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 incidence 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 recommendations. 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. The high resistance rate (93%) to ampicillin/sulbactam predicts the limited efficacy of this antibiotic, in the hospitals studied. Among all the 100 isolates, the frequency of MDR and XDR phenotypes were 58% and 13%, respectively, while no pan-drug resistant (PDR) strains were found. In the MDR K. pneumoniae strains, 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 91.4% 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.

Genotypic Characterization of Carbapenem-Resistant Klebsiella pneumoniae Isolated from an Egyptian University Hospital

“…Meropenem had a 30% resistance rate, whereas imipenem and ertapenem both had a 31.3% resistance rate. This outcome was consistent with the research conducted by Farhadi et al [ 31 ], who observed that 33% of the K. pneumoniae isolates were resistant to imipenem. Furthermore, Pereira et al [ 32 ] found that 73 Klebsiella isolates found in samples of a urinary tract infection were extremely resistant to IMP.…”

Prevalence of ESBL genes in Klebsiella pneumoniae from individuals with community-acquired urinary tract infection in rural communities of Enugu State, Nigeria

“…However, out of the 29 MDR isolates, only 10 (34.5%) were ESBL positive, and out of the 6 XDR isolates, only 3 (50%) were ESBL positive. The findings of this study reflect similar findings in similar studies performed elsewhere [22], [23], [24], [25]. However, we report that apart from possession of ESBL genes, which are known to confer resistance to bacterial organisms, there are other factors that are responsible to for drug resistance as observed in this study, which the present study could not determine.…”

Early Response of Antimicrobial Resistance and Virulence Genes Expression in Classical, Hypervirulent, and Hybrid hvKp-MDR Klebsiella pneumoniae on Antimicrobial Stress

“…Major (84.3%) K. pneumoniae isolates in our study were MDR with resistance to carbapenems for 45.7% isolates. Such high MDR rates were reported from China and Iran [30,31]. The prevalence of beta-lactamase genes bla CTX-M in our study was 74.2%, carbapenemase genes bla OXA-48 and bla NDM at 40.0% and 11.4%, respectively, similar to the prevalence of these genes published previously [31].…”

“…Such high MDR rates were reported from China and Iran [30,31]. The prevalence of beta-lactamase genes bla CTX-M in our study was 74.2%, carbapenemase genes bla OXA-48 and bla NDM at 40.0% and 11.4%, respectively, similar to the prevalence of these genes published previously [31]. Hypermucoviscous isolates identified in this study (n = 11) were attributed to ST23 K1 , ST86 K2 , ST23 K57 , ST65 K2 , and ST218 K57 genetic lines.…”