High prevalence of Klebsiella pneumoniae carbapenemase-mediated resistance in K. pneumoniae isolates from Egypt

Abstract

The emergence and rapid spread of antibiotic-resistant Klebsiella pneumoniae isolates harbouring the bla KPC gene that encodes for carbapenemase production have complicated the management of patient infections. This study in a tertiary care hospital in Egypt used real-time PCR assay to test ertapenem-nonsusceptible isolates of K. pneumoniae for the presence of the bla KPC gene and compared the results with modified Hodge test. Antibiotic sensitivity was performed by standard methods, and interpreted following both the old CLSI breakpoints (M100-S19) for carbapenems and the revised breakpoints (M100-S22). From the 45 non-duplicate isolates of K. pneumoniae recovered from different clinical specimens, a high prevalence of ertapenem-nonsusceptible isolates (44.4%) was reported using the new lower CLSI breakpoints. The bla KPC gene was confirmed in 14/20 (70.0%) of these isolates. The high prevalence of ertapenem nonsusceptibility at a tertiary care hospital in Egypt was predominantly attributed to K. pneumoniae carbapenemase-mediated resistance mechanisms in K. pneumoniae isolates. RÉSUMÉ L'émergence et la propagation rapide des souches de Klebsiella pneumoniae résistantes aux antibiotiques et porteuses du gène bla KPC codant la production de carbapénèmases ont compliqué la prise en charge des infections des patients. La présente étude menée dans un hôpital de soins tertiaires en Égypte a utilisé la méthode de PCR en temps réel pour évaluer la présence du gène bla KPC dans les isolats de K. pneumoniae non sensibles à l'ertapénème, puis a comparé les résultats à l'aide du test de Hodge modifié. La sensibilité aux antibiotiques a été évaluée à l'aide des méthodes standards, puis a été interprétée selon les anciens seuils du Clinical and Laboratory Standards Institute (M100-S19) pour les carbapénèmes et selon les seuils révisés (M100-S22). Après l'analyse des 45 isolats non-dupliqués de K. pneumoniae prélevés à partir de différents échantillons cliniques, une prévalence élevée d'isolats non sensibles à l'ertapénème (44,4 %) a été rapportée selon les nouveaux seuils plus bas du Clinical and Laboratory Standards Institute. La présence du gène bla KPC a été confirmée dans 14 isolats sur 20 (70,0 %). La forte prévalence de la non sensibilité à l'ertapénème dans un hôpital de soins tertiaires en Égypte était principalement imputable aux mécanismes de résistance médiés par les carbapénèmases dans les isolats de K. pneumoniae.

Molecular typing and virulence analysis of multidrug resistant Klebsiella pneumoniae clinical isolates recovered from Egyptian hospitals

“…In this context, there has been a significant increase in carbapenem resistance among K. pneumoniae isolates in Egypt during the last few years (from 13.9% to 44.4%)33233. K. pneumoniae isolates possess several mechanisms to evade the activity of carbapenems.…”

Global Dissemination of Carbapenemase-Producing Klebsiella pneumoniae: Epidemiology, Genetic Context, Treatment Options, and Detection Methods

“… Sonnevend et al (2015a) , two K. pneumoniae ST14 strains producing KPC-2 were first identified in the United Arab Emirates of the Arabian Peninsula. In Africa, several countries such as South Africa ( Brink et al, 2012 ), Algeria ( Bakour et al, 2015b ), and Egypt ( Metwally et al, 2013 ), have also isolated KPC-producing K. pneumoniae .…”

Detection of blaKPC and blaNDM Genes in Carbapenems Resistant Strains of Klebsiella pneumoniae Isolated from some Egyptian Hospitals Patients

“…In addition, in a study in Egypt, Metwally et al investigated 20 K. pneumoniae isolates for KPC production by MHT. The results were positive in 14 isolates (70%) (24) . These results show a fair agreement with the results of the current study.…”

“…In Italy, Mosca et al investigated 38 K. pneumoniae isolates and found that all of the isolates (100%) were positive for blaKPC gene detection (23) . In Egypt, Metwally et al investigated 20 K. pneumoniae isolates; 14 isolates of which (70%) were found positive for blaKPC gene detection (24) . In the present study, among the 35 K. pneumoniae isolates which gave positive results for both EDTA disc synergy test and MHT, 5 isolates (14.28%) were positive for detection of blaNDM by PCR.…”