Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia

Messaoudi, Aziza; Mansour, Wejdène; Jaidane, Nadia; Chaouch, Cherifa; Boujaafar, N.; Bouallègue, Olfa

doi:10.4314/ahs.v19i2.24

Cited by 15 publications

(11 citation statements)

References 41 publications

(40 reference statements)

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“…Results from our epidemiological study placed the prevalence of carbapenem-resistance among Enterobacteriaceae and gram-negative bacteria isolates in the study location at 22%. This value lower than those reported in literature from other locations—Uganda (30.6% [18] ), Tanzania (42.0% [19] ), India (24.0% [20] ), but higher than that reported from Tunisia (15.8% [21] ). Other studies from different locations in Nigeria have also reported varying numbers with Shettima et al [22] reporting a prevalence of 6.8% from Northeast Nigeria, while Ogbolu et al [23] and Olalekan et al [24] reported a prevalence of 36.8% and 27.4% respectively.…”

Section: Discussioncontrasting

confidence: 67%

Carbapenem-resistant <em>Enterobacteriaceae</em> (CRE) and gram-negative bacterial infections in south-west Nigeria: a retrospective epidemiological surveillance study

Adesanya

Igwe

2020

AIMS Public Health

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Background Carbapenem-resistant Enterobacteriaceae (CRE) are often responsible for severe, life-threatening infections and they represent a critical threat to the available antibiotic agents and to global health. An understanding of the epidemiology of these infections will be indispensable to the development of appropriate case management as well as infection prevention and control (IPC) measures in any healthcare setting. Objectives The objective of this study was to investigate and describe the epidemiology of carbapenem-resistant Enterobacteriaceae (CRE) and other gram-negative bacteria in a tertiary hospital in south west Nigeria using routinely collected microbiological laboratory data. Methods A retrospective collection of microbiological laboratory records from the January to June 2018 was performed. All culture and antimicrobial susceptibility test results of patients who required laboratory tests were collected. Other information collected include: patient demographics, clinical specimen types and the requesting hospital department. The data was analyzed using SPSS Windows version 24. Comparison between categorical variables was done using chi-square tests while independent sample t-test was used to determine significant mean differences between groups. A p < 0.05 was taken to be statistically significant. Results The prevalence of carbapenem-resistance among Enterobacteriaceae and gram-negative bacteria isolates was 22% (n = 39/177). Of these, 35.9% (n = 14) were Klebsiella pneumonia , 30.8% (n = 12) were Pseudomonas aeruginosa and 15.4% (n = 6) were Klebsiella oxytoca . 87.2% (n = 34) of these were also multi-drug resistant, with a mean total resistance score of 3.92 (SD = ± 1.44). There were differences observed in proportion of carbapenem-resistance across clinical specialties and age groups; however, these differences were not statistically significant. Independent sample t-test revealed that carbapenem-resistant isolates exhibited more drug resistance than carbapenem-sensitive isolates (3.93 vs. 2.30; p < 0.001). Conclusion Carbapenem resistance is an important threat to the current antibiotic armory. Active surveillance, particularly in the healthcare setting is required to identify high risk groups, inform better treatment options and infection prevention and control measures.

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Section: Discussioncontrasting

confidence: 67%

Carbapenem-resistant <em>Enterobacteriaceae</em> (CRE) and gram-negative bacterial infections in south-west Nigeria: a retrospective epidemiological surveillance study

Adesanya

Igwe

2020

AIMS Public Health

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“…The prevalence of CRKP varies across different populations, regions and countries from 16% to nearly 40%. 24 , 25 There is an urgent need to diagnose CRKP strains and prevent their transmission in hospitals at the early stage of infection. In this study, we developed a MALDI-TOF MS-based assay that was compared to the reference broth micro-dilution method.…”

Section: Introductionmentioning

confidence: 99%

A Rapid Antimicrobial Susceptibility Test for Klebsiella pneumoniae Using a Broth Micro-Dilution Combined with MALDI TOF MS

