High Frequency of Multidrug-resistant (Mdr) Klebsiella Pneumoniae Harboring Several β-lactamase and Integron Genes Collected From Several Hospitals in the North of Iran

Abstract

Background: Klebsiella pneumoniae is one of the leading causes of hospital outbreaks worldwide. Also, antibiotic-resistant K. pneumoniae is progressively being involved in invasive infections with high morbidity and mortality. The aim of the current study was to determine antimicrobial susceptibility patterns and the incidences of resistance genes (integron types and β-lactamase-encoded genes) among clinical isolates of K. pneumoniae. Methods: In this cross-sectional study, a total of 100 clinical samples were obtained from hospitalized patients in three teaching hospitals in the north of Iran, from November 2018 and October 2019. Antimicrobial susceptibility testing was performed using disk agar diffusion test in line with CLSI recommendation. For colistin, minimum inhibitory concentration (MIC) was determined using broth microdilution. Based on antibiogram, multi-drug resistant (MDR) and extensive-drug resistant (XDR) strains were detected. Finally, integron types and β-lactamase resistance genes were identified using polymerase chain reaction technique.Results. The most and least clinical samples were related to the urine and bronchoalveolar lavage, respectively. Based on the antibiogram results, amikacin and gentamicin exhibited good activity against K. pneumoniae strains in vitro. High resistance rate (93%) to ampicillin/sulbactam also predict the limited efficacy of this antibiotic. Among all the 100 isolates, the frequency of MDR and XDR strains were 58% and 13%, respectively, while no pan-drug resistant (PDR) isolates were found. The prevalence of blaSHV, blaTEM, blaCTX-M-15, blaKPC, blaOXA-48, blaNDM β-lactamase genes were 91.4%, 82.7%, 79.3%, 29.3%, 36.2% and 6.9%, respectively, however 58% of the isolates were carrying intI gene. Class II and III integrons were not detected in any isolates. Conclusion: The MDR K. pneumoniae is becoming a serious problem in hospitals, with many strains developing resistance to most available antimicrobials. Our results indicate co-presence of a series of β-lactamase and integron types on the MDR strains recovered from hospitalized patients. The increasing rate of these isolates emphasizes the importance of choosing an appropriate antimicrobial regimen based on antibiotic susceptibility pattern.

Class 1 integrons and multiple mobile genetic elements in clinical isolates of the Klebsiella pneumoniae complex from a tertiary hospital in eastern China

“…In addition, more types and numbers of resistance genes were identified in class 1 integron-positive isolates than in class 1 integron-negative isolates, such as aadA2 (75% vs. 5.65%), bla KPC-2 (77.08% vs. 16.90%), and bla SHV-1 (73.96% vs. 12.68%), which made the class 1 integron-positive group show higher MIC levels for the corresponding antimicrobials. Similar to transposons, class 1 integrons can capture resistance genes from bacteria of various sources (Fluit and Schmitz, 2004;Firoozeh et al, 2019;Farhadi et al, 2021). It plays an important role in resistance gene spreading by means of horizontal gene transfer between bacteria of different species or genera, resulting in the increasing emergence of MDR bacteria, especially clinical pathogens (Fluit and Schmitz, 2004;Firoozeh et al, 2019;Farhadi et al, 2021).…”

“…Similar to transposons, class 1 integrons can capture resistance genes from bacteria of various sources (Fluit and Schmitz, 2004;Firoozeh et al, 2019;Farhadi et al, 2021). It plays an important role in resistance gene spreading by means of horizontal gene transfer between bacteria of different species or genera, resulting in the increasing emergence of MDR bacteria, especially clinical pathogens (Fluit and Schmitz, 2004;Firoozeh et al, 2019;Farhadi et al, 2021). Twelve groups of 29 complete class 1 integrons were identified in 17 isolates with complete genome sequences.…”

Antibiotic Resistance Profile of Escherichia coli and Klebsiella pneumoniae Isolated from Nworie River, Owerri, Imo State, Nigeria

“…This was similarly observed in the research carried out by Carl et al [15] when they observed two E. coli isolates that also showed 100% resistance to polymyxin B and colistin. Farhadi et al [16] observed 62.22% resistance of Klebsiella. However, in the work of Naveed-ur-Rehman et al [17], there was 100% sensitivity of Klebsiella pneumoniae to Polymyxin B and that led to the use of the antibiotic to cure eight (8) out of fourteen ( 14) patients (57.1%).…”

Study of prevalence and antimicrobial susceptibility pattern of blood culture isolates from a tertiary care hospital in South India

“…Previous studies highlight high frequency of prevalence of MDR Klebsiella pneumoniae with 30-day mortality rate as high as 45% in patients with K. pneumonia BSI. 15,16 28% of Klebsiella and 21% E. coli were detected to be multi drug resistant strains. Klebsiella pneumoniae is notorious for its ability to accumulate and transfer resistance determinants, and it has been well-recognized as a leading causative agent of hospital-based infections over the previous decades.…”