Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of bla harboring Klebsiella pneumoniae

Kumudunie, Wirittamulla Gamage Maheshika; Wijesooriya, L.I.; Namalie, K.D.; Sunil-Chandra, N.P.; Wijayasinghe, Yasanandana Supunsiri

doi:10.1016/j.jiph.2020.04.010

Cited by 16 publications

(20 citation statements)

References 35 publications

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“…A total of 117 previously characterized Enterobacteriaceae clinical isolates were tested to evaluate the performance of four phenotypic carbapenemase detection assays, namely MHT, mCIM, CNPt, and CNPt-direct [20]. These strains included 54 genetically identified CP-CRE producing carbapenemases of Ambler class A.…”

Section: Bacterial Isolatesmentioning

confidence: 99%

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

2021

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Rapidly progressing antibiotic resistance is a great challenge in therapy. In particular, the infections caused by carbapenem-resistant Enterobacteriaceae (CRE) are exceedingly difficult to treat. Carbapenemase production is the predominant mechanism of resistance in CRE. Early and accurate identification of carbapenemase-producing carbapenem-resistant Enterobacteriaceae (CP-CRE) is extremely important for the treatment and prevention of such infections. In the present study, four phenotypic carbapenemase detection tests were compared and an algorithm was developed for rapid and cost-effective identification of CP-CRE. A total of 117 Enterobacteriaceae (54 CP-CRE, 3 non-CP-CRE, and 60 non-CRE) isolates were tested for carbapenemase production using modified Hodge test (MHT), modified carbapenem inactivation method (mCIM), Carba NP test (CNPt), and CNPt-direct test. The overall sensitivity/specificity values were 90.7%/92.1% for MHT, 100%/100% for mCIM, 75.9%/100% for CNPt, and 83.3%/100% for CNPt-direct. OXA-48-like enzymes were detected with 93.2% sensitivity by MHT and >77.3% sensitivity by two Carba NP tests. MHT could only detect half of the NDM carbapenemase producers. CNPt-direct exhibited enhanced sensitivity compared to CNPt (100% vs 25%) for detection of NDM producers. Considering these findings we propose CNPt-direct as the first test followed by mCIM for rapid detection of CP-CRE. With this algorithm >80% of the CP-CRE could be detected within 24 hours from the time the sample is received and 100% CP-CRE could be detected in day two. In conclusion, mCIM was the most sensitive assay for the identification of CP-CRE. CNPt-direct performed better than CNPt. An algorithm consisting CNPt-direct and mCIM allows rapid and reliable detection of carbapenemase production in resource-limited settings.

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Section: Bacterial Isolatesmentioning

confidence: 99%

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

2021

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“…Focusing on the phenotype and molecular analysis of CRKP isolates, the results revealed that the primary resistance mechanism of CRKP was carbapenemase production, which was consistent with other researches. 36,37 The bla KPC-2 and bla NDM-1 were two major carbapenemase genes in our study, accounting for 63.6% and 30.3%, respectively. KPC-2 is the most commonly identified enzyme among over 20 reported KPC variants so far, 38 and the majority of NDM-1-producers also harbored various other resistance genes but mostly were still susceptible to polymyxin B and tigecycline, 39 which were highly correlated with our results.…”

Section: Discussionmentioning

confidence: 61%

Carbapenem-Resistant Klebsiella pneumoniae in Southwest China: Molecular Characteristics and Risk Factors Caused by KPC and NDM Producers

