Co-existence of
 bla
 NDM-1
 and
 bla
 KPC-2
 in clinical isolates of
 Klebsiella pneumoniae
 from Pakistan

Sattar, Harse; Toleman, Mark A.; Nahid, Fouzia; Zahra, Rabaab

doi:10.1179/1973947814y.0000000223

Cited by 31 publications

(27 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As previously reported 37 , this isolate should be multi-drug resistant against most antibiotics, excluding tigecycline. Previous studies only found this double carbapenemase-producer in K. pneumoniae, E. cloacae, Citrobacter freundii and Enterobacter hormaechei isolates from Brazil, Pakistan, China, and India 38 39 40 41 42 . However, we did not find the mutation of outer membrane porin (Omp) in KPC or NDM-producing isolates.…”

Section: Discussionmentioning

confidence: 85%

The role of doxycycline in the therapy of multidrug-resistant E. coli – an in vitro study

Lai

Chen

Huang

et al. 2016

Sci Rep

View full text Add to dashboard Cite

This study assessed the in vitro antibacterial activity of combinations of amikacin and doxycycline or tigecycline against multidrug-resistant E. coli isolates. Twenty-four different pulsotypes, including 10 extended-spectrum β-lactamase (ESBL)-, 10 carbapenem-resistant, 2 New Delhi Metallo-beta-lactamase (NDM)- and 2 Klebsiella pneumoniae carbapenemase (KPC)-E. coli isolates were collected. All 24 isolates were susceptible to amikacin and tigecycline. Only 30% of ESBL and 50% of carbapenem-resistant E. coli were susceptible to doxycycline. Both of the NDM-E. coli had a MIC of 64 μg/ml. The checkerboard method showed that for the ESBL- and carbapenem-resistant E. coli, the synergistic effects of amikacin/doxycycline were 80% and 90%, respectively. For the two KPC- and two NDM-E. coli, the FIC index of amikacin/doxycycline were 0.5/0.375 and 0.5/0.281, respectively. For the ESBL- and carbapenem-resistant E. coli isolates, the combinations of amikacin and doxycycline exhibited synergistic activities against 80%, and 80% and 10% vs 60%, and 80% and 10% of the isolates at concentrations of 1x, 1/2x and 1/4xMIC, respectively. The synergistic effect seems to be similar for doxycycline and tigecycline based combinations with amikacin. In conclusion, the antibacterial activity of doxycycline can be enhanced by the addition of amikacin and is observed against most multidrug-resistant E. coli isolates.

show abstract

Section: Discussionmentioning

confidence: 85%

The role of doxycycline in the therapy of multidrug-resistant E. coli – an in vitro study

Lai

Chen

Huang

et al. 2016

Sci Rep

View full text Add to dashboard Cite

show abstract

“…As with KPC, coexistence of NDMs and other carbapenemases in K. pneumoniae has also been reported worldwide, in Brazil (NDM-1/KPC-2; Pereira et al, 2015 ), Malaysia (NDM-1/OXA-232; Al-Marzooq et al, 2015 ), South Korea (NDM-5/OXA-181; Cho et al, 2015 ), China (NDM-1/IMP-4; Chen et al, 2015 ), India (NDM-1/OXA-232; Al-Marzooq et al, 2015 ), Turkey (NDM-1/OXA-48; Kilic and Baysallar, 2015 ), Pakistan (NDM-1/KPC-2; Sattar et al, 2014 ), Switzerland (NDM-1/OXA-48; Seiffert et al, 2014 ), United Arab Emirates (NDM-1/OXA-48-like; Dash et al, 2014 ), Australia (NDM-1/OXA-48; Sidjabat et al, 2015 ), Morocco (NDM-1/OXA-48; Barguigua et al, 2013 ), Singapore (NDM-1/OXA-181 and NDM-5/OXA-181; Balm et al, 2013 ), and the USA (NDM-1/OXA-232; Doi et al, 2014 ).…”

