Molecular Epidemiology and Drug Resistance Pattern of Carbapenem-ResistantKlebsiella pneumoniaeIsolates from Iran

Jafari, Zeinab; Harati, Ahad Ali; Haeili, Mehri; Kardan-Yamchi, Jalil; Jafari, Sirous; Jabalameli, Fereshteh; Meysamie, Alipasha; Abdollahi, Alireza; Feizabadi, Mohammad Mehdi

doi:10.1089/mdr.2017.0404

Cited by 40 publications

(43 citation statements)

References 39 publications

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“…Carbapenem resistance in these is often mediated by NDM-1 and OXA-48 production followed by KPC (KPC-2), VIM (VIM-1 and VIM-4), and IMP (Rastegar Lari et al, 2013; Azimi et al, 2014; Nobari et al, 2014; Fazeli et al, 2015; Rajabnia et al, 2015; Firoozeh et al, 2016, 2017; Sedighi et al, 2017; Shahcheraghi et al, 2017; Armin et al, 2018; Ghotaslou et al, 2018; Hosseinzadeh et al, 2018; Moghadampour et al, 2018a). The majority of the studies reported no clonal relatedness among isolated carbapenem resistant K. pneumoniae in each center (Shahcheraghi et al, 2013; Jafari et al, 2018; Kiaei et al, 2018). This is with the exception of three centers where an identical genotype was observed for VIM-1 producers (Nobari et al, 2014), for NDM-1 producers the strains were distributed into two major clonal complexes including ST13 and ST392 (Shoja et al, 2018) and among NDM-1 and/or OXA-48 positive ones the predominant cluster/pulsotype was associated to ST11 and ST893 (Solgi et al, 2018).…”

Section: Distribution Of Multi-drug Resistant Organisms In Humansmentioning

confidence: 99%

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

et al. 2019

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In the last decade, extended-spectrum cephalosporin and carbapenem resistant Gram-negative bacilli (GNB) have been extensively reported in the literature as being disseminated in humans but also in animals and the environment. These resistant organisms often cause treatment challenges due to their wide spectrum of antibiotic resistance. With the emergence of colistin resistance in animals and its subsequent detection in humans, the situation has worsened. Several studies reported the transmission of resistant organisms from animals to humans. Studies from the middle east highlight the spread of resistant organisms in hospitals and to a lesser extent in livestock and the environment. In view of the recent socio-economical conflicts that these countries are facing in addition to the constant population mobilization; we attempt in this review to highlight the gaps of the prevalence of resistance, antibiotic consumption reports, infection control measures and other risk factors contributing in particular to the spread of resistance in these countries. In hospitals, carbapenemases producers appear to be dominant. In contrast, extended spectrum beta lactamases (ESBL) and colistin resistance are becoming a serious problem in animals. This is mainly due to the continuous use of colistin in veterinary medicine even though it is now abandoned in the human sphere. In the environment, despite the small number of reports, ESBL and carbapenemases producers were both detected. This highlights the importance of the latter as a bridge between humans and animals in the transmission chain. In this review, we note that in the majority of the Middle Eastern area, little is known about the level of antibiotic consumption especially in the community and animal farms. Furthermore, some countries are currently facing issues with immigrants, poverty and poor living conditions which has been imposed by the civil war crisis. This all greatly facilitates the dissemination of resistance in all environments. In the one health concept, this work re-emphasizes the need to have global intervention measures to avoid dissemination of antibiotic resistance in humans, animals and the environment in Middle Eastern countries.

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Section: Distribution Of Multi-drug Resistant Organisms In Humansmentioning

confidence: 99%

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

et al. 2019

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“…The increasing prevalence of multidrug-resistant (MDR) Gram-negative bacteria has led to re-introduction of colistin, especially for infections sustained by K. pneumoniae 4. Nevertheless, in the last years, colistin resistance has also emerged in CR -Kp with rates as high as 36% 3,13,14. In this case, resistance is due to structural modifications of lipopolysaccharide (LPS) that is the target for colistin.…”

Section: Introductionmentioning

confidence: 99%

“…Management of CR- Kp infections is associated with long hospitalizations and poor outcomes1,14 and complicated by MDR emergence, which severely limits antimicrobial treatment options 14. Since K. pneumoniae is among the most frequent agents in nosocomial settings,8 identification of outbreaks due to MDR strains is crucial.…”

Section: Introductionmentioning

confidence: 99%

Molecular Epidemiological Insights into Colistin-Resistant and Carbapenemases-Producing Clinical Klebsiella pneumoniae Isolates

