Phenotypic and genotypic detection of carbapenemase-producing Escherichia coli and Klebsiella pneumoniae in Accra, Ghana

Abstract

Aim To describe the occurrence of carbapenem resistance among multidrug-resistant (MDR) Escherichia coli and Klebsiella pneumoniae isolated from clinical specimens in Accra using phenotypic and genotypic methods. Methodology The study was cross-sectional, involving 144 clinical MDR E. coli and K. pneumoniae isolates recovered from the Central Laboratory of the Korle Bu Teaching Hospital (KBTH). The isolates were re-cultured bacteriologically, identified using standard biochemical tests, and subjected to antibiotic susceptibility testing using the Kirby-Bauer method. Carbapenem resistance was determined based on imipenem, meropenem, and ertapenem zones of inhibition, as well as minimum inhibitory concentrations (MICs). Carbapenemase production was determined phenotypically by modified Hodge test (MHT) and modified carbapenem inactivation method (mCIM), and genotypically with multiplex PCR targeting the blaKPC, blaIMP, blaNDM, blaVIM, and blaOXA-48 genes. Results Of the 144 MDR isolates, 69.4% were E. coli, and 30.6% were K. pneumoniae. The distribution of antimicrobial resistance rates among them was ampicillin (97.2%), cefuroxime (93.1%), sulfamethoxazole-trimethoprim (86.8%), tetracycline (85.4%), cefotaxime and cefpodoxime (77.1% each), amoxicillin-clavulanate (75%), ceftriaxone (73.6%), ciprofloxacin (70.8%), levofloxacin (66.0%), cefepime (65.3%), ceftazidime (64.6%), gentamicin (48.6), piperacillin-tazobactam (40.3%), cefoxitin (14.6%), amikacin (13.9%), ertapenem and meropenem (5.6% each), and imipenem (2.8%). In total, 5.6% (8/144) of them were carbapenem-resistant (carbapenem MIC range = 0.094–32.0 μg/ml), with 75% (6/8) of these testing positive by the phenotypic tests and 62.5% (5/8) by the genotypic test (of which 80% [4/5] carried blaOXA-48 and 20% (1/5) blaNDM). The blaVIM, blaIMP, and blaKPC genes were not detected. Conclusion Although the rates of antibiotic resistance among the isolates were high, the prevalence of carbapenemase producers was low. The finding of blaOXA-48 and blaNDM warrants upscaling of antimicrobial resistance surveillance programmes and fortification of infection prevention and control programmes in the country.

ESBL and carbapenemase-producing Enterobacteriaceae in infectious pleural effusions: current epidemiology at Hôpital du Mali

“…This MDR rate aligns with previous study in Turkey reporting the widespread occurrence of MDR bacteria ( 26 ). The study findings revealed a higher prevalence of carbapenem resistance (7.2%) compared to the previous report by Dwomoh et al ( 32 ), which documented a resistance rate of 5.6%. Hackman et al ( 33 ) reported a similar rate of carbapenem resistance.…”

The Antimicrobial Resistance (AMR) Rates of Enterobacterales in a Rural Hospital from the Eastern Region, Ghana: A Retrospective Study, 2022

“…The Enterobacterales family is broad and includes many genera of clinical interest, within which carbapenemases and carriage of extended-spectrum β-lactamases (ESBLs) are the most significant resistance mechanisms. Furthermore, resistance to fluoroquinolones is present in at least half of the clinical isolates of Escherichia coli reported in many parts of the world [ 8 , 9 , 10 , 11 , 12 ]. All this makes these infections very difficult to treat, especially since carbapenems such as imipenem, meropenem, and ertapenem have been used as a last resort in the treatment of patients infected with Enterobacteriaceae [ 13 , 14 ].…”

Antimicrobial susceptibility testing data analysis over 3 years at the Yaoundé General Hospital, Cameroon

“…Although some authors described the presence of phenotypic resistance patterns without the presence of resistance genes, 26 others near us have found the presence of resistance genes even though in a lower proportion compared with phenotypic resistance patterns. 27 This finding raised our concern to quickly set up additional tests for phenotypic carbapenemase detection, and also storage of strains for further genotypic assays. We also found low susceptibility to fosfomycin compared with other studies, 28 as the disc diffusion method for fosfomycin implies some additional specificity such as adding G6PD solution, which is ideal and more accurate in the determination of MIC.…”