Multi-drug carbapenem-resistant Klebsiella pneumoniae infection carrying the OXA-48 gene and showing variations in outer membrane protein 36 causing an outbreak in a tertiary care hospital in Riyadh, Saudi Arabia

Zaman, Taher uz; Aldrees, Mohammed; Johani, Sameera M. Al; Alrodayyan, Maha; Aldughashem, Faizah A.; Balkhy, Hanan H.

doi:10.1016/j.ijid.2014.05.021

Cited by 85 publications

(59 citation statements)

References 38 publications

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“…In our study, we found 81.9% of the NDM-1 isolates co-expressed different ESBL and/or AmpC genes, exhibiting a complex β-lactamase background that was consistent with previous studies [2526]. The SHV-type ESBL gene was the most prevalent among the isolates, followed by the CTX-M-type, which is in agreement with two previous results [2728]. Furthermore, the identification of DHA-1 as the predominant AmpC in the CRKP isolates is similar to the recent findings in China [29].…”

Section: Discussionsupporting

confidence: 93%

Multidrug Resistance Mechanisms of Carbapenem Resistant Klebsiella pneumoniae Strains Isolated in Chongqing, China

Yan

Jia

et al. 2017

Ann Lab Med

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BackgroundCarbapenem-resistant Klebsiella pneumoniae (CRKP) is considered a serious global threat. However, little is known regarding the multidrug resistance (MDR) mechanisms of CRKP. This study investigated the phenotypes and MDR mechanisms of CRKP and identified their clonal characteristics.MethodsPCR and sequencing were utilized to identify antibiotic resistance determinants. Integron gene cassette arrays were determined by restriction fragment length polymorphism (RFLP) analysis. Multi-locus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE) were used for epidemiological analysis. Plasmids were typed by using a PCR-based replicon typing and analyzed by conjugation and transformation assays.ResultsSeventy-eight strains were identified as resistant to at least one carbapenem; these CRKP strains had a high prevalence rate (38.5%, 30/78) of carbapenemase producers. Additionally, most isolates harbored MDR genes, including Extended spectrum β-lactamases (ESBLs), AmpC, and quinolone and aminoglycoside resistance genes. Loss of porin genes was observed, and Class 1 integron was detected in 66.7% of the investigated isolates. PFGE and MLST results excluded the occurrence of clonal dissemination among these isolates.ConclusionsA high prevalence of NDM-1 genes encoding carbapenem resistance determinants was demonstrated among the K. pneumoniae isolates. Importantly, this is the first report of blaNDM-1 carriage in a K. pneumoniae ST1383 clone in China and of a MDR CRKP isolate co-harboring blaNDM-1, blaKPC-2, blaCTX-M, blaSHV, acc(6′)-Ib, rmtB, qnrB, and acc(6′)-Ib-cr.

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Section: Discussionsupporting

confidence: 93%

Multidrug Resistance Mechanisms of Carbapenem Resistant Klebsiella pneumoniae Strains Isolated in Chongqing, China

Yan

Jia

et al. 2017

Ann Lab Med

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“…In our study, bla OXA‐48 gene was detected in 9/24 (37.5%) of the resistant isolates; however, Abdallah et al, did not detect it at all in Egypt . Iraz et al, have reported bla OXA‐48 gene with a lower percentage (13%); however Zaman et al, detected bla OXA‐48 gene with a percentage (100%) in Saudi Arabia . The bla VIM‐1 gene was detected in 6/24 (25%) of our isolates, and another Egyptian study also has detected bla VIM‐1 gene amongst K pneumoniae isolates but with a lower percentage (7%) .…”