Wang

Song

2021

IDR

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Background: Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) is a novel method that can be used to identify pathogens and has potential applications in the detection of drug-resistant bacteria. Purpose: To evaluate the ability of a MALDI-TOF MS-based broth micro-dilution method in detecting the minimum inhibitory concentration (MIC) values of Klebsiella pneumoniae to ceftriaxone and imipenem. Materials and Methods: Sixty strains of K. pneumoniae with different levels of resistance to carbapenems and cephalosporins were randomly collected. The 0.5 McFarland (Mc) concentration of the bacterial suspension was inoculated in cation-adjusted Mueller-Hinton broth (CAMHB) with a final cell turbidity of 5×10 5 CFU/mL. The broth was incubated with serial concentrations of antibiotics. After centrifuging the bacterial suspensions, the lysed cells were analyzed by MALDI-TOF MS to identify the growth-promoting or inhibitory effects on K. pneumoniae. The molecular mechanisms of resistance were investigated by PCR and DNA sequencing analysis. Results: The expression of known resistance genes (blaKPC, blaFOX, blaDHA, blaCTX-M and blaTEM) was detected in the 30 carbapenems-resistant strains. The agreement between the MIC values derived from the MALDI-TOF MS analysis and from the broth microdilution method was 61.7% for ceftriaxone and 71.7% for imipenem. According to the Clinical and Laboratory Standards Institute (CLSI) breakpoint of resistance to ceftriaxone and imipenem, the 60 isolates were accurately classified as resistant or susceptible isolates with 100% sensitivity and 100% specificity. Conclusion:The transmission and infection of multidrug-resistant bacteria could be better managed and treated with the rapid identification of strains and antimicrobial susceptibility. A MALDI-TOF MS-based susceptibility test could be used to identify resistance of K. pneumoniae within a short time-frame. This approach could potentially be used as a supplementary antimicrobial susceptibility test that could be investigated on more bacterial species combined with different antibiotics.

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“…pneumoniae isolates in Egypt as it increased from 13.9% to 44.4% [ 25 , 35 ]. Several mechanisms are responsible for this type of resistance including AmpC or ESBL production with porin loss, carbapenemase production, or metallo-β-lactamase production [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

Characterization of β-lactam resistance in K. pneumoniae associated with ready-to-eat processed meat in Egypt

Abdel-Rhman

2020

PLoS ONE

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K. pneumoniae was known as a nosocomial infection that causes human diseases. It is considered as one of the food-borne pathogens as it causes septicemia and diarrhea in humans. This study aims to characterize K. pneumoniae strains isolated from ready to eat processed meat phenotypically and genetically. Three hundred and fifty ready to eat processed meat (Luncheon-meat) samples were collected. Forty-four (12.6%) K. pneumoniae strains were isolated and bio-typed, where the majority were identified to belong to biotype B1. K1 and K2 serotypes were detected and strains were classified as hypermucoviscous K. pneumoniae (HVKP) and classic K. pneumoniae (CKP) (26 and 18 isolates, respectively). The isolates were resistant to several classes of β-lactam antibiotics, ceftazidim and cefotaxime (95.5%), cefoxitin (93.2%), ertapenem (90.9%) and amoxicillin-clavulanic acid (86.4%). They were classified as extended spectrum β-lactamases (ESBLs), AmpC or carbapenemase-producers phenotypically. Eighteen β-lactamase genes were investigated by PCR. The most prominent genes were SHV (63.6%), TEM (52.2%), CTX-M15 (50%), AMPC (47.7%), CIT-M (45.5%) and VIM (43.2%). Co-detection of β-lactam resistance genes revealed 42 gene profiles. Twenty-four isolates had the complete efflux system (AcrAB-ToƖC). Besides, Integrons (I, II, III) were detected in 20 isolates. Molecular typing by ERIC-PCR showed high genetic diversity between isolates as 34 different patterns were identified. Overall, this study confirmed the hazards posed by the presence of multiple resistance genes in the same isolate and this should not be undervalued. Besides, the horizontal transfer of plasmid harboring resistance genes between isolates in food represents potential health risks for consumers in Egypt and so the control and inhibition plans are necessary.

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Epidemiology of resistance and phenotypic characterization of carbapenem resistance mechanisms in Klebsiella pneumoniae isolates at Sahloul University Hospital-Sousse, Tunisia

Cited by 15 publications

References 41 publications

Carbapenem-resistant <em>Enterobacteriaceae</em> (CRE) and gram-negative bacterial infections in south-west Nigeria: a retrospective epidemiological surveillance study

Carbapenem-resistant <em>Enterobacteriaceae</em> (CRE) and gram-negative bacterial infections in south-west Nigeria: a retrospective epidemiological surveillance study

A Rapid Antimicrobial Susceptibility Test for Klebsiella pneumoniae Using a Broth Micro-Dilution Combined with MALDI TOF MS

Characterization of β-lactam resistance in K. pneumoniae associated with ready-to-eat processed meat in Egypt

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