Section: The Epidemiology Genetic Context Treatment Options and Dementioning

confidence: 99%

Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods

et al. 2016

View full text Add to dashboard Cite

The emergence of carbapenem-resistant Gram-negative pathogens poses a serious threat to public health worldwide. In particular, the increasing prevalence of carbapenem-resistant Klebsiella pneumoniae is a major source of concern. K. pneumoniae carbapenemases (KPCs) and carbapenemases of the oxacillinase-48 (OXA-48) type have been reported worldwide. New Delhi metallo-β-lactamase (NDM) carbapenemases were originally identified in Sweden in 2008 and have spread worldwide rapidly. In this review, we summarize the epidemiology of K. pneumoniae producing three carbapenemases (KPCs, NDMs, and OXA-48-like). Although the prevalence of each resistant strain varies geographically, K. pneumoniae producing KPCs, NDMs, and OXA-48-like carbapenemases have become rapidly disseminated. In addition, we used recently published molecular and genetic studies to analyze the mechanisms by which these three carbapenemases, and major K. pneumoniae clones, such as ST258 and ST11, have become globally prevalent. Because carbapenemase-producing K. pneumoniae are often resistant to most β-lactam antibiotics and many other non-β-lactam molecules, the therapeutic options available to treat infection with these strains are limited to colistin, polymyxin B, fosfomycin, tigecycline, and selected aminoglycosides. Although, combination therapy has been recommended for the treatment of severe carbapenemase-producing K. pneumoniae infections, the clinical evidence for this strategy is currently limited, and more accurate randomized controlled trials will be required to establish the most effective treatment regimen. Moreover, because rapid and accurate identification of the carbapenemase type found in K. pneumoniae may be difficult to achieve through phenotypic antibiotic susceptibility tests, novel molecular detection techniques are currently being developed.

show abstract

“…Hence it is of great significance to understand the genetic context of carbapenemases and how carbapenemase-producing strains further evolve resistance to the last remaining active antibiotics such as colistin. Carbapenemases including VIM, IMP, OXA-48, KPC and NDM-1 have been reported from Pakistan recently [ 7 – 9 ]. However, the knowledge about the variants of these acquired carbapenemases and their genetic contexts still remain scarce.…”

Section: Introductionmentioning

confidence: 99%

A blaOXA-181-harbouring multi-resistant ST147 Klebsiella pneumoniae isolate from Pakistan that represent an intermediate stage towards pan-drug resistance

2017

Self Cite

View full text Add to dashboard Cite

Carbapenem resistant Klebsiella pneumoniae (CR-KP) infections are an ever-increasing global issue, especially in the Indian subcontinent. Here we report genetic insight into a blaOXA-181 harbouring Klebsiella pneumoniae, belonging to the pandemic lineage ST147, that represents an intermediate stage towards pan-drug resistance. The CR-KP isolate DA48896 was isolated from a patient from Pakistan and was susceptible only to tigecycline and colistin. It harboured blaOXA-181 and was assigned to sequence type ST147. Analysis from whole genome sequencing revealed a very high sequence similarity to the previously sequenced pan-resistant K. pneumoniae isolate MS6671 from the United Arab Emirates. The two isolates are very closely related with only 46 chromosomal nucleotide differences, 14 indels and differences in plasmid content. Both carry a substantial number of plasmid-borne and chromosomally encoded resistance determinants. Interestingly, the two differences in susceptibility between the isolates could be attributed to DA48896 lacking an insertion of blaOXA-181 into the mgrB gene that results in colistin resistance in MS6671 and SNPs affecting AcrAB efflux pump expression likely to result in tigecycline resistance. These differences between the otherwise very similar isolates indicate that strong selection has occurred for resistance towards these last-resort drugs and illustrates the trajectory of resistance evolution of OXA-181-producing versions of the ST147 international risk clone.

show abstract

Co-existence of bla _NDM-1 and bla _KPC-2 in clinical isolates of Klebsiella pneumoniae from Pakistan

Cited by 31 publications

References 14 publications

The role of doxycycline in the therapy of multidrug-resistant E. coli – an in vitro study

The role of doxycycline in the therapy of multidrug-resistant E. coli – an in vitro study

Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods

A blaOXA-181-harbouring multi-resistant ST147 Klebsiella pneumoniae isolate from Pakistan that represent an intermediate stage towards pan-drug resistance

Contact Info

Product

Resources

About

Co-existence of bla NDM-1 and bla KPC-2 in clinical isolates of Klebsiella pneumoniae from Pakistan

Cited by 31 publications

References 14 publications

The role of doxycycline in the therapy of multidrug-resistant E. coli – an in vitro study

The role of doxycycline in the therapy of multidrug-resistant E. coli – an in vitro study

Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods

A blaOXA-181-harbouring multi-resistant ST147 Klebsiella pneumoniae isolate from Pakistan that represent an intermediate stage towards pan-drug resistance

Contact Info

Product

Resources

About

Co-existence of bla _NDM-1 and bla _KPC-2 in clinical isolates of Klebsiella pneumoniae from Pakistan