Section: Discussioncontrasting

confidence: 55%

Multidrug‐resistant Klebsiella pneumoniae in hospital‐acquired infections: Concomitant analysis of antimicrobial resistant strains

et al. 2019

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Background Hospital‐acquired infections caused by K pneumoniae are difficult to eradicate since K pneumoniae carries resistance genes for many antimicrobials, including carbapenems. The study aimed to determine the prevalence of hospital‐acquired infections caused by multiple drug‐resistant K pneumoniae and identify carbapenem and fluoroquinolone resistance by phenotypic and genotypic methods amongst hospitalised patients. Methods Two hundred and fifty samples from patients with hospital‐acquired infections were included. Identification and susceptibility testing for K pneumoniae isolates was performed by standard methods. The detection of carbapenemase resistance (blaKPC, blaVIM‐1 and blaOXA‐48) and plasmid‐mediated quinolone resistance (PMQR; qnrA, qnrB and qnrS) genes was performed using PCR assay. Results Out of 250 samples, 42 (16.8%) were multiple drug‐resistant K pneumoniae, and the frequency of K Pneumoniae isolation was higher in urine samples, in the age group (<10 years), in ICU and in patients with longer hospital stay. Twenty‐four (57%) of the isolates were resistant to Meropenem, 13 (31%) were resistant to Imipenem and 35 (83.3%) were resistant to Ciprofloxacin. blaOXA‐48 gene was detected in 9 (21.4%) of isolates, and blaVIM‐1 gene was detected in 6 (14.3%) of isolates. However, no isolate harboured blaKPC gene. PMQR genes were detected in 100% of ciprofloxacin resistant isolates, and qnrS was the dominant. Conclusion Multidrug‐resistant K pneumoniae isolates harbouring blaOXA‐48, blaVIM‐1 and PMQR genes are emerging in hospitals particularly with long hospital stays.

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“…Furthermore, the ST29 was the predominant ST of carbapenem-resistant K . pneumoniae isolates in Saudi Arabia 35 . The ST15, ST17, ST54, and ST107 isolates producing ESBL, DHA-1, KPC-2 or NDM-1metallo-β-lactamase have been found in Taiwan, China and other various geographic areas in the world 36–42 .…”

Section: Discussionmentioning

confidence: 99%

Klebsiella pneumoniae Isolates from Meningitis: Epidemiology, Virulence and Antibiotic Resistance

Chuang

Chen

et al. 2017

Sci Rep

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Klebsiella pneumoniae (KP) resistance to broad-spectrum cephalosporin (BSC) in meningitis is important because of limited therapeutic options. To investigate the antibiotic resistance, virulence and epidemiology of KP in meningitis, we conducted a retrospective study for 33 non-metastatic isolates, including primary meningitis (n = 20) and post-craniotomy meningitis (n = 13) collected from 1999 to 2013. BSC resistance was found in 9 (27.3%) isolates, all from post-craniotomy meningitis, harboring bla SHV-5 (n = 6), bla CMY-2 (n = 2), bla DHA-1 (n = 2), and bla TEM-1B (n = 1). Positive virulence factors were hypermucoviscosity (n = 22), larger bacterial size (n = 24), virulent capsule serotypes (n = 24, K2, 11; K1, 5; K57, 3; K5, 2; K20, 2 and K54, 1), rmpA (n = 23), rmpA 2 (n = 20), aerobactin gene (n = 22) and high-grade serum resistance (n = 23, 69.7%). Higher mouse lethality (LD50 < 106) was found in 16 isolates (48.5%). Post-craniotomy isolates were significantly less virulent than primary meningitis isolates, except for similar serum resistance capability. The pulsotype and sequence typing (ST) results were diverse. A minor cluster with pulsotype C and ST23 (n = 5) was identified in primary meningitis isolates. In conclusion, virulence factors and BSC resistance corresponded to about 70% and 30% of KP meningitis isolates respectively. BSC remains appropriate for treating primary meningitis, whereas meropenem is indicated for post-craniotomy meningitis empirically.

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Multi-drug carbapenem-resistant Klebsiella pneumoniae infection carrying the OXA-48 gene and showing variations in outer membrane protein 36 causing an outbreak in a tertiary care hospital in Riyadh, Saudi Arabia

Cited by 85 publications

References 38 publications

Multidrug Resistance Mechanisms of Carbapenem Resistant Klebsiella pneumoniae Strains Isolated in Chongqing, China

Multidrug Resistance Mechanisms of Carbapenem Resistant Klebsiella pneumoniae Strains Isolated in Chongqing, China

Multidrug‐resistant Klebsiella pneumoniae in hospital‐acquired infections: Concomitant analysis of antimicrobial resistant strains

Klebsiella pneumoniae Isolates from Meningitis: Epidemiology, Virulence and Antibiotic Resistance

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