%, 90%], and OPA [98%, 90%, 90%] for carbapenemase producers, ESBLs, and MRSA, respectively. In comparison to other studies [28,[39][40][41] that reported on the prevalence of carbapenemase producers and ESBLs among HAP patients, our results revealed a higher rate of detection. This higher resistance rate could be attributed to the large use of antimicrobial agents among ICU patients, leading to more selective pressure and the appearance of different resistant phenotypes.…”

Genomic Characterization of Extensively Drug-Resistant NDM-Producing Acinetobacter baumannii Clinical Isolates With the Emergence of Novel blaADC-257

“…A threatening rise in the incidence of carbapenem-resistant A. baumannii has been increasingly reported worldwide ( Levy-Blitchtein et al, 2018 ; Moghnieh et al, 2018 ; Alcantar-Curiel et al, 2019 ) and in Egypt as well ( Al-Hassan et al, 2019 ; Benmahmod et al, 2019 ; Mabrouk et al, 2020 ), leaving behind a substantial number of difficult to treat infections. For a deeper insight into the molecular mechanisms underlying carbapenem resistance in this highly problematic pathogen, a collection of 20 A. baumannii clinical isolates was screened for carbapenemase-coding genes by PCR.…”