Tella¹,

Tamburro²,

Guerrizio³

et al. 2019

IDR

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PurposeCarbapenemases-producing Klebsiella pneumoniae are challenging antimicrobial therapy of hospitalised patients, which is further complicated by colistin resistance. This study describes molecular epidemiological insights into colistin-resistant and carbapenemases-producing clinical K. pneumoniae.Patients and methodsCultures collected from 26 hospitalised patients during 2014–2017 in the main hospital in Molise Region, central Italy, were characterized. The minimum inhibitory concentration for 19 antibiotics was determined, including carbapenems and colistin. Prevalence of resistance-associated genes was investigated through PCR, detecting blaKPC, blaGES, blaVIM, blaIMP, blaNDM, blaOXA-48, blaCTX-M, blaTEM, blaSHV, and mcr-1,2,3,4,5,6,7,8. The mgrB gene was also analysed in colistin-resistant strains by PCR and sequencing assays. K. pneumoniae were typed by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST).ResultsTwenty out of 26 K. pneumoniae were phenotypically resistant to carbapenems and 19 were resistant to colistin. All isolates harbored blaKPC, and blaSHV, blaTEM and blaVIM were further the most common resistance-associated genes. In colistin-resistant strains, mcr-1,2,3,4,5,6,7,8 variants were not detected, while mutations and insertion elements in mgrB were observed in 68.4% (n=13) in 31.6% (n=6) isolates, respectively. PFGE revealed 12 clusters and 18 pulsotypes at 85% and 95% cut-off, while the Sequence Types ST512 (n=13, 50%), ST101 (n=10, 38.5%), ST307 (n=2, 7.7%) plus a novel ST were detected using MLST.ConclusionAll K. pneumoniae showed a multidrug-resistant phenotype, particularly to carbapenems and colistin. According to national data, blaKPC was the prevailing carbapenemase, followed by blaVIM, while blaTEM and blaSHV were among the most frequent beta-lactamases. Consistent with previous reports in Italy, ST512 was the most common clone, particularly during 2014–15, whilst ST101 became dominant in 2016–17. Colistin resistance was mainly associated with deleterious mutations and transposon in the mgrB gene. Improvements of surveillance, compliance with infection prevention procedures and antimicrobial stewardship are essential to limit the spread of resistant K. pneumoniae.

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“…Shokri et al (25) found that the tigecycline and fosfomycin are the most effective antibiotics against K. pneumonia and P. aeruginosa, who had New Dehli Metallo-β-lactamase, respectively, in Iranian patients. Moreover, a study recently conducted in Iran reported the effectiveness of tigecycline against K. pneumonia (26). According to an evidence-based review, carbapenem-resistant Gram-negative pathogens were the most challenging issue and antibiotic regimen, including carbapenem plus tigecycline or colistin, were the most effective therapeutic option in low-level resistance cases (27).…”

Section: Discussionmentioning

confidence: 99%

Clinico-Microbiological Investigation on Fosfomycin and Tigecycline Resistant Gram-Negative Bacilli Isolated from Urinary Tract Infections: A Potential Resurgence

Dastborhan

Varshochi

Hasani

et al. 2020

Jundishapur J Microbiol

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Background: Traditional antibiotics are no longer as effective as before for controlling pathogens associated with urinary tract infections (UTI), which shows the necessity of developing new and more effective antibiotics. Objectives: The current study aimed to evaluate in vitro susceptibility of fosfomycin and tigecycline towards common antibiotic-resistant Gram-negative bacilli isolated from the urinary tract. Besides, clinico-microbiological on fosfomycin and tigecycline resistant Gram-negative bacilli was investigated. Methods: In this descriptive cross-sectional study, 150 resistant gram-negative bacilli were isolated from urine specimens send for culture, and antibiotic susceptibility assessment to the Division of Microbiology of Sina Hospital affiliated to Tabriz University of Medical Sciences which were collected from April-September 2017 are included. Antibiotic susceptibilities were evaluated according to the Clinical and Laboratory Standards published by the Institute and the criteria of the Food and Drug Administration. Results: Of 150 isolates, 138 (92%) were susceptible, and 2 (1.3%) were resistant to both fosfomycin and tigecycline, as confirmed by disk diffusion and Epsilonmeter tests. The difference was statistically significant (P = 0.001). Conclusions: Based on the results, resistance to the conventional antibiotics prescribed for the treatment of UTI was significantly high. Fosfomycin and tigecycline have an appropriate antimicrobial activity towards gram-negative-resistant isolates involved in UTIs.

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Molecular Epidemiology and Drug Resistance Pattern of Carbapenem-ResistantKlebsiella pneumoniaeIsolates from Iran

Cited by 40 publications

References 39 publications

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

Understanding the Epidemiology of Multi-Drug Resistant Gram-Negative Bacilli in the Middle East Using a One Health Approach

<p>Molecular Epidemiological Insights into Colistin-Resistant and Carbapenemases-Producing Clinical <em>Klebsiella pneumoniae</em> Isolates</p>

Clinico-Microbiological Investigation on Fosfomycin and Tigecycline Resistant Gram-Negative Bacilli Isolated from Urinary Tract Infections: A Potential Resurgence

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