Emergence of co-existence of blaNDM with rmtC and qnrB genes in clinical carbapenem-resistant Klebsiella pneumoniae isolates in burning center from southeast of Iran

Abstract

Dissemination of carbapenemase-producing Klebsiella pneumoniae along with 16S rRNA methyltransferase (16S-RMTase) has been caused as a great concern for healthcare settings. The aim of this study was to investigate the prevalence of resistance genes among K. pneumoniae isolates. During October 2015 to February 2016, 30 non-duplicative K. pneumoniae strains were isolated from clinical specimens in a burn center in Kerman, Iran. Antibiotic susceptibility tests of isolates, carbapenemase, extended-spectrum beta-lactamases (ESBLs) and AmpC beta-lactamase-producing isolates were determined by phenotypic methods. The beta-lactamase, oqxA/B efflux pumps, qnr A, B, S, 16S-RMTase (rmt A, B, and C), and mcr-1 resistance genes were determined by PCR. Enterobacterial repetitive intergenic consensus (ERIC)-PCR was used for molecular typing. According to our findings, tigecycline has been shown the most active agent against K. pneumoniae isolates. Antibiotic resistance genes, bla, bla, bla, bla, bla, bla, bla, bla, bla, bla, rmtC, qnrB, qnrS, oqxA, and oqxB, were detected in 11 (36.7%), 13 (43.3%), 11 (36.6%), 5 (16.6%), 9 (30%), 1 (3.3%), 1 (3.3%), 1 (3.3%), 1 (3.3%), 2 (6.7%), 1 (3.3%), 9 (30%), 2 (6.7%), 18 (60%), and 13 (43.3%) of isolates, respectively. The bla with rmtC was simultaneously observed in one isolate. ERIC-PCR results revealed 25 distinct patterns in eight clusters (A-H) and five singletons. This study highlights the high prevalence of bla and emergence of rmtC among carbapenem-resistant K. pneumoniae. The resistance genes are often co-located on the conjugative plasmids, so it might be the reason of the rapid spread of them. The prevalence of multidrug-resistant K. pneumoniae isolates limits the available treatment options and presents tremendous challenges to public health.

The complex genetic region conferring transferable antibiotic resistance in multidrug-resistant and extremely drug-resistant Klebsiella pneumoniae clinical isolates

“…Similar to our finding, Kiaei et al. reported that qnrB was the dominant gene among the qnr genes and the prevalences of qnrB and qnrS were 30% and 6.7%, respectively [ 24 ]. Furthermore, the study that was performed by Benaicha et al.…”

“…also showed that resistance to cephalosporins was high, and imipenem had the best inhibitory effect on K. pneumoniae . Furthermore, they reported that other antibiotics, such as fosfomycin, ertapenem and gentamicin, had a good effect on isolates, with 8%, 9% and 8% resistance, respectively [ 24 ]. In a previous study in Iran, the rate of resistance of K. pneumoniae isolates to the antibiotic imipenem was 7.2%, which is less than the resistance obtained from the present study; it can be concluded that resistance to carbapenems is increasing in Iran [ 27 ].…”

“…MDR was defined as acquired resistance to at least one agent in three or more antimicrobial categories. XDR was defined as bacterial isolates remain susceptible to only one or two antimicrobial categories [ 23 , 24 ].…”

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“…pneumoniae is an important nosocomial pathogen that is well known due to its widespread antibiotic resistance and high pathogenicity. 96,97 The ability of resistance to common antibiotics has made the management of K. pneumoniae a major challenge, especially in burn patients. 98,99 Among gram-negative bacteria that cause burn infections, K. pneumoniae is responsible for 15.2% of the infections.…”

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“…Several characteristics including high affinity to Protein Binding Penicillin 2, excellent permeability across bacterial membranes, and stability against most β-lactamases makes carbapenems as potent antibiotics against gram-negative bacteria. 6 , 7 Although carbapenems are one of the most commonly used antibiotics against drug-resistant P. aeruginosa infection, these antibiotics have lost their effectiveness with advent of XDR P. aeruginosa isolates. The XDR isolates of the P. aeruginosa have been found in different countries, and their clinical impact has been reviewed, however, combat with this challenge is a major concern.…”