Prevalence and characterization of carbapenem-resistant Klebsiella pneumoniae isolated from intensive care units of Mansoura University hospitals

Moemen, Dalia; Masallat, Doaa T.

doi:10.1016/j.ejbas.2017.01.001

Cited by 19 publications

(36 citation statements)

References 31 publications

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“…Although the rate we observed was lower than that in a study in the USA [24], it was higher than the previous reports in Egypt. The prevalence of CPKP was found to be 33.3% among K. pneumoniae isolates in a study performed by Moemen and Masallat [23]; 44.3% at the Suez Canal University Hospitals in a study performed by El-Sweify et al [10]; and 13.9% in the Egyptian National Cancer Institute in a study performed by Ashour and El-Sharif [25]. Increasing rates of CPKP isolates may be due to the misuse of carbapenems, as carbapenems are considered the best choice for the treatment of serious infections caused by multi-drug resistant pathogens in our hospitals, where there is presently no implementation of an antimicrobial stewardship program [26].…”

Section: Discussionmentioning

confidence: 92%

“…Carbapenemase-producing Klebsiella pneumoniae (CPKP) is one of the most widespread pathogens among hospital-acquired multi-drug resistant pathogen associated infections [7]. Although many reports exhibited the emergence of carbapenem resistant K. pneumoniae in Egypt [12,23] in the last decades, the data on plasmid epidemiology and which plasmid types are mainly associated with the spread of bla KPC2 and/or bla NDM1 plasmids in Egypt are rare. Thus, in this study, we attempted to determine the plasmids responsible for transferring the determinants of carbapenem-resistance among K. pneumoniae isolates in this country.…”

Section: Discussionmentioning

confidence: 99%

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The Inc FII Plasmid and its Contribution in the Transmission of blaNDM-1 and blaKPC-2 in Klebsiella pneumoniae in Egypt

et al. 2019

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The emergence of bla KPC-2 and bla NDM-1 producing Klebsiella pneumoniae represents a great problem in many Egyptian hospitals. One hundred and twenty-six K. pneumoniae isolates from patients admitted to Assiut University Hospital were identified by an API20E kit. Carbapenemase-producing K. pneumoniae (CPKP) was detected by the modified carbapenem inactivation method (mCIM), the EDTA-modified carbapenem inactivation method (eCIM), and an E-test. Based on the polymerase chain reaction, all isolates were negative for bla-VIM-1 and bla-IMP-1 , fifteen of these isolates were positive for both bla KPC-2 and bla NDM-1 , two isolates were positive for bla KPC-2 only, and twenty-eight isolates were positive for bla-NDM-1 only. Although one isolate was positive for the string test, all CPKP isolates were negative for capsular genes. Only 71.1% of CPKP transferred their plasmids to their corresponding transconjugants (E. coli J53). The resistance patterns of the clinical isolates and their transconjugates were similar, except for 12 isolates, which showed differences with their transconjugates in the resistance profile of four antibiotics. Molecular typing of the plasmids based on replicon typing showed that Inc FIIK and FII plasmids predominated in isolates and their transconjugants carrying bla KPC-2 and/or bla NDM-1 . Conjugative Inc FII plasmids play an important role in the spread of CPKP, and their recognition is essential to limit their spread.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

The Inc FII Plasmid and its Contribution in the Transmission of blaNDM-1 and blaKPC-2 in Klebsiella pneumoniae in Egypt

et al. 2019

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“…K. pneumoniae is associated with increased mortality and morbidity of hospitalized patients, especially in acute care settings like intensive care units (ICUs) and cardiac care units (CCUs). 31 Carbapenems are one of the most effective agents for treating infections caused by MDR K. pneumoniae. 32 Unfortunately, resistance to carbapenem among K. pneumoniae continues to increase.…”

Section: Discussionmentioning

confidence: 99%

The First Egyptian Report Showing the Co-Existence of blaNDM-25, blaOXA-23, blaOXA-181, and blaGES-1 Among Carbapenem-Resistant K. pneumoniae Clinical Isolates Genotyped by BOX-PCR

