Spread of NDM-1-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Istanbul, Turkey

Poirel, Laurent; Yılmaz, Mesut; Istanbullu, Ayse; Arslan, Ferhat; Mert, Ali; Bernabeu, Sandrine; Nordmann, Patrice

doi:10.1128/aac.02047-13

Cited by 60 publications

(51 citation statements)

References 27 publications

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“…However, decreased resistance rates were observed to piperacillin-tazobactam (45%), ciprofloxacin (36%), gentamicin (30%), levofloxacin (27%), and amikacin (9%). Several studies have shown that K. pneumoniae isolates are resistant to antibiotics such as thirdgeneration cephalosporins, carbapenems, fluoroquinolones, and aminoglycosides [26,27]. Lowlevel resistance to amikacin and gentamicin may be good news in the K.pneumoniae-related infections for our isolates and furthermore, ciprofloxacin and piperacillin-tazobactam resistance is in line with a recent study, 29.9% and 22.3%, respectively [28].…”

Section: Discussionsupporting

confidence: 84%

Comparison of biofilm formation and efflux pumps in ESBL and carbapenemase producing Klebsiella pneumoniae

Yazgan

Türkel

Güçkan

et al. 2018

J Infect Dev Ctries

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Introduction: Klebsiella pneumoniae is an opportunistic pathogen that causes a range of diseases. The appearance of extended-spectrum β-lactamase -and carbapenemase-producing strains, in addition to the biofilm-forming phenotype, is a major problem in the clinical environment. Methodology: A total of 33 clinical K. pneumoniae isolates were used in this study. Antimicrobial susceptibilities were assessed by a disc diffusion assay. Biofilm formation was determined by a microtiter plate assay, staining with 1% crystal violet and measuring absorbance after destaining. Moreover, expression of acrA, kdeA, ketM, kpnEF, and kexD efflux associated genes was measured by qRT-PCR. Results: Isolates displayed high resistance to β-lactams such as cefazolin, cefuroxime, ceftriaxone, cefepime, piperacillin-tazobactam, imipenem, and meropenem and decreased resistance to gentamicin, amikacin, ciprofloxacin, and levofloxacin. ESBL-producing isolates formed more biofilm than carbapenemase-producing isolates. The mRNA expression levels in KPC isolates for acrA (2-fold), kdeA (2.7-fold), ketM (2.2-fold), and kpnEF (3.4-fold) were significantly increased compared to ESBL-producing isolates. There was no significant difference in kexD expression level. Conclusions: Under the conditions used here ESBL-producing isolates formed more biofilm than KPC postive isolates; this was associated with virulence determinants which were also transferred by plasmids together with ESBLs enzymes. Moreover, the upregulation of acrA, kdeA, ketM, and kpnEF efflux pumps was seen in carbapenemase-producing isolates demonstrating that high expression of efflux pumps alone could not confer resistance but may act as a physiological determinant such as bacterial pathogenicity and virulence, and cell-to-cell communication for bacteria.

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Section: Discussionsupporting

confidence: 84%

Comparison of biofilm formation and efflux pumps in ESBL and carbapenemase producing Klebsiella pneumoniae

Yazgan

Türkel

Güçkan

et al. 2018

J Infect Dev Ctries

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“…However, these antibiotics frequently show unfavourable pharmacokinetics and adverse effects, mainly in patients with underlying conditions. NDM-1-producing Enterobacteriaceae, in particular K. pneumoniae and Enterobacter cloacae, have been previously reported in Istanbul, Turkey (Poirel et al, 2012(Poirel et al, , 2014. NDM-1-producing K. pneumoniae was probably imported into Turkey from Iraq (Poirel et al, 2012).…”

Section: Discussionmentioning

confidence: 90%

NDM-1-producing Acinetobacter baumannii ST85 now in Turkey, including one isolate from a Syrian refugee

Heydari

Mammina

Köksal

2015

Journal of Medical Microbiology

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New Delhi metallo-b-lactamase-1 (NDM-1), an acquired class B carbapenemase, is a significant clinical threat owing to the extended hydrolysis of b-lactams including carbapenems. Here, to the best of our knowledge we describe for the first time in Turkey two NDM-1-producing Acinetobacter baumannii isolates recovered from intensive care unit patients. The presence of bla NDM-1 was detected by PCR and confirmed by sequencing. The clonal relationship was assessed by PFGE and multilocus sequence typing. Both isolates were positive for bla NDM-1 and were attributed with the sequence type 85. One isolate was from a Syrian refugee, whereas the second was from a patient who had never travelled outside Turkey. Our findings confirmed that the rapid spread of NDM-1-producing Gram-negative organisms could become a major challenge for the treatment and control of healthcare-associated infections in our geographical area. They suggest also that NDM-1-producing strains and/or their genetic determinants are probably being imported from Syria to neighbouring countries.