Li¹,

Ding²,

Yang³

et al. 2021

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Background Carbapenem-resistant Klebsiella pneumoniae (CRKP) infection has attracted worldwide concern and became a serious challenge for clinical treatment. The aims of this study were to evaluate the molecular characteristics and risk factors for CRKP infection. Methods All the CRKP strains were screened for antimicrobial resistance genes, virulence genes, and integron by polymerase chain reaction (PCR). Plasmid typing was performed by plasmid conjugation assay and PCR-based replicon typing (PBRT). The genetic environments of bla KPC-2 and bla NDM-1 were analyzed by using overlapping PCR and molecular typing was performed by multi-locus sequence typing (MLST). Risk factors for CRKP infection were analyzed by logistic regression model. Results All the 66 CRKP isolates were multidrug-resistant, but all of them were susceptible to tigecycline and polymyxin B. Among the CRKP isolates, 42 bla KPC-2 -positive strains were identified carrying IncFII plasmids. Meanwhile, 24 bla NDM -positive strains were found on lncX3 plasmids, including 20 bla NDM-1 isolates and 4 bla NDM-5 isolates. Most of CRKP isolates contained several virulence genes and the class I integron ( intl1 ). The genetic environments of bla KPC-2 and bla NDM-1 revealed that the conserved regions ( tnpA-tnpR -IS kpn8-bla KPC-2 ) and ( bla NDM-1 - ble MBL -trpF-tat ) were associated with the dissemination of KPC-2 and NDM-1. ST11 was the most common type in this work. Hematological disease, tracheal cannula, and use of β-lactams and β-lactamase inhibitor combination were identified as independent risk factors for CRKP infection. Conclusion This study established the resistance pattern, molecular characteristics, clonal relatedness, and risk factors of CRKP infection. The findings of the novel strain that co-harboring bla NDM-5 and bla IMP-4, and the novel ST4495 indicated that the brand-new types have spread in Southwest China, emphasizing the prevent and control the further dissemination of CRKP isolates are highly needed.

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“…The higher consumption of Watch group antibacterials in the private sector in Sri Lanka is a concern especially as there is no data to suggest that the causative bacteria and/or their antibacterial sensitivity patterns differ between the sectors. This is more alarming as there is an increasing emergence of multi drug resistant bacteria in the country [ 16 – 18 , 29 ]. It has also been shown that some of the pathogens causing lower respiratory tract infections are resistant to the first line Access antibacterials but show an increased sensitivity to 2 nd line (Watch) agents [ 30 ].…”

Section: Resultsmentioning

confidence: 99%

A national survey of antibacterial consumption in Sri Lanka

et al. 2021

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Introduction Optimizing the use of antibacterial medicines is an accepted strategy to combat the antibacterial resistance. Availability of reliable antibacterial consumption (ABC) data is a prerequisite to implement this strategy. Objectives To quantify and describe the national ABC in Sri Lanka and to examine any differences in the consumption between public and private sector. Methods The methodology for this survey was adapted from World Health Organization (WHO) methodology for a global programme on surveillance of antimicrobial consumption. Aggregate data on national consumption of systemic antibacterials (J01- Anatomical Therapeutic Chemical Classification (ATC) for 2017 were retrospectively extracted from all available data sources and classified using ATC classification. Quantity of consumption was converted to Defined Daily Doses (DDDs). Data are presented as total consumption and comparison between the public and private sector. Selected key quality indicators of ABC were compared between these two sectors. Findings From the available data sources, the total ABC in 2017 was 343.46 million DDDs. Private sector consumption accounted for 246.76 million DDDs compared to 97.96 million DDDs distributed to entire public sector by the Ministry of Health. Beta-lactam-penicillins antibacterial group accounted for 58.79% in public sector compared to 27.48% in private sector while macrolides, quinolones and other beta-lactam antibacterials accounted for 60.51% in the private compared to 28.41% in public sector. Consumption of Reserve group antibacterials was negligible, and limited to private sector. Watch category antibacterials accounted for 46%, 24% and 54% of the total, public and private sector consumption, respectively. Conclusions A disproportionately higher use of broad spectrum and Watch category antibacterials was observed in the private sector which needs further study. This national consumption survey highlights the need and provides the opening for establishment of ABC surveillance in Sri Lanka.

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Epidemiology of multidrug-resistant Enterobacteriaceae in Sri Lanka: First evidence of bla harboring Klebsiella pneumoniae

Cited by 16 publications

References 35 publications

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

Comparison of four low-cost carbapenemase detection tests and a proposal of an algorithm for early detection of carbapenemase-producing Enterobacteriaceae in resource-limited settings

Carbapenem-Resistant Klebsiella pneumoniae in Southwest China: Molecular Characteristics and Risk Factors Caused by KPC and NDM Producers

A national survey of antibacterial consumption in Sri Lanka

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