Emergence of New Delhi Metallo-Beta-Lactamase (NDM) and Klebsiella pneumoniae Carbapenemase (KPC) Production by Escherichia coli and Klebsiella pneumoniae in Southern Vietnam and Appropriate Methods of Detection: A Cross-Sectional Study

Abstract

Carbapenemase-producing Enterobacteriaceae (CPE) are well known to cause many serious infections resulting in increasing mortality rate, treatment cost, and prolonged hospitalization. Among the widely recognized types of carbapenemases, New Delhi β-lactamase (NDM) and Klebsiella pneumoniae carbapenemase (KPC) are the most important enzymes. However, in Vietnam, there are only scattered reports of CPE due to the lack of simple and affordable methods that are suitable to laboratory conditions. This study aims to survey the characteristics of carbapenem-resistant E. coli and K. pneumoniae (CR-E/K) at two hospitals in Southern Vietnam and perform some simple methods to detect the two enzymes. A total of 100 CR-E/K strains were collected from clinical isolates of Gia Dinh People’s Hospital and Dong Nai General Hospital, Vietnam, from November 2017 to May 2018. The patient-related information was also included in the analysis. We conducted real-time polymerase chain reaction (PCR), Modified Hodge Test (MHT), and combined disk test (CDT) on all isolates. Carbapenemase-encoding genes were detected in 47 isolates (36 NDM, 10 KPC, and one isolate harboring both genes). The E. coli strain carrying simultaneously these two genes was the first case reported here. Most of isolates were collected from patients in ICU, Infectious Disease Department, and Department of Urologic Surgery. Urine and sputum were two common specimens. The true positive rate (sensitivity, TPR) and specificity (SPC) of the imipenem–EDTA (ethylen diamine tetra acetic acid) for NDM detection and the imipenem–PBA (phenylboronic acid) for KPC detection on E. coli were 93.8%, 97.1% and 66.7%, 95.7%, respectively. Meanwhile, the imipenem–EDTA for NDM detection and the imipenem–PBA for KPC detection among K. pneumonia achieved 90.5%, 100% and 100%, 92.9% TPR and SPC, respectively. However, MHT showed low sensitivity and specificity. Our findings showed that CP-E/K were detected with high prevalence in the two hospitals. We suggest that CDT can be used as a low-priced and accurate method of detection.

Detection of Carbapenem-Resistance Genes in Klebsiella Species Recovered from Selected Environmental Niches in the Eastern Cape Province, South Africa

“…This may be as a result of industrial activities in the different geographic areas with Chris Hani DM having the highest number of hospitals and industries. Among the few recent studies carried out on the prevalence of CRE, Hoang et al [ 48 ] reported similar distributions of NDM and KPC-producing Klebsiella spp. in hospital and aquatic isolates in Vietnam which supports our present study.…”

<p>Molecular Mechanisms and Epidemiology of Carbapenem-Resistant <em>Escherichia coli</em> Isolated from Chinese Patients During 2002–2017</p>

“…The relatively higher incidence revealed that the ongoing surveillance is urgently warranted in China. From the clinical perspective, there have been reports of transmission of E. coli in the ICU, 28,29 and clinicians should be vigilant about the potential presence of this species. Our study also confirmed that carbapenemresistant strains were most commonly isolated from patients aged >65 years who were treated in the ICU.…”

Phenotypic and Molecular Characterization of Carbapenem-Resistant Enterobacteriaceae from Clinical Bacterial Isolates: A Multicenter Retrospective Chart Review Study in western of Saudi Arabia

“…(20,31) Furthermore, though OXA-48 pathogens have a high ability to rapidly mutate and thereby expanding their spectrum of activity (7), less resistance was observed in them. (32,33). These results show that there is signi cant variability in the susceptibility of different CRE isolates to different antimicrobial agents.…”