The Molecular Characterization of Nosocomial Carbapenem-Resistant Klebsiella pneumoniae Co-Harboring blaNDM and blaOXA-48 in Jeddah

Abstract

Carbapenem-resistant Klebsiella pneumoniae (CRKP)-associated infections have become a major concern and life-threatening worldwide. Understanding the epidemiology of CRKP using a reliable molecular technology can help to develop an effective infection control policies. In the western region of Saudi Arabia, there are no sufficient data on the prevalence of CRKP and its carbapenem-resistant determinants. Therefore, this study aimed to determine the molecular epidemiology of CRKP and identify the most common carbapenemase genes. In the current study, a total of 191 CRKP isolates were collected and obtained from clinical specimens of patients at King Fahad Armed Forces Hospital (KFAFH), Jeddah, Saudi Arabia. All isolates that were resistant or intermediately susceptible to either of the carbapenem antimicrobials (imipenem, meropenem, or ertapenem) were included. All CRKP showed resistance to ceftazidime, cefepime, and piperacillin/tazobactam, whereas low (14%) and moderate (37.7%) levels of resistance were reported against tigecycline and colistin, respectively. The most common carbapenemase genes identified were blaOXA-48 (n = 157 [82.2%]), followed by blaNDM in 27 (14%) isolates. The blaVIM and blaKPC were reported in only one isolate each and no blaIMP producers were detected among all tested isolates. The high prevalence of OXA-48 among K. pneumoniae isolates reported in the current study may reflect that OXA-48 has become an endemic in Saudi Arabian hospitals. The second major finding was that the identification of CRKP co-harbors both blaNDM and blaOXA-48, and such isolates can be threating for healthcare societies (patients and healthcare workers) due to their high level of resistance to carbapenems. These results suggest that the use of molecular diagnostic methods and proper surveillance programs are required to monitor and control the spread of all multidrug-resistant (MDR) bacteria, including CRKP. Therefore, further research is recommended to expand the study and further analyze the genotyping of the most common clones of CRKP in other hospitals in the western regions of Saudi Arabia.

Ceftazidime-Avibactam plus aztreonam synergistic combination tested against carbapenem-resistant Enterobacterales characterized phenotypically and genotypically: a glimmer of hope

“…Furthermore, in Iraq; Haji et al [20] reported bla VIM gene to be the most prevalent gene detected and no bla KPC gene was found. Regarding Saudi Arabia, Alhazmi et al [27] found that bla OXA-48 gene was the most common gene detected, and consistent with our results all of their isolates were negative for the bla IMP gene.…”

Identification and Characterization of Plasmids and Genes from Carbapenemase-Producing Klebsiella pneumoniae in Makkah Province, Saudi Arabia

“…On the other hand, no isolates exhibited positivity for the KPC production activity, as shown in Table 5 . The KPC enzyme is considered one of the non-dominant genes in the K. pneumoniae bacterium isolated in Saudi Arabia, which was previously monitored in studies conducted on wastewater [ 41 , 42 ].…”

Clinical and epidemiological characteristics of multi-drug resistant Enterobacterales isolated from King Fahad Hospital of the University, AlKhobar, Saudi Arabia

“…For instance, In Riyadh city, the antibiotic resistance profile of MDR-KP and the carbapenem MICs for most strains were 16 µg/mL [ 22 ]. Similarly, a recent report from Jeddah, Saudi Arabia, showed elevated MRP and IMIP MICs (above 16 g/mL) in CRE K. pneumonia isolates co-harbouring OXA-48 and New Delhi metallo-beta lactamase (NDM) carbapenemases [ 23 ]. However, the studies mentioned above targeted MDR-KP isolates (similar to our study), and not all K. pneumonia strains were received in the microbiological laboratory.…”