Detection of plasmid-mediated colistin resistance in carbapenem-resistant Escherichia coli and Klebsiella pneumoniae isolates in Suez Canal University Hospitals

Khattab, Sally; Sweify, Mohamed Ali Al; Metwally, Lobna; Elazab, Sahar; Hashem, Asmaa

doi:10.21608/mid.2021.78200.1162

Cited by 3 publications

(8 citation statements)

References 12 publications

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“…Klebsiella spp were the most frequent CRGNB isolates (36.1%) followed by Escherichia coli (32.9%), Pseudomonas aeruginosa (12.9%), Acinetobacter spp (8.4%), Enterobacter spp (5.8%) and Citrobacter spp (3.9%). Matching with carbapenem resistance rates (54.5% and 55.8%) in previous studies 17,4 . On the contrary, lower rates (18.5% and 23.1%) were reported in other studies 18-19 .…”

Section: Discussionsupporting

confidence: 60%

“…Carbapenem resistant Enterobacteriaceae (CRE) comprise both carbapenemase producing (CP-CRE) which produce carbapenemase enzymes hydrolyzing carbapenem and non-carbapenemase producing CRE (non-CP-CRE) strains that have other causes like drug efflux pumps and outer membrane protein structural mutations resulting in drug impermeability 4,23 . In this research, 129 of CRGNB isolates (83.2%) were carbapenemase positive by mCIM, among them 85 isolates (65.9%) were metallo-β lactamase producers.…”

Section: Discussionmentioning

confidence: 99%

“…The polymyxins including colistin are considered the last choice of antibiotics for treatment of infections with carbapenem resistant Gram-negative bacilli (CRGNB). Colistin interacts with the bacterial outer membrane by removing divalent cations from the negatively-charged phosphate groups of the Lipid A leading to cell lysis 4 . Colistin is very effective against most Enterobacterales and non-fermenting Gramnegative pathogens such as Pseudomonas aeruginosa and Acinetobacter baumannii.…”

Section: Introductionmentioning

confidence: 99%

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Assessment of Colistin Susceptibility among Carbapenem-Resistant Clinical Isolates

Ajlan¹,

Elmahdy

Sleem

2022

Egyptian Journal of Medical Microbiology

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Background: Colistin is the last treatment option for infections caused by carbapenem resistant Gram-negative bacilli (CRGNB). The increasing spread of chromosomally encoded and plasmid-mediated colistin resistance made colistin susceptibility assessment a necessity. Objectives: Assessment of colistin susceptibility in CRGNB by broth micro dilution method (BMD), as the standard method and colistin broth disk elution method (CBDE), as a substitute procedure with genotypic determination of plasmid mediated colistin resistance (mcr) genes. Methodology: CRGNB were collected and identified by conventional methods. Testing carbapenemase production by modified Carbapenem Inactivation Method (mCIM) and colistin susceptibility (by BMD and CBDE) were done and results were interpreted regarding CLSI ( 2022) guidelines followed by genotypic detection of mcr-1, -2, -3, -4, and -5 genes by multiplex PCR. Results: 155 out of 308 GNB (50.3%) were carbapenem resistant. Among them, 129 (83.2%) isolates were carbapenemase positive by mCIM. Colistin susceptibility testing by BMD revealed 43 out of 155 CRGNB isolates (27.7%) were colistin resistant. Sensitivity, specificity, PPV, NPV and accuracy of CBDE were 99.09%, 93.33%, 97.32% 97.67%, 97.42% respectively with almost perfect agreement with BMD. By PCR, only 3 CRGNB isolates (6.98%) carried mcr-1 while other mcr genes were not detected at all. Conclusion: Colistin resistance rate among CRGNB is concerning, causing serious and even deadly infections so prospective surveillance is essential. Broth disk elusion method is a simple, non-expensive reliable option to test colistin susceptibility.

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Section: Discussionsupporting

confidence: 60%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Assessment of Colistin Susceptibility among Carbapenem-Resistant Clinical Isolates

Ajlan¹,

Elmahdy

Sleem

2022

Egyptian Journal of Medical Microbiology

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“…Of them, 35 were discovered to be colistin resistant. Multiplex PCR revealed that some mcr-genes (mcr-1, mcr-2, and mcr-3 genes) were found in 44% (21) isolates, 95% (20) E. coli, and 5% (1) K. pneumoniae. mcr-1 (85%), mcr-1 and mcr-2 combined (5%), mcr-2 alone (5%), and mcr-2 alone and mcr-3 combined (5%).…”

Section: Discussionmentioning

confidence: 99%

“…The amplification was seen by gel-electrophoresis on 1.5% agarose gel (at 130 Volts), followed by ethidiumbromide staining. 21,22…”

Section: Dna Extraction and Pcr Amplificationmentioning

confidence: 99%

Detection of Plasmid-Mediated Colistin Resistance Genes in Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from Some Hospitals in Khartoum

Abdelmagid¹,

Hamoda²,

Hassan³

et al. 2023

Ind. J. Pharm. Pract.

