Detection and Characterization of Carbapenem Resistant Enterobacteriacea in Sohag University Hospitals

Abstract

The spread of carbapenem resistance among Enterobacteriaceae have become a problem for healthcare facilities worldwide. Community and hospital-acquired infections caused by these bacteria have been associated with significant morbidity and mortality with limited treatment options. Rapid detection of carbapenem resistant Enterobacteriaceae (CRE) is important for infection control. Objectives: To detect the prevalence of carbapenem resistant Enterobacteriaceae (CRE) species and determine their antimicrobial susceptibility profile using the Vitek 2 system and the presence of carbapenemases genes using Multiplex PCR. Methodology: Various clinical samples were collected from 469 patients from Sohag University Hospitals in the period between August 2016 and April 2018, CRE isolates were identified by conventional methods and antimicrobial susceptibility testing using disc diffusion method and also performed by Vitek 2 automated system, Multiplex PCR was used for detection of carbapenemases genes as blaKPC, blaVIM, blaIMP, blaNDM-1 and blaOXA-48. Results: The prevalence of carbapenem resistant Enterobacteriaceae (CRE) species was 19.9%, Klebsiella pneumoniae was the most common species (51.4%), Escherichia coli (28.6%), Enterobacter aerogenes(8.6%) and Acinetobacter baumannii (5.7%). Vitek 2 system identified CRE isolates with 82.7% sensitivity, 98.6 % specificity and 90.6% diagnostic accuracy 25.7% of CRE strains were isolated from the internal ICU and 20 % from Chest Department, and mostly isolated from urine(40%) and from endotracheal tubes swabs(28.6 %) 77.1 % of CRE isolates contained carbapenemases genes, 62.1 % were blaKPC positive, 20.7 % were blaVIM-positive, 3.4 % were blaNDM-positive, 13.8 % were blaOXA-48-positive and none was blaIMP-positive. Conclusion: Conventional methods supported by Vitek 2 system is a valuable method for identification of CRE species, the detected carbapenemases genes in this study indicate that carbapenem resistance is spreading in Egypt and support the use of molecular methods for the rapid detection of CRE for successful implementation of infection control measures. We recommend routine testing to determine carbapenem resistance in Enterobacteriaceae in health facilities in Egypt.

Phenotypic Detection of Carbapenem Resistant Enterobacteriaceae Isolates and Assessment of Their Susceptibility to the Novel Ceftazidime-Avibactam Combination

“…The current study showed that most of CRE were isolated from urine samples. Similar finding was found by Mohamed et al 22 in Egypt. However, Amer et al 19 in Egypt; Pang et al 25 in China reported that most of CRE were isolated from blood, tracheal aspirate samples respectively.…”

“…Nineteen out of 25 CRE isolates were K. pneumoniae (76%), so it was the most common CRE isolated from ICU. Other studies performed by Xu et al 26 , Baran and Aksu 1 , Pang et al 25 , and Mohamed et al 22 also reported that K. pneumoniae was the most common CRE isolated. On the other hand, Amjad et al 27 reported that E-coli was the most common CRE.…”

Molecular Detection of bla OXA-48 Carbapenemase in Uropathogenic Klebsiella pneumoniae Strains from Suez Canal University Hospital

“…This finding is consistent with those of Al-Zahrani and Alasiri in Saudia Arabia which reported that ICU patients are more vulnerable population to K. pneumoniae infections representing 42.6% 20 . A recent Egyptian study reported that the prevalence of CRE species was 19.9% in Sohag and Klebsiella Pneumoniae was the most common isolated species representing 51.4% of the isolates 21 . Previous studies have also reported that ICU admission was associated with KPC colonization and infection 22, 23 .…”

Detection of Carbapenemase Producing Enterobacteriaceae using the Modified Carbapenem Inactivation Method

“…Infections caused by CRE are accompanied with high deaths due to narrow treatment choices; treatment options involve antibiotics that are both less effective and more toxic than β-lactams. 3 Detection of carbapenemases in microbiology laboratories is a challenge; accurate and fast detection methods are importantly needed. The detection of carbapenemases in Enterobacteriaceae consists of a screening step followed by a confirmatory step.…”