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“…Infections caused by carbapenemresistant Enterobacteriaceae in infants and children are of great concern, as these individuals do not tolerate the various available agents, which frequently makes carbapenems the last-resort therapeutic option for treating severe infections in children. Curiously, reports of pediatric outbreaks caused by ST14 were found in Italy, where isolates carried FOX-7 AmpC ␤-lactamase (46); in Tanzania, where isolates carried the ESBL CTX-M-15 (50); and in Turkey, where isolates carried NDM-1 (48).…”

Section: Discussionmentioning

confidence: 99%

A Two-Year Surveillance in Five Colombian Tertiary Care Hospitals Reveals High Frequency of Non-CG258 Clones of Carbapenem-Resistant Klebsiella pneumoniae with Distinct Clinical Characteristics

Ocampo

Chen

Cienfuegos-Gallet

et al. 2016

Antimicrob Agents Chemother

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The global spread of carbapenem-resistant Klebsiella pneumoniae (CR-Kp) has been largely associated with sequence type 258 (ST258) and its related variants (clonal group 258 [CG258]). Here we describe the molecular epidemiology of CR-Kp from five tertiary care hospitals in Medellín, the second largest city in Colombia. All CR-Kp-infected patients admitted from June 2012 to June 2014 were included (n ‫؍‬ 193). Patients' clinical information was obtained from medical records. Carbapenemase KPC, VIM, IMP, NDM, and OXA-48 genes were detected by PCR. A CG258-tonB79 cluster-specific real-time PCR (targeting the multilocus sequence type [MLST] tonB79 allele), pulsed-field gel electrophoresis (PFGE), and MLST analysis were performed for typing. Remarkably, 62.2% (n ‫؍‬ 120) of isolates were from STs unrelated to CG258 (non-CG258). KPC-3 predominated in CG258 isolates (86.3%), while KPC-2 prevailed in non-CG258 isolates (75.5%) (P < 0.001). Multidrug resistance (MDR) frequency was significantly higher in CG258 strains (91.4% versus 56.1%; P < 0.001). ST512 (a single-locus variant of ST258) is the main ST in CG258 (96.3%), and isolates in this group showed closely related pulsotype and similar resistance gene profiles, suggesting the clonal spread of this strain. In contrast, high heterogeneity of STs (34/54), including eight novel STs, was found in non-CG258 isolates. Among non-CG258 isolates, ST14 (13.3%; n ‫؍‬ 16) and ST307 (14.2%; n ‫؍‬ 17) were the most frequent, and they showed distinct molecular and clinical characteristics in comparison to CG258 isolates. Our results suggest that the dissemination of carbapenem resistance in Medellín is due to heterogeneous K. pneumoniae clones, likely the result of horizontal transmission of KPC in different unrelated lineages, further highlighting the challenge in CR-Kp infection control and the need for a multifocal intervention. Carbapenem-resistant Klebsiella pneumoniae (CR-Kp) is currently one of the most important pathogens causing health care-associated infections, which typically occur in patients with prolonged hospital stay and previous antibiotic exposure (1-3). The most common mechanism of carbapenem resistance in K. pneumoniae is the production of carbapenemases, among which K. pneumoniae carbapenemase (KPC) is by far the most relevant and prevalent (4, 5).Since the initial identification of KPC in 1996 in North Carolina (6), KPC-producing strains have spread worldwide, causing major hospital outbreaks in North America, Europe, Asia, and Latin America (2, 7, 8) and leading to a reduction of therapeutic options that has resulted in high mortality and morbidity rates and increasing length of hospital stay and associated costs (2, 4, 5, 9). The global spread of KPC-producing Klebsiella pneumoniae (KPC-Kp) has been linked mostly to one genetic lineage, the multilocus sequence type 258 (ST258) and its related variants, i.e., clonal group 258 (CG258) (1, 10, 11). Members of CG258 include ST258, its single-locus variants (SLVs) (e.g., ST11, ST512, ST340, and ST437), and the...

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Spread of NDM-1-Producing Enterobacteriaceae in a Neonatal Intensive Care Unit in Istanbul, Turkey

Cited by 60 publications

References 27 publications

Comparison of biofilm formation and efflux pumps in ESBL and carbapenemase producing Klebsiella pneumoniae

Comparison of biofilm formation and efflux pumps in ESBL and carbapenemase producing Klebsiella pneumoniae

NDM-1-producing Acinetobacter baumannii ST85 now in Turkey, including one isolate from a Syrian refugee

A Two-Year Surveillance in Five Colombian Tertiary Care Hospitals Reveals High Frequency of Non-CG258 Clones of Carbapenem-Resistant Klebsiella pneumoniae with Distinct Clinical Characteristics

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