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Background: Currently, a final-resort therapy for MDR Klebsiella pneumoniae and Escherichia coli is the antibiotic colistin (polymyxin E). Plasmid-mediated colistinresistance genes (mcr-9, mcr-8, mcr-5, mcr-3, mcr-2 and mcr-1) is one of the mechanisms by which these bacteria resist colistin. The aim of the study is to evaluate the presence of these genes in isolates of Klebsiella pneumoniae and Escherichia coli that are phenotypically colistin-resistant in a number of hospitals in Khartoum State. Materials and Methods: One hundred eighty-five bacterial strains (gram-negative rods) were identified from clinical specimens of male and female hospitalized patients. Various patients' urine, wounds, tissues, and blood samples were obtained. Isolates were identified using conventional methods of identification. Antimicrobial susceptibility testing for colistin was conducted using the disc diffusion method. Colistin-resistant K. pneumoniae and E. coli isolates were isolated and conventional PCR was employed to identify plasmid-mediated mcr-9, mcr-8, mcr-5, mcr-3, mcr-2 and mcr-1genes. The Chi-square test was administered, and p-values of 0.05 were deemed statistically significant. Results: The disc diffusion method revealed that around 35 (18%) of 185 isolates were resistant to colistin. 21 (60%) of the 35 colistin-resistant isolates were E. coli, and 14 (40%) were K. pneumoniae. All 35 colistin-resistant isolates and 13 colistin-susceptible isolates were examined for colistin-resistant genes. In 21 of 48 tested isolates, colistin-resistant genes were found. 14 (66%) of 21 isolates were resistant according to both the disc diffusion and PCR tests. There were determined to be mcr-3, mcr-2, and mcr-1 gene. mcr-1 accounted for 18 (85%), 5% mcr-1 combined with mcr-2 , 5% mcr-2 , and 5% mcr-2 in combination with mcr-3. Conclusion: The frequency of colistin-resistant E. coli and K. pneumoniae in Sudanese hospitals was found to be worrisome, thereby reducing the range of available treatment alternatives. The emergence of the colistin-resistant genes mcr-2 and mcr-1 in some Sudanese hospitals is caused by plasmids, and this is a problem for hospitals because horizontal transfer of this plasmid could cause the resistance to spread to many isolates there.

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Carbapenem Resistance in Gram-Negative Bacteria: A Hospital-Based Study in Egypt

et al. 2023

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Background and Objectives: The global spread of carbapenem resistance and the resulting increase in mortality forced the World Health Organization (WHO) to claim carbapenem-resistant enterobacteriaceae (CRE) as global priority pathogens. Our study aimed to determine the prevalence of carbapenemase-encoding genes and major plasmid incompatibility groups among Gram-negative hospital-based isolates in Egypt. Material and Methods: This cross-sectional study was carried out at Mansoura University Hospitals over 12 months, from January to December 2019. All the isolates were tested for carbapenem resistance. The selected isolates were screened by conventional polymerase chain reaction (PCR) for the presence of carbapenemase genes, namely blaKPC, blaIMP, blaVIM, and blaNDM-1. PCR-based plasmid replicon typing was performed using the commercial PBRT kit. Results: Out of 150 isolates, only 30 (20.0%) demonstrated carbapenem resistance. Klebsiella pneumoniae was the most resistant of all isolated bacteria, and blaNDM was the predominant carbapenemases gene, while the most prevalent plasmid replicons were the F replicon combination (FIA, FIB, and FII) and A/C. Plasmids were detected only in Klebsiella pneumoniae, Escherichia coli, Enterobacter cloacae, and Pseudomonas aeruginosa. Remarkably, we found a statistically significant association between carbapenemase genes and plasmid replicons, including blaNDM, IncA/C, and IncX. Conclusions: Our study demonstrated an alarming rise of plasmid-mediated carbapenem-resistant bacteria in our locality. The coexistence of resistance genes and plasmids highlights the importance of a targeted antibiotic surveillance program and the development of alternative therapeutic options at the local and international levels. Based on our results, we suggest a large-scale study with more Enterobacteriaceae isolates, testing other carbapenemase-encoding genes, and comparing the replicon typing method with other plasmid detection methods. We also recommend a national action plan to control the irrational use of antibiotics in Egypt.

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Detection of plasmid-mediated colistin resistance in carbapenem-resistant Escherichia coli and Klebsiella pneumoniae isolates in Suez Canal University Hospitals

Cited by 3 publications

References 12 publications

Assessment of Colistin Susceptibility among Carbapenem-Resistant Clinical Isolates

Assessment of Colistin Susceptibility among Carbapenem-Resistant Clinical Isolates

Detection of Plasmid-Mediated Colistin Resistance Genes in Clinical Isolates of Klebsiella pneumoniae and Escherichia coli from Some Hospitals in Khartoum

Carbapenem Resistance in Gram-Negative Bacteria: A Hospital-Based Study in Egypt

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