El-Badawy¹,

El‐Far²,

Althobaiti³

et al. 2020

IDR

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Background and Objective: The emergence of carbapenem-resistant K. pneumoniae (CRKP) continues to escalate and is alarming because of the emergence of pan drugresistant strains. The objective of this study was to investigate the existence of 12 carbapenemase genes among CRKP clinical isolates. Methods: Ninety-six Klebsiella spp. clinical isolates were collected. The isolates were identified phenotypically and genotypically. These isolates were screened for susceptibility to 24 different antibiotics. The modified Hodge test (MHT) and the Carba Nordmann/Poirel (NP) test were used to phenotypically screen carbapenem-resistant strains for carbapenemase production. Phenotypic characterization of carbapenemases was performed using the combined disk synergy test (CDST). Additionally, the presence of 12 carbapenemase genes in CRKP isolates was investigated. The DNA sequence of bla NDM and bla GES genes was determined. The BOX-PCR technique was used to determine the clonal relationship between CRKP isolates. Results: All carbapenem-resistant isolates were related to K. pneumoniae. Susceptibility testing showed that 19.79% (19/96) of the collected isolates were carbapenem-resistant. Of the CRKP isolates, 68.42% (13/19) tested positive for the MHT and Carba NP test. CDST showed that 42.11% (8/19), 63.16% (12/19), 47.37% (9/19), and 73.68% (14/19) of the CRKP isolates tested positive for the inhibitory effect of clavulanic acid, sulbactam, phenylboronic acid, and tazobactam, respectively, while 84.21% (16/19) and 68.42% (13/16) tested positive for the inhibitory effect of EDTA and mercaptopropionic acid, respectively. It was found that 10.53% (2/19) of the isolates tested positive for the inhibitory effect of sodium chloride. Molecular investigation of carbapenemases showed that 26.32% (5/19), 73.68% (14/19), 21.05% (4/19), 10.53% (2/19), and 5.26% (1/19) of the isolates tested positive for bla NDM , bla OXA-48 , bla OXA-181 , bla OXA-51 , and bla OXA-23 , respectively. None of the isolates tested positive for bla OXA-40 and bla OXA-58. Two allelic variants of bla NDM (bla NDM-1 and bla NDM-25) were detected. BOX-PCR revealed high clonal relatedness between CRKP isolates. Conclusion: MHT was more sensitive than Carba NP test for evaluating carbapenemase production and class D carbapenemase genes were the most prevalent of the 12 carbapenemase genes that were evaluated.

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“…Over the past few decades, K. pneumoniae, a Gram-negative pathogen, has emerged as a pathogen of concern posing serious challenges to the treatment regimens [6,7]. Carbapenems are considered as the drug of choice for treating infections by ESBL strains of K. pneumoniae.…”

Section: Discussionmentioning

confidence: 99%

Complicated urinary tract infection with Extensive Drug resistant Klebsiella pneumoniae treated with combinatorial therapy of CSE-1034 along with Carbapenems. A case report and the review of literature

Saseedharan

2018

Asian J Pharm Clin Res

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Colistin is considered one of the last available therapeutic options to treat infections caused by carbapenem-resistant Klebsiella pneumoniae (CRKP).However, with an increase in the use of colistin to treat CRKP infections, colistin resistance is emerging and there are no standard treatment regimensfor these type of infections. In the present case report, we are discussing a case of 64-year-old male patient having complicated urinary tract infection(cUTI) by CRKP, treated successfully with ceftriaxone+sulbactam+EDTA (CSE-1034) and carbapenem combination therapy. Conclusively, CSE-1034 incombination with or without carbapenems could be a successful therapeutic option for the treatment of CRKP cUTI cases.

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Prevalence and characterization of carbapenem-resistant Klebsiella pneumoniae isolated from intensive care units of Mansoura University hospitals

Cited by 19 publications

References 31 publications

The Inc FII Plasmid and its Contribution in the Transmission of blaNDM-1 and blaKPC-2 in Klebsiella pneumoniae in Egypt

The Inc FII Plasmid and its Contribution in the Transmission of blaNDM-1 and blaKPC-2 in Klebsiella pneumoniae in Egypt

<p>The First Egyptian Report Showing the Co-Existence of <em>bla</em><sub>NDM-25</sub>, <em>bla</em><sub>OXA-23</sub>, <em>bla</em><sub>OXA-181</sub>, and <em>bla</em><sub>GES-1</sub> Among Carbapenem-Resistant <em>K. pneumoniae</em> Clinical Isolates Genotyped by BOX-PCR</p>

Complicated urinary tract infection with Extensive Drug resistant Klebsiella pneumoniae treated with combinatorial therapy of CSE-1034 along with Carbapenems. A case report and the